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Incidental COVID-19 related lung apical findings on stroke CTA during the COVID-19 pandemic

Abstract

Background Authors have noticed an increase in lung apex abnormalities on CT angiography (CTA) of the head and neck performed for stroke workup during the coronavirus disease 2019 (COVID-19) pandemic.

Objective To evaluate the incidence of these CTA findings and their relation to COVID-19 infection.

Methods In this retrospective multicenter institutional review board-approved study, assessment was made of CTA findings of code patients who had a stroke between March 16 and April 5, 2020 at six hospitals across New York City. Demographic data, comorbidities, COVID-19 status, and neurological findings were collected. Assessment of COVID-19 related lung findings on CTA was made blinded to COVID-19 status. Incidence rates of COVID-19 related apical findings were assessed in all code patients who had a stroke and in patients with a stroke confirmed by imaging.

Results The cohort consisted of a total of 118 patients with mean±SD age of 64.9±15.7 years and 57.6% (68/118) were male. Among all code patients who had a stroke, 28% (33/118) had COVID-19 related lung findings. RT-PCR was positive for COVID-19 in 93.9% (31/33) of these patients with apical CTA findings.

Among patients who had a stroke confirmed by imaging, 37.5% (18/48) had COVID-19 related apical findings. RT-PCR was positive for COVID-19 in all (18/18) of these patients with apical findings.

Conclusion The incidence of COVID-19 related lung findings in stroke CTA scans was 28% in all code patients who had a stroke and 37.5% in patients with a stroke confirmed by imaging. Stroke teams should closely assess the lung apices during this COVID-19 pandemic as CTA findings may be the first indicator of COVID-19 infection.

  • CT angiography
  • infection
  • stroke

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Footnotes

  • Contributors Study design: SK, JS, MC, JM, PB. Data collection: SK, JS, MC, KM, BR. Statistical analysis: SK, PB. Manuscript writing: SK, JS, MC, KM, BR, BND, JM, AD, PB.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Institutional review board (IRB) of the Mount Sinai School of Medicine, in accordance with Mount Sinai’s Federal Wide Assurances (FWA#00005656, FWA#00005651) to the Department of Health and Human Services, approval was obtained on an expedited basis with a waiver of informed consent. IRB approval number: #20-03376.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data for this manuscript are included in the manuscript. There is no supplementary information.

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