Correlating CT severity score and laboratory parameters in COVID-19 patients: the Indian experience

Background: Patients with COVID-19 infection present with myriad of symptoms to the clinicians. Many of these patients undergo HRCT chest and various lab tests during their treatment. Correlation between various lab parameters and severity of the disease on chest CT would be helpful in management of such patients. In situations where CT is not available, lab parameters may help to predict disease severity. The primary objective was to find out if there was any correlation between CT severity scores and laboratory parameters in patients having COVID-19 and if one can be extrapolated in cases where CT facilities may not be available.Methods: This is a retrospective, descriptive, and observational study. CT severity scores were obtained in all the patients using the 25 point scale. The following lab parameters were assessed: TLC, DLC, SGOT, SGPT, CRP, D-Dimer, IL-6, Serum Ferritin and serum LDH. Correlation was done between the CT score and various lab parameters using Pearson correlation coefficient test.Results: 285 patients with positive COVID-19 RT-PCR test were included in the study. CT score showed statistically significant positive correlation with age, TLC, Neutrophil count, SGOT, SGPT, CRP, D-dimer, IL-6, Ferritin and LDH with p-values less than 0.05. Negative correlation was seen with Lymphocyte count. Severe disease was found to be more common in older patients.Conclusions: In our study, CRP, LDH, Serum ferritin, IL-6 and D-dimer levels were observed to have positive correlation with disease severity on CT.  Thus these measured at the time of admission can be taken into consideration to predict radiological severity

MRI findings in ruptured ovarian ectopic pregnancy: an unexplored avenue

Ovarian ectopic pregnancy (OEP) is a rare form of ectopic pregnancy (EP) and constitutes approximately 0.5-3% of all ectopic cases. Its presentation mimics the symptoms of tubal ectopic pregnancy, hemorrhagic ovarian cyst/follicle, tubo-ovarian abscess, urinary tract calculi, appendicitis or ovarian torsion. Occasionally determining the anatomic location of an extra-tubal ectopic pregnancy based on ultrasound imaging and presentation alone can be challenging, particularly when it is adherent to the fallopian tube. Although transvaginal ultrasound (TVS) is the primary modality used in the diagnosis, various forms of OEP and its complications may be incidentally detected and further evaluated on computed tomography (CT) or magnetic resonance imaging (MRI) when an alternative diagnosis is suspected. We reported a case of a second gravid para zero, 25 years old lady, who came with pain in the left lower abdomen. Her urine pregnancy test was positive. TVS showed empty uterine cavity, an extremely tender, heterogenous hyperechoic right adnexal mass, but no obvious gestation sac (GS). A large hematoma was detected adjacent to it in the pouch of Douglas (POD). Keeping a high suspicion of ectopic pregnancy, MRI was performed to evaluate the lesion better which revealed a natural, non-assisted, ruptured right ovarian ectopic pregnancy and was subsequently confirmed at laparotomy and proven on histopathology. Patient underwent left oophorectomy and discharged on 4th day with uneventful follow up.