Rapid onset honeycombing fibrosis in spontaneously breathing patient with COVID-19

Combet, Margot; Pavot, Arthur; Savale, Laurent; Humbert, Marc; Monnet, Xavier

doi:10.1183/13993003.01808-2020

Cited by 45 publications

(39 citation statements)

References 3 publications

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“…At the time of this early follow-up, evolution toward lung fibrosis was suspected in 7 patients showing bronchial/bronchiolar dilatation within areas of ground-glass attenuation requiring further evaluation before assessing the presence of irreversible fibrotic changes. None of our patients had CT features of honeycombing as described during the acute phase of COVID-19 [ 26 , 27 ].…”

Section: Discussionmentioning

confidence: 99%

Assessment of pulmonary arterial circulation 3 months after hospitalization for SARS-CoV-2 pneumonia: Dual-energy CT (DECT) angiographic study in 55 patients

et al. 2021

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Background During COVID-19, the main manifestations of the disease are not only pneumonia but also coagulation disorders. The purpose of this study was to evaluate pulmonary vascular abnormalities 3 months after hospitalization for SARS-CoV-2 pneumonia in patients with persistent respiratory symptoms. Methods Among the 320 patients who participated in a systematic follow-up 3 months after hospitalization, 76 patients had residual symptoms justifying a specialized follow-up in the department of pulmonology. Among them, dual-energy CT angiography (DECTA) was obtained in 55 patients. Findings The 55 patients had partial ( n = 40; 72.7%) or complete ( n = 15; 27.3%) resolution of COVID-19 lung infiltration. DECTA was normal in 52 patients (52/55; 94.6%) and showed endoluminal filling defects in 3 patients (3/55; 5.4%) at the level of one ( n = 1) and two ( n = 1) segmental arteries of a single lobe and within central and peripheral arteries ( n = 1). DECT lung perfusion was rated as non-interpretable ( n = 2;3.6%), normal ( n = 17; 30.9%) and abnormal ( n = 36; 65.5%), the latter group comprising 32 patients with residual COVID-19 opacities (32/36; 89%) and 4 patients with normal lung parenchyma (4/36; 11%). Perfusion abnormalities consisted of (a) patchy defects (30/36; 83%), (b) PE-type defects (6/36; 16.6%) with ( n = 1) or without proximal thrombosis ( n = 5); and (c) focal areas of hypoperfusion (2/36; 5.5%). Increased perfusion was seen in 15 patients, always matching GGOs, bands and/or vascular tree-in- bud patterns. Interpretation DECT depicted proximal arterial thrombosis in 5.4% of patients and perfusion abnormalities suggestive of widespread microangiopathy in 65.5% of patients. Lung microcirculation was abnormal in 4 patients with normal lung parenchyma.

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Section: Discussionmentioning

confidence: 99%

Assessment of pulmonary arterial circulation 3 months after hospitalization for SARS-CoV-2 pneumonia: Dual-energy CT (DECT) angiographic study in 55 patients

et al. 2021

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“…Margot Combet and colleagues in an interesting case study published in European Respiratory Journal, reported rapid onset of honeycombing fibrosis in a patient with COVID-19 [ 6 ], with typical similarity to idiopathic pulmonary fibrosis (IPF) and similar questions were raised by Paolo Spagnolo et al regrading post-COVID-19 pulmonary fibrosis [ 7 ]. In histopathological micrographs from patients with IPF, we observed high ACE2 expression in the intimal, medial, and adventitial layers of the pulmonary arteries.…”

mentioning

confidence: 97%

Endothelial to mesenchymal transition: a precursor to post-COVID-19 interstitial pulmonary fibrosis and vascular obliteration?

Eapen

Gaikwad

et al. 2020

Eur Respir J

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“…This proves that these interstitial changes are not only a result of post-ARDS brosis or ventilator induced lung damage, but also a consequence of the direct virus induced injury and aberrant local immune response leading to ILD. Combet et al recently described a case of a spontaneously breathing patient who developed rapid honeycombing following COVID-19 disease which responded to high-dose steroids and nintedanib [26]. Tale et al also reported a similar case of a patient with persistent hypoxemia after recovery from moderate COVID-19 disease with 3 week follow-up HRCT showing artitechtural distortion, interlobar septal thickening and traction bronchiectasis [27].…”

Section: Discussionmentioning

confidence: 99%

COVID-19 Associated Interstitial Lung Disease - An Emerging Entity

Zubairi¹,

Shaikh

Zubair

et al. 2020

Preprint

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Background: COVID-19 disease associated pulmonary sequalae has been increasingly reported after recovery from acute infection. Therefore, we aim to explore the charactersitics of interstitial lung disease in patients with COVID-19.Methods: An observational study was conducted in patients with COVID-19 associated ILD from April 2020 till September 2020. Patients ≥18 years of age with COVID-19 who were diagnosed with ILD based on respiratory symptoms and HRCT chest imaging after the recovery phase of COVID-19 infection were recruited. Data was recorded on a structured proforma, and descriptive analysis was performed using Stata version 12.1.Results: A total of 30 patients with COVID-associated ILD were identified. The mean age of patients was 59.14 (SD 12.60) and 27 (90%) were males. Four HRCT patterns of interstitial lung disease were seen; organizing pneumonia in 10 (33.33%), non-specific interstitial pneumonitis in 17 (56.67%), usual interstitial pneumonitis in 12 (40%) and probable usual interstitial pneumonitis in 14 (46.67%). Diffuse involvement was found in 15 (50%) patients, while peripheral predominance in 15 (50%) and other significant findings were seen in 8 (26.67%) patients. All patients were treated with corticosteroids. The case fatality rate was 16.67%. Amongst the survivors, 8 (32%) recovered completely, 9 (36%) improved, while 8 (32%) patients had static or progressive disease.Conclusions: This is the first study from Southeast Asia that identified COVID-associated interstitial lung disease in patients who had no pre-existing lung disease, highlighting the importance of timely recognition and treatment of an entity that might lead to fatal outcome.

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Rapid onset honeycombing fibrosis in spontaneously breathing patient with COVID-19

Cited by 45 publications

References 3 publications

Assessment of pulmonary arterial circulation 3 months after hospitalization for SARS-CoV-2 pneumonia: Dual-energy CT (DECT) angiographic study in 55 patients

Assessment of pulmonary arterial circulation 3 months after hospitalization for SARS-CoV-2 pneumonia: Dual-energy CT (DECT) angiographic study in 55 patients

Endothelial to mesenchymal transition: a precursor to post-COVID-19 interstitial pulmonary fibrosis and vascular obliteration?

COVID-19 Associated Interstitial Lung Disease - An Emerging Entity

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