Concealed SARS-CoV-2 interstitial pneumonia unmasked by infarct-like acute myocarditis

A 38-year-old otherwise healthy man presented to the emergency department for sudden-onset oppressive chest pain. On admission, vital parameters were within normal limits and physical examination was unremarkable. Since the ECG showed mild ST-segment eleva- tion in the inferior leads (Panel A), he underwent urgent coronary angiography which ruled out obstructive coronary artery disease (Panel B). Transthoracic echocardiogram showed preserved left ven- tricular (LV) ejection fraction with inferolateral wall hypokinesis. The peak of high-sensitive troponin I was 4038 ng/L (normal value <20). Acute myocarditis was suspected, and a cardiac magnetic resonance (CMR) was performed. High signal intensity (SI) of the mid-basal LV lateral wall on T2 short tau inversion recovery (STIR) sequences con- sistent with myocardial oedema (Panel C) and subepicardial late gado- linium enhancement in the same location (Panel D) were detected. Unexpectedly, areas of high SI on T2-STIR images were also noted on both lungs (Panel C), suggesting a pulmonary inflammatory pro- cess. Despite an initially negative chest X-ray, computed tomography revealed bilateral ground-glass opacity with multifocal consolidation and thickening of interlobular septa consistent with interstitial pneumonia (Panel E). Considering the ongoing coronavirus outbreak, a nasopharyngeal swab was obtained resulting positive for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection. The patient remained free from either cardiovascular or respiratory symptoms and presented only mild fever (37.5C). Laboratory tests detected an increase of transaminases and C-reactive protein (6.73 mg/dL; normal value <0.5) with stable lymphocytopenia. After 20 days of hospitalization, he was discharged with the diagnosis of infarct-like myocarditis associated with subclinical SARS-CoV-2 respiratory infection. Acute myocarditis in the setting of SARS-CoV-2 infection has been anecdotally reported and its mechanism remains to be elucidated. So far, the SARS-CoV-2 genome has never been detected within the myocardium, suggesting an immune-mediated inflammatory myocardial injury. For the first time we reported a case of subclinical SARS-CoV-2 interstitial pneumonia occasionally unmasked by CMR performed for acute myocarditis

Role of cardiac magnetic resonance in MINOCA of unclear etiology: A case report of a suspicious paradoxical coronary embolism

The acronym MINOCA (Myocardial Infarction with Non-Obstructive Coronary Arteries) refers to myocardial infarction with normal or near-normal coronary arteries on invasive angiography. The broad spectrum of pathological mechanisms responsible for myocardial injury in MINOCA makes defining the exact underlying etiology challenging. We report the uncommon case of an acute myocardial infarction with normal coronary arteries suggestive of MINOCA caused by paradoxical coronary embolism due to a wide right-to- left shunting through a patent fossa ovalis. Integrated multimodality imaging diagnostic work-up, including cardiac magnetic resonance, transesophageal contrast echocardiography, and transcranial contrast Doppler, has been crucial for identifying the most likely mechanism underlying MINOCA

Inflammatory Microenvironment in Early Non-Small Cell Lung Cancer: Exploring the Predictive Value of Radiomics

Patient prognosis is a critical consideration in the treatment decision-making process. Conventionally, patient outcome is related to tumor characteristics, the cancer spread, and the patients’ conditions. However, unexplained differences in survival time are often observed, even among patients with similar clinical and molecular tumor traits. This study investigated how inflammatory radiomic features can correlate with evidence-based biological analyses to provide translated value in assessing clinical outcomes in patients with NSCLC. We analyzed a group of 15 patients with stage I NSCLC who showed extremely different OS outcomes despite apparently harboring the same tumor characteristics. We thus analyzed the inflammatory levels in their tumor microenvironment (TME) either biologically or radiologically, focusing our attention on the NLRP3 cancer-dependent inflammasome pathway. We determined an NLRP3-dependent peritumoral inflammatory status correlated with the outcome of NSCLC patients, with markedly increased OS in those patients with a low rate of NLRP3 activation. We consistently extracted specific radiomic signatures that perfectly discriminated patients’ inflammatory levels and, therefore, their clinical outcomes. We developed and validated a radiomic model unleashing quantitative inflammatory features from CT images with an excellent performance to predict the evolution pattern of NSCLC tumors for a personalized and accelerated patient management in a non-invasive way

