Need for caution in the diagnosis of radiation pneumonitis during the COVID-19 pandemic
Fecha
2020Autor
Shaverdian, Narek
Shepherd, Annemarie F.
Rimner, Andreas
Wu, Abraham J.
Simone II, Charles B.
Gelblum, Daphna Y.
Daniel R. Gomez
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Resumen
Purpose: Patients with cancer are at high risk for mortality from coronavirus disease 2019 (COVID-19). Radiation pneumonitis (RP) is
a common toxicity of thoracic radiation therapy with clinical and imaging features that overlap with those of COVID-19; however, RP is
treated with high-dose corticosteroids, which may exacerbate COVID-19eassociated lung injury. We reviewed patients who presented
with symptoms of RP during the intensification of a regional COVID-19 epidemic to report on their clinical course and COVID-19
testing results.
Methods and Materials: The clinical course and chest computed tomography (CT) imaging findings of consecutive patients who
presented with symptoms of RP in March 2020 were reviewed. The first regional COVID-19 case was diagnosed on March 1, 2020. All
patients underwent COVID-19 qualitative RNA testing.
Results: Four patients with clinical suspicion for RP were assessed. Three out of 4 patients tested positive for COVID-19. All patients
presented with symptoms of cough and dyspnea. Two patients had a fever, of whom only 1 tested positive for COVID-19. Two patients
started on an empirical high-dose corticosteroid taper for presumed RP, but both had clinical deterioration and ultimately tested positive
for COVID-19 and required hospitalization. Chest CT findings in patients suspected of RP but ultimately diagnosed with COVID-19
showed ground-glass opacities mostly pronounced outside the radiation field.
Conclusions: As this pandemic continues, patients with symptoms of RP require diagnostic attention. We recommend that patients
suspected of RP be tested for COVID-19 before starting empirical corticosteroids and for careful attention to be paid to chest CT
imaging to prevent potential exacerbation of COVID-19 in these high-risk patients.
Palabras clave
COVID-19; Diagnosis of radiation pneumonitis; PandemicEnlace al recurso
https://doi.org/10.1016/j.adro.2020.04.015Colecciones
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