key: cord-0791506-4hqufkam
authors: Mucientes Rasilla, J.; Jimeno Pernett, R.; Cardona Arboniés, J.
title: Diagnosis of COVID-19 pneumonia in asymptomatic patients after an oncological PET/CT
date: 2020-07-17
journal: nan
DOI: 10.1016/j.remnie.2020.04.013
sha: b9e9a5363893355e617c38f361a3e62837be0407
doc_id: 791506
cord_uid: 4hqufkam

Abstract Introduction On January 30, 2020, the World Health Organization (WHO) declared an international emergency due to the pandemic caused by a new coronavirus. There are some oncological indications that have special priority and studies are still being carried out despite the current situation. In these studies we have found suspicious findings of COVID-19 pneumonia in asymptomatic patients. The objective of this work is to assess the incidence of these findings, describe their characteristics and the evolution of suspected patients. Material and methods Oncological PET studies carried out in asymptomatic patients between March 18 and April 8, 2020 have been reviewed. Patients who presented findings suggestive of corresponding to an pulmonary infectious process were selected. Clinical findings have been reviewed to confirm or rule out SARS-CoV2 infection. Results During the specified period, a total of 129 PET-CT studies were performed. Of these, 11 (8.5%) found suspicious findings of a pulmonary infectious process. These were 8 men and 3 women aged between 30 and 79 years (mean 62.2). Conclusions Patients with COVID 19 can present few symptoms of the disease, and in PET-CT studies both presymptomatic and almost asymptomatic patients can be detected, so nuclear medicine physicians should take special attention to the pulmonary evaluation of PET-CT studies.

El 30 de enero de 2020 la organización mundial de la salud (OMS) declaró una emergencia internacional por la pandemia causada por un nuevo coronavirus. Existen algunas indicaciones oncológicas que tienen especial prioridad y se siguen realizando estudios a pesar de la situación actual. En estos estudios hemos encontrado hallazgos sospechosos de neumonía COVID-19 en pacientes asintomáticos. El objetivo de este trabajo es valorar la incidencia de estos hallazgos, describir sus características y valorar la evolución de los pacientes sospechosos.

Se han revisado los estudios PET oncológicos realizados entre el 18 de marzo y el 8 de abril de 2020. Se han identificado los pacientes que presentaban hallazgos sugerentes de corresponder con un proceso infeccioso pulmonar de forma incidental en pacientes asintomáticos. Se han revisado las historias clínicas de estos pacientes para confirmar o descartar la infección por SARS-CoV2 RESULTADOS Durante el periodo especificado se realizaron un total de 129 estudios PET-TC con indicación oncológica. De ellos, en 11 (8,5%) se encontraron hallazgos sospechosos de proceso infeccioso pulmonar. Se trataba de 8 varones y 3 mujeres con edades comprendidas entre los 30 y los 79 años (media 62,2). CONCLUSIONES Los pacientes con COVID 19 pueden presentar escasos síntomas de la enfermedad, y en los estudios PET-TC se pueden detectar tanto pacientes presintomáticos como pacientes casi asintomáticos por lo que los médicos nucleares deben prestar especial atención en la valoración pulmonar de los estudios PET-TC.

On January 30, 2020, the World Health Organization (WHO) declared an international emergency due to the pandemic caused by a new coronavirus. There are some oncological indications that have special priority and studies are still being carried out despite the current situation. In these studies we have found suspicious findings of COVID-19 pneumonia in asymptomatic patients. The objective of this work is to assess the incidence of these findings, describe their characteristics and the evolution of suspected patients.

Oncological PET studies carried out in asymptomatic patients between March 18 and April 8, 2020 have been reviewed. Patients who presented findings suggestive of corresponding to an pulmonary infectious process were selected. Clinical findings have been reviewed to confirm or rule out SARS-CoV2 infection.

During the specified period, a total of 129 PET-CT studies were performed. Of these, 11 (8.5%) found suspicious findings of a pulmonary infectious process. These were 8 men and 3 women aged between 30 and 79 years (mean 62.2).

Patients with COVID 19 can present few symptoms of the disease, and in PET-CT studies both presymptomatic and almost asymptomatic patients can be detected, so nuclear medicine physicians should take special attention to the pulmonary evaluation of PET-CT studies . coronavirus disease which is a respiratory tract infection involving fever, cough and radiographic alterations. The virus produces severe pneumonia with respiratory distress, placing the lives of patients at risk 2 . The mean incubation period is 5-6 days, although this may vary greatly (from 0 to 24 days) 3 . The mean time from symptom onset to recovery is of 2 weeks, if the involvement is mild, and from 3 to 5 weeks in cases of severe disease. In the analysis of the outbrreak in China, the WHO suggested that asymptomatic cases were of little relevance in the expansion of the pandemic. However, clusters of patients in which the index case was asymptomatic have been described 4 and in other cases, it is asumed that the index case was in a presymptomatic period 5 In these studies we have detected findings suspicious of COVID-19 pneumonia in asymptomatic patients. The aim of this study was to evaluate the incidence of these findings, describe their characteristics and assess the evolution of patients suspected of having COVID- year-old male patient who underwent the study for suspicion of recurrence of cancer of the larnyx. Several areas of ground glass density with FDG uptake are observed. A thyroid lesion can also be observed in the MIP image. The patient was admitted for study. The PCR study was positive, and on questioning the patient he only reported mild hyporexia and ageusia. The day after the study, blood analysis showed lymphophenia, and an increase in C reactive protein and D-dimer levels. The patient did not present cough, fever or gastrointestinal symptoms and was discharged after 3 days, with the recommendation of home confinement.

J o u r n a l P r e -p r o o f Figura 2: Corte axial de TC, PET-TC, PET e imagen MIP de paciente varón de 63 años que se realiza el estudio por sospecha de recidiva de cáncer de laringe. Se observan varias áreas con densidad en vidrio deslustrado, con captación de FDG. En la imagen MIP se observa también una lesión en tiroides. Se ingresó para estudio. Se realizó PCR que resultó positiva, reinterrogado el paciente solo refería leve hiporexia y ageusia. El día posterior del estudio se realizó analítica que mostró linfopenia, aumento de proteína C reactiva y de dímero-D. No presentó tos, fiebre ni síntomas gastrointestinales y fue dado de alta tras tres días de ingreso recomendándose aislamiento domiciliario.

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The authors declare no conflict of interests.J o u r n a l P r e -p r o o f