A rare case of ileo-ileal intussusception due to a bleeding lipomatous mass treated by laparoscopic ileal resection

INTRODUCTION: Adult intussusception is a rare cause of bowel obstruction with atypical presentation. It can be associated with primary or secondary intestinal tumors and, rarely, with lipomatous masses. CASE REPORT: We report the case of a 69-year old man presenting with a history of gastrointestinal bleeding and anemia. Upper and lower endoscopies were negative for bleeding. On abdominal contrast enhanced computerized tomography (CT) scan, a trans-omental hernia in the right lower abdominal quadrant was diagnosed with no active bleeding or evidence of tumor. On exploratory laparoscopy we detected an ileo-ileal intussusception caused by a submucosal mass in the distal ileum, which was reduced and we then performed a segmental resection of the involved small bowel tract. The patient fully recovered by postoperative day 3 when he was discharged home. Final pathology confirmed an ileal lipoma. CONCLUSION: Ileal intussusception caused by lipoma is a rare condition, which can be diagnosed with endoscopy, barium enema, and abdominal ultrasound or CT scanning, but preoperative diagnosis may be difficult. The treatment of choice is the reduction of the intussusception and the resection (laparoscopic or open) of the involved tract

Computed tomographic colonography in the evaluation of a case of giant colonic diverticulum

The aim of this article was to present our experience with CT-colonography evaluation of a case of giant colonic diverticulum. Despite the high prevalence of diverticular disease in the Western world, giant colonic diverticula are rare entities, with fewer than 200 cases reported in literature

CT-derived Chest Muscle Metrics for Outcome Prediction in Patients with COVID-19

Background Lower muscle mass is a known predictor of unfavorable outcome, but its prognostic impact on COVID-19 patients is unknown. Purpose To investigate the contribution of CT-derived muscle status in predicting clinical outcomes in COVID-19 patients. Materials and Methods Clinical/laboratory data and outcomes (intensive care unit [ICU] admission and death) were retrospectively retrieved for patients with reverse transcriptase polymerase chain reaction-confirmed COVID-19, who underwent chest CT on admission in four hospitals in Northern Italy from February 21 to April 30, 2020. Extent and type of pulmonary involvement, mediastinal lymphadenopathy, and pleural effusion were assessed. Cross-sectional areas and attenuation of paravertebral muscles were measured on axial CT images at T5 and T12 vertebral level. Multivariable linear and binary logistic regression, including calculation odds ratios (OR) with 95% confidence intervals (CIs), were used to build four models to predict ICU admission and death, tested and compared using receiver operating characteristic curve (ROC) analysis. Results A total 552 patients (364 men; median age 65 years, interquartile range 54-75) were included. In a CT-based model, lower-than-median T5 paravertebral muscle area showed the highest ORs for ICU admission (OR 4.8, 95% CI 2.7-8.5; P<.001) and death (OR 2.3, 95% CI 1.0-2.9; P=.027). When clinical variables were included in the model, lower-than-median T5 paravertebral muscle area still showed the highest ORs both for ICU admission (OR 4.3; 95% CI 2.5-7.7; P<.001) and death (OR 2.3, 95% CI 1.3-3.7; P=.001). At ROC analysis, the CT-based model and the model including clinical variables showed the same area under the curve (AUC) for ICU admission prediction (AUC 0.83, P=.380) and were not different in predicting death (AUC 0.86 versus AUC 0.87, respectively, P=.282). Conclusion In hospitalized patients with COVID-19, lower muscle mass on CT was independently associated with ICU admission and hospital mortality