Publication: Covid-19 Ön Tanısı ile Çekilen Toraks Tomografilerinde Saptanan Rastlantısal Bulgular
Abstract
ÖZET Amaç: Çalışmamızın amacı COVID-19 pandemisi sürecinde çekilen toraks BT tetkiklerinde saptanan rastlantısal bulguların prevalansının değerlendirilmesi ve bu bulguların yaş, cinsiyet ve sigara kullanımı ile ilişkisinin belirlenmesidir. Gereç ve Yöntem: Bu çalışma Eylül 2020 ve Eylül 2021 tarihleri arasındaki bir yıllık süre zarfında, 3. Basamak bir eğitim hastanesi olan Ondokuz Mayıs Üniversitesi Tıp Fakültesi Hastanesi COVID-19 poliklinikleri, acil servisi ve günübirlik polikliniklerine, ateş, öksürük, balgam, nefes darlığı, boğaz ağrısı, koku alamama, halsizlik gibi semptomlarla başvuran ve COVID-19 ön tanısı ile toraks BT çekilen 1291 hasta ile, retrospektif ve gözlemsel olarak yapılmıştır. Daha önceden tanılı akciğer kanseri, nodülü, interstisyel akciğer hastalığı ve enfeksiyonu olan hastalar çalışmaya dahil edilmemiştir. Tespit edilen rastlantısal bulgular primer kitle, parankim metastazı, nodül, parankim bulgusu, kardiyak bulgular, göğüs duvarı anomalileri, mediasten/plevra anomalileri, ekstratorasik anomaliler başlıkları altında toplanıp yaş, cinsiyet ve sigara kullanımı açısından karşılaştırılarak değerlendirilmiştir Bulgular: Çalışmaya dahil edilen hastaların sadece %35,2 (n=455) sinde toraks BT de COVID-19'a özgü tutulum mevcuttur. Parankimal bulgular %44,7 (n=577) ile en sık rastlantısal bulgulardır. Sigara kullanan kişilerde COVID-19'un toraks BT deki spesifik tutulumu daha az görülmektedir (p<0,001). Primer akciğer kitleleri sigara içenlerin %2,7 (n=11) sinde, oransal olarak 2 kat fazla görülmekle beraber istatistiksel farklılık saptanmamıştır. Sigara kullanan kişilerde göğüs duvarı bulguları dışındaki diğer tüm rastlantısal bulgular daha sıktır (p<0,05). 50 yaş üzerindeki hastalarda tüm rastlantısal bulgular daha sık görülmektedir (p<0,05). Çalışmamızın sonuçlarına göre akciğerinde rastlantısal olarak kitle saptanan ve takip sonucunda akciğer kanseri tanısı alan altı hastanın hepsi 50 yaşın üzerinde idi, hepsinin sigara kullanım öyküsü vardı. Sonuç: Çalışmamızda COVID-19 ön tanısıyla toraks BT çekilen hastaların büyük çoğunluğunun toraks tomografisinde COVID-19'a özgü herhangi bir bulgu saptanmamıştır. Toraks BT'nin COVID-19 tanısında maalesef gereksiz şekilde fazla kullanıldığı görülmektedir. COVID-19 tanısında toraks BT tanı için kullanılacaksa PCR negatif ancak klinik şüphesi yüksek olan hastalarda kullanılması mantıklı bir yaklaşım olacaktır. COVID-19'a özgü toraks BT bulguları ve çalışmamızda değerlendirilen tüm rastlantısal bulgular 50 yaş üzeri kişilerde daha sık görülmektedir. 50 yaşın üzerindeki COVID-19 hastalarının değerlendirilmesi ve yönetiminde toraks BT tetkiki önem arz etmektedir. Çalışmamızın verilerine göre sigara kullanan hastalarda COVID-19'a özgü toraks BT tutulumu daha az olmaktadır. Sigaranın bu konudaki etkisinin daha ayrıntılı çalışmalarla aydınlatılması gerekmektedir. Çalışmamızda sigara kullanan kişilerin akciğerinde kanseri ve prekanseröz lezyonlar oransal olarak 2 kat fazla görülmekle beraber istatistiksel fark tespit edilememiştir Bu durum hasta popülasyonumuzun kısıtlı olmasına bağlı olabileceği için örneklem büyütülünce istatistiksel olarak daha anlamlı bulgular saptanabileceğini düşünmekteyiz. Çalışmamızın sonuçlarına göre akciğerinde rastlantısal olarak kitle saptanan ve takip sonucunda akciğer kanseri tanısı alan altı hastanın hepsi 50 yaşın üzerinde idi, hepsinin sigara kullanım öyküsü vardı. Literatürle birlikte değerlendirildiğinde, ülkemizde de 50 yaş üzerinde, sigara öyküsü olan hastalar için toraks BT ile tarama çalışmaları üzerinde durulmasının faydalı olacağına inanmaktayız. Anahtar Kelimeler: COVID-19, Rastlantısal bulgu, Toraks BT
ABSTRACT Objective: The aim of our study is to evaluate the prevalence of incidental findings detected in thorax CT examinations performed during the COVID-19 pandemic and to determine the relationship of these findings with age, gender and smoking. Material and Method: This study was conducted retrospectively and observationally during a one-year period between September 2020 and September 2021, including 1291 patients who underwent chest CT with the preliminary diagnosis of COVID-19, presenting with complaints of fever, cough, sputum, shortness of breath, sore throat, smelling disorder and fatigue to the COVID-19 outpatient clinics, emergency department and other outpatient clinics of Ondokuz Mayıs University Faculty of Medicine Hospital, which is a tertiary level training hospital. Patients with previously known history of lung malignancy, nodule, interstitial lung disease and infection were not included in the study. The incidental pathologies detected in this study were classified under the headings of primary mass lesion, parenchymal metastasis, parenchymal nodule, other parenchymal findings, cardiac findings, chest wall anomalies, mediastinum/pleura anomalies, extrathoracic anomalies and were compared and evaluated in terms of age, gender and smoking status. Findings: Only 35.2% (n=455) of the patients included in the study had COVID-19-specific findings on thorax CT. Parenchymal findings are the most common incidental findings with 44.7% (n=577). COVID-19 spesific findings on thorax CT is less common in smokers (p<0.001). Although primary lung masses were detected in 2,7% (n=11) of the patients, proportionally twice as common in smokers, no statistical difference was detected in our study. All incidental pathologies except chest wall pathologies are more common in smokers (p<0.05). All incidental findings are more common in patients over 50 years of age (p<0.05). According to our results, of the six patients who were detected with incidental lung