Radiological–pathological signatures of patients with COVID-19-related pneumomediastinum: is there a role for the Sonic hedgehog and Wnt5a pathways?

Baratella, Elisa; Bussani, Rossana; Zanconati, Fabrizio; Marrocchio, Cristina; Giudici, Fabiola; Braga, Luca; Maiocchi, Serena; Berlot, Giorgio; Volpe, Maria Concetta; Moro, Edoardo; Confalonieri, Paola; Cova, Maria Assunta; Confalonieri, Marco; Salton, Francesco; Ruaro, Barbara

doi:10.1183/23120541.00346-2021

Cited by 47 publications

(50 citation statements)

References 10 publications

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“…Literature reports that pleural effusion is an atypical finding in SARS-CoV2-2 infection [20][21][22][23][24][25][26][27][28][29][30]. Indeed, the presence of pleural effusion observed in 11% of our series could well be attributed to coexisting comorbidities rather than the infectious process itself, as it occurred in the elderly patients and those with underlying cardiovascular diseases.…”

Section: Discussionmentioning

confidence: 60%

Interstitial Lung Disease at High Resolution CT after SARS-CoV-2-Related Acute Respiratory Distress Syndrome According to Pulmonary Segmental Anatomy

Baratella

Ruaro

Marrocchio

et al. 2021

JCM

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Background: The purpose of this study was to evaluate High-Resolution CT (HRCT) findings in SARS-CoV-2-related ARDS survivors treated with prolonged low-dose methylprednisolone after hospital discharge. Methods: A total of 44 consecutive patients (M: 32, F: 12, average age: 64), hospitalised in our department from April to September 2020 for SARS-CoV-2-related ARDS, who had a postdischarge CT scan, were enrolled into this retrospective study. We reviewed the electronic medical charts to collect laboratory, clinical, and demographic data. The CT findings were evaluated and classified according to lung segmental distribution. The imaging findings were correlated with spirometry results and included ground glass opacities (GGOs), consolidations, reticulations, bronchiectasis/bronchiolectasis, linear bands, and loss of pulmonary volume. Results: Alterations in the pulmonary parenchyma were observed in 97.7% of patients at HRCT (median time lapse between ARDS diagnosis and HRCT: 2.8 months, range 0.9 to 6.7). The most common findings were linear bands (84%), followed by GGOs (75%), reticulations (34%), bronchiolectasis (32%), consolidations (30%), bronchiectasis (30%) and volume loss (25%). They had a symmetric distribution, and both lower lobes were the most affected areas. Conclusions: A reticular pattern with a posterior distribution was observed 3 months after discharge from severe COVID-19 pneumonia, and this differs from previously described postCOVID-19 fibrotic-like changes. We hypothesized that the systematic use of prolonged low-dose of corticosteroid could be the main reason of this different CT scan appearance.

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Section: Discussionmentioning

confidence: 60%

Interstitial Lung Disease at High Resolution CT after SARS-CoV-2-Related Acute Respiratory Distress Syndrome According to Pulmonary Segmental Anatomy

Baratella

Ruaro

Marrocchio

et al. 2021

JCM

Self Cite

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“…Coronavirus disease 2019 (COVID- 19), which is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has infected more than 130 million people worldwide. COVID-19 leads to respiratory manifestations that can range from mild flu-like symptoms such as fever, cough, and fatigue to severe respiratory failure requiring intensive care (1,2).…”

Section: Introductionmentioning

confidence: 99%

Characteristics and Prognostic Factors of Pulmonary Fibrosis After COVID-19 Pneumonia

et al. 2022

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BackgroundFew is known about the long-term pulmonary sequelae after COVID-19 infection. Hence, the aim of this study is to characterize patients with persisting pulmonary sequelae at follow-up after hospitalization. We also aimed to explore clinical and radiological predictors of pulmonary fibrosis following COVID-19.MethodsTwo hundred and 20 consecutive patients were evaluated at 3–6 months after discharge with high-resolution computed tomography (HRCT) and categorized as recovered (REC) or not recovered (NOT-REC). Both HRCTs at hospitalization (HRCT0), when available, and HRCT1 during follow-up were analyzed semiquantitatively as follows: ground-glass opacities (alveolar score, AS), consolidations (CONS), and reticulations (interstitial score, IS).ResultsA total of 175/220 (80%) patients showed disease resolution at their initial radiological evaluation following discharge. NOT-REC patients (45/220; 20%) were mostly older men [66 (35–85) years vs. 56 (19–87); p = 0.03] with a longer in-hospital stay [16 (0–75) vs. 8 (1–52) days; p < 0.0001], and lower P/F at admission [233 (40–424) vs. 318 (33–543); p = 0.04]. Moreover, NOT-REC patients presented, at hospital admission, higher ALV [14 (0.0–62.0) vs. 4.4 (0.0–44.0); p = 0.0005], CONS [1.9 (0.0–26.0) vs. 0.4 (0.0–18.0); p = 0.0064], and IS [11.5 (0.0– 29.0) vs. 0.0 (0.0–22.0); p < 0.0001] compared to REC patients. On multivariate analysis, the presence of CONS and IS at HRCT0 was independent predictors of radiological sequelae at follow-up [OR 14.87 (95% CI: 1.25–175.8; p = 0.03) and 28.9 (95% CI: 2.17–386.6; p = 0.01, respectively)].ConclusionsIn our population, only twenty percent of patients showed persistent lung abnormalities at 6 months after hospitalization for COVID-19 pneumonia. These patients are predominantly older men with longer hospital stay. The presence of reticulations and consolidation on HRCT at hospital admission predicts the persistence of radiological abnormalities during follow-up.

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“…It might be the result of spreading inflammation in the lungs along with the change in their architecture 5 . Baratella et al have hypothesized that sonic hedgehog (SHH) and Wnt5a signaling might have been associated with COVID‐19 pneumomediastinum tracheal lesions as the autopsies of COVID‐19 cases showed an irregular regenerative process with cartilage tissue remodeling (unpresented in non‐COVID‐19 cases) 6 …”

Section: Introductionmentioning

confidence: 99%

Young convalescent COVID‐19 pneumonia with extensive pneumomediastinum emphysema: Case report

Jagosz

Guzik

Moczała

et al. 2022

Clinical Case Reports

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Radiological–pathological signatures of patients with COVID-19-related pneumomediastinum: is there a role for the Sonic hedgehog and Wnt5a pathways?

Abstract: et al. Radiological-pathological signatures of patients with COVID-19-related pneumomediastinum: is there a role for sonichedgehog and Wnt5a pathways?. ERJ Open Res 2021; in press (

Cited by 47 publications

References 10 publications

Interstitial Lung Disease at High Resolution CT after SARS-CoV-2-Related Acute Respiratory Distress Syndrome According to Pulmonary Segmental Anatomy

Interstitial Lung Disease at High Resolution CT after SARS-CoV-2-Related Acute Respiratory Distress Syndrome According to Pulmonary Segmental Anatomy

Characteristics and Prognostic Factors of Pulmonary Fibrosis After COVID-19 Pneumonia

Young convalescent COVID‐19 pneumonia with extensive pneumomediastinum emphysema: Case report

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