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


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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  • 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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