masses, and diagnosed with lung cancer as a result of follow-up were over the age of 50 and all had a history of smoking. Conclusion: In our study, no specific finding of COVID-19 were detected in the thorax CT imaging of the majority of patients who underwent chest CT with a preliminary diagnosis of COVID-19. Unfortunately, it appears that thorax CT is used unnecessarily in the diagnosis of COVID-19. It would be a logical approach to use thorax CT as a diagnostic tool, especially in the diagnosis of COVID-19 in patients with negative PCR but high clinical suspicion. Specific thorax CT findings of COVID-19 and all incidental findings evaluated in our study are more common in people over 50 years of age. Thorax CT examination is important in the evaluation and management of COVID-19 patients over the age of 50. According to the data of our study, the ratio of COVID-19 specific finding in thorax CT is less in patients with history of smoking. The effect of smoking on this issue needs to be clarified with more detailed studies. In our study, although the malignant and premalignant lesions of the lung were seen proportionally twice as often in smokers, no statistical difference was detected. This could be due to our limited patient population, and it is within our belief that more statistically significant findings could be detected if the sample of the study was expanded. According to our results, of the six patients who were detected with incidental lung masses, and diagnosed with lung cancer as a result of follow-up were over the age of 50 and all had a history of smoking. When reviewed together with the literature, we believe that it would be rewarding to focus on screening studies in our country with thorax CT for patients over 50 years of age and with a history of smoking. Keywords: COVID-19, Incidental finding, Thorax CT
ABSTRACT Objective: The aim of our study is to evaluate the prevalence of incidental findings detected in thorax CT examinations performed during the COVID-19 pandemic and to determine the relationship of these findings with age, gender and smoking. Material and Method: This study was conducted retrospectively and observationally during a one-year period between September 2020 and September 2021, including 1291 patients who underwent chest CT with the preliminary diagnosis of COVID-19, presenting with complaints of fever, cough, sputum, shortness of breath, sore throat, smelling disorder and fatigue to the COVID-19 outpatient clinics, emergency department and other outpatient clinics of Ondokuz Mayıs University Faculty of Medicine Hospital, which is a tertiary level training hospital. Patients with previously known history of lung malignancy, nodule, interstitial lung disease and infection were not included in the study. The incidental pathologies detected in this study were classified under the headings of primary mass lesion, parenchymal metastasis, parenchymal nodule, other parenchymal findings, cardiac findings, chest wall anomalies, mediastinum/pleura anomalies, extrathoracic anomalies and were compared and evaluated in terms of age, gender and smoking status. Findings: Only 35.2% (n=455) of the patients included in the study had COVID-19-specific findings on thorax CT. Parenchymal findings are the most common incidental findings with 44.7% (n=577). COVID-19 spesific findings on thorax CT is less common in smokers (p<0.001). Although primary lung masses were detected in 2,7% (n=11) of the patients, proportionally twice as common in smokers, no statistical difference was detected in our study. All incidental pathologies except chest wall pathologies are more common in smokers (p<0.05). All incidental findings are more common in patients over 50 years of age (p<0.05). According to our results, of the six patients who were detected with incidental lung masses, and diagnosed with lung cancer as a result of follow-up were over the age of 50 and all had a history of smoking. Conclusion: In our study, no specific finding of COVID-19 were detected in the thorax CT imaging of the majority of patients who underwent chest CT with a preliminary diagnosis of COVID-19. Unfortunately, it appears that thorax CT is used unnecessarily in the diagnosis of COVID-19. It would be a logical approach to use thorax CT as a diagnostic tool, especially in the diagnosis of COVID-19 in patients with negative PCR but high clinical suspicion. Specific thorax CT findings of COVID-19 and all incidental findings evaluated in our study are more common in people over 50 years of age. Thorax CT examination is important in the evaluation and management of COVID-19 patients over the age of 50. According to the data of our study, the ratio of COVID-19 specific finding in thorax CT is less in patients with history of smoking. The effect of smoking on this issue needs to be clarified with more detailed studies. In our study, although the malignant and premalignant lesions of the lung were seen proportionally twice as often in smokers, no statistical difference was detected. This could be due to our limited patient population, and it is within our belief that more statistically significant findings could be detected if the sample of the study was expanded. According to our results, of the six patients who were detected with incidental lung masses, and diagnosed with lung cancer as a result of follow-up were over the age of 50 and all had a history of smoking. When reviewed together with the literature, we believe that it would be rewarding to focus on screening studies in our country with thorax CT for patients over 50 years of age and with a history of smoking. Keywords: COVID-19, Incidental finding, Thorax CT
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