Follow-up chest radiographic findings in patients with MERS-CoV after recovery

Karuna M Das; Edward Y Lee; Rajvir Singh; Mushira A Enani; Khalid Al Dossari; Klaus Van Gorkom; Sven G Larsson; Ruth D Langer

doi:10.4103/ijri.IJRI_469_16

Indian Journal of Radiology and Imaging, Table of Contents

CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2017; 27(03): 342-349
DOI: 10.4103/ijri.IJRI_469_16

Thoracic Imaging

Follow-up chest radiographic findings in patients with MERS-CoV after recovery

Authors

Karuna M Das

Department of Radiology, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, UAE; Department of Medical Imaging, King Fahad Medical City, Riyadh, KSA
Edward Y Lee

Department of Radiology and Medicine, Pulmonary Division, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
Rajvir Singh

Department of Cardiology and Biostatistics, Hamad Medical Corporation, Doha, Qatar
Mushira A Enani

Department of Medicine (Infectious Disease), King Fahad Medical City, Riyadh, KSA
Khalid Al Dossari

Department of Medical Imaging, King Fahad Medical City, Riyadh, KSA
Klaus Van Gorkom

Department of Radiology, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, UAE
Sven G Larsson

Department of Medical Imaging, King Fahad Medical City, Riyadh, KSA
Ruth D Langer

Department of Radiology, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, UAE

Abstract

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Abstract

Purpose: To evaluate the follow-up chest radiographic findings in patients with Middle East respiratory syndrome coronavirus (MERS-CoV) who were discharged from the hospital following improved clinical symptoms. Materials and Methods: Thirty-six consecutive patients (9 men, 27 women; age range 21–73 years, mean ± SD 42.5 ± 14.5 years) with confirmed MERS-CoV underwent follow-up chest radiographs after recovery from MERS-CoV. The 36 chest radiographs were obtained at 32 to 230 days with a median follow-up of 43 days. The reviewers systemically evaluated the follow-up chest radiographs from 36 patients for lung parenchymal, airway, pleural, hilar and mediastinal abnormalities. Lung parenchyma and airways were assessed for consolidation, ground-glass opacity (GGO), nodular opacity and reticular opacity (i.e., fibrosis). Follow-up chest radiographs were also evaluated for pleural thickening, pleural effusion, pneumothorax and lymphadenopathy. Patients were categorized into two groups: group 1 (no evidence of lung fibrosis) and group 2 (chest radiographic evidence of lung fibrosis) for comparative analysis. Patient demographics, length of ventilations days, number of intensive care unit (ICU) admission days, chest radiographic score, chest radiographic deterioration pattern (Types 1-4) and peak lactate dehydrogenase level were compared between the two groups using the student t-test, Mann-Whitney U test and Fisher's exact test. Results: Follow-up chest radiographs were normal in 23 out of 36 (64%) patients. Among the patients with abnormal chest radiographs (13/36, 36%), the following were found: lung fibrosis in 12 (33%) patients GGO in 2 (5.5%) patients, and pleural thickening in 2 (5.5%) patients. Patients with lung fibrosis had significantly greater number of ICU admission days (19 ± 8.7 days; P value = 0.001), older age (50.6 ± 12.6 years; P value = 0.02), higher chest radiographic scores [10 (0-15.3); P value = 0.04] and higher peak lactate dehydrogenase levels (315-370 U/L; P value = 0.001) when compared to patients without lung fibrosis. Conclusion: Lung fibrosis may develop in a substantial number of patients who have recovered from Middle East respiratory syndrome coronavirus (MERS-CoV). Significantly greater number of ICU admission days, older age, higher chest radiographic scores, chest radiographic deterioration patterns and peak lactate dehydrogenase levels were noted in the patients with lung fibrosis on follow-up chest radiographs after recovery from MERS-CoV.

Keywords

Lung fibrosis - MERS-CoV - Chest radiograph

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References

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