Radiology Diagnostics of a New Coronavirus Infection in Pregnant Women. Experience of O.M. Filatov Municipal Clinical Hospital No. 15, Moscow

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Abstract

Background. The pandemic of coronavirus pneumonia (COVID-19) is spreading globally at an accelerated rate and is a major health problem. The purpose of this study was to assess the possibility of using a combination of radiation diagnostic methods in lung lesions in pregnant women, with confirmed coronavirus infection and suspected COVID-19 pneumonia, hospitalized in O.M. Filatov Municipal Clinical Hospital No. 15, Moscow.

Methods. Retrospectively analyzed changes in lung parenchyma and pleura detected by multispiral computed tomography of chest organs and pulmonary ultrasound in 90 pregnant patients with clinical manifestations of viral pneumonia and confirmed coronavirus infection.

Results. Examined 90 patients with clinical manifestations of pneumonia and PCR-confirmed COVID-19. Among the clinical manifestations, coughing, fever, shortness of breath prevailed. Most changes detected by lung tomography (performed in 92% of patients), had a polysegmental and bilateral character, were more often localized in the peripheral departments, in 74 (89%) patients were involved in a pathological process of more than two lobes, in 77 (93%) of the patients were determined the centers of pulmonary tissue compaction by the type of “ground glass”, and the combination of the above manifestations with the presence of foci of consolidation and reticular changes was noted in 23 (28%) cases. Among the complications more common: thickening of the pleura, hydrothorax, less often pneumothorax. In 43 (48%) patients, MSCT was supplemented by ultrasound examination of the lungs and pleura, and in 21 (23%) patients, ultrasound was used in isolation as a dynamic control tool to reduce dose load and comply with the ALARA principle, while in 7 (8%) patients, ultrasound was used as the only diagnostic tool due to refusal to perform MSCT.

Conclusion. Radiosemiotics of lung lesions in pregnant women with COVID-19, detected in MSCT of thoracic organs, does not differ from that in non-pregnant patients. The appearance of specific zones of pulmonary tissue compaction in the form of a “gound glass”, as a manifestation of a unilateral or bilateral, mono- or polyphocal lung lesion, is highly likely to indicate a manifestation of COVID-19. Pulmonary ultrasound also allows detecting characteristic changes in lung parenchyma and pleura in pregnant women, correlating with MSCT data, primarily in patients with medium-severe forms of pneumonia. Use of ultrasonography corresponds to the principle of ALARA in medicine, remaining a choice method with the women refusing the visualization interfaced to beam loading that can be used in the period of COVID-19 pandemic.

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About the authors

Dmitriy A. Doroshenko

O.M. Filatov Municipal Clinical Hospital No. 15; Pirogov Russian National Research Medical University

Email: drdoroshenko@mail.ru
ORCID iD: 0000-0001-8045-1423
SPIN-code: 9451-7029

MD, PhD

Russian Federation, Moscow; Moscow

Yuriy I. Rumyantsev

O.M. Filatov Municipal Clinical Hospital No. 15

Author for correspondence.
Email: rumyantsev5@mail.ru
ORCID iD: 0000-0002-6210-3908
SPIN-code: 1745-3929

Radiologist

Russian Federation, 23 Veshnyakovskaya str., 111539, Moscow

Oксана A. Shapsigova

O.M. Filatov Municipal Clinical Hospital No. 15

Email: ksy-sha72@mail.ru
ORCID iD: 0000-0002-5666-1292

MD, PhD

Russian Federation, Moscow

Borislav V. Silaev

O.M. Filatov Municipal Clinical Hospital No. 15

Email: drsilaev@yandex.ru
ORCID iD: 0000-0002-9698-3915
SPIN-code: 3970-9048

MD, PhD

Russian Federation, Moscow

Olga V. Konisheva

O.M. Filatov Municipal Clinical Hospital No. 15

Email: okonysheva@mail.ru
ORCID iD: 0000-0002-8064-2761
SPIN-code: 2155-1395

MD, PhD

Russian Federation, Moscow

Sergey A. Gumenyuk

Scientific and Practical Center for Emergency Medical Care of the Moscow Department of Health

Email: gkb15@zdrav.mos.ru
ORCID iD: 0000-0002-4172-8263
SPIN-code: 2275-4337

MD, PhD

Russian Federation, Moscow

Valeriy I. Vechorko

O.M. Filatov Municipal Clinical Hospital No. 15; Pirogov Russian National Research Medical University

Email: emma.makoeva123@mail.ru
ORCID iD: 0000-0003-3568-5065
SPIN-code: 3192-2421

MD, PhD

Russian Federation, Moscow; Moscow

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Supplementary files

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1. Fig. 1. MSCT. Area of "frosted glass" in the left lung

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2. Fig. 2. Ultrasound. Many B-lines

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3. Fig. 3. Ultrasound. Fragment of the "white lung" - consolidation

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4. Figure: 4, a. MSCT. Bilateral lesion severity CT-2

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5. Fig. 4, b. MSCT. Increase in the lesion volume, transfer of the patient to mechanical ventilation

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6. Fig. 4, c. Patient B. 38 years old - negative dynamics through 7 days

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7. Figure: 4 d, MSCT. Bilateral subtotal changes in posterior parts of both lungs

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8. Figure: 4, e. MSCT. Development of right-sided pneumothorax, emphysema of soft tissues

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9. Fig. 4, f. MSCT. Pneumothorax on the right in the sagittal plane

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10. Fig. 5, a. Ultrasound. Cortical consolidation

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11. Fig. 5 b. Ultrasound. Thickening of the pleura with subpleural consolidation

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12. Fig. 5, c. Predominantly right-sided lesion, confirmed by MSCT

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13. Fig. 5, d. MSCT. Left lung changes

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14. Fig. 6, a. Ultrasound. "Triangular" deformity of the pleural line

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15. Fig. 6, b. MSCT. Axial plane. Bilateral changes, mainly on the left

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16. Fig. 6, c. MSCT. Severity of CT-2

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