Gaucher disease type 2 often progresses to life-threatening complications such as respiratory distress or the entrance of food into the respiratory passages (aspiration pneumonia). No malignancy is identified. We compared the expression profile against control lungs (donor lungs discarded for transplantation), and explanted tissue from patients with idiopathic pulmonary fibrosis (IPF). Thrombocytopenia was defined as a platelet count of less than 150,000 per cubic millimeter. On a lateral decubitus, amounts as small as 50ml of fluid are possible. Terms of Use. Described chest radiographic signs include: Fleischner sign: enlarged pulmonary artery (20%) Hampton hump: peripheral wedge of airspace opacity and implies lung infarction (20%) Crossref (%), Median time until development of pneumonia (IQR) days, Use of extracorporeal membrane oxygenation no. 9. Distribution of temperature no./total no. Lancet 2020;395:497-506. MedicineNet does not provide medical advice, diagnosis or treatment. Hospital course was best established in 19 of the 23 patients. Although a lung-protective ventilation strategy has improved the long-term pulmonary outcomes of ARDS patients, lung fibrosis significantly contributes to morbidity and mortality. Laboratory confirmation of SARS-CoV-2 was performed at the Chinese Center for Disease Prevention and Control before January 23, 2020, and subsequently in certified tertiary care hospitals. Sample size was determined based on previous studies using human samples from our group. and H.K.-Q. Moreover, the presence of any coexisting illness was more common among patients with severe disease than among those with nonsevere disease (38.7% vs. 21.0%). [1] Together, this corresponds to a background radiation equivalent time of about 10 days. The pattern mimics interstitial lung disease (ILD) specifically non-specific interstitial pneumonia (NSIP). Targeting hypoxia signaling for perioperative organ injury. Collagen-producing lung cell atlas identifies multiple subsets with distinct localization and relevance to fibrosis. Table 1. Gastroenterology 2003;125:1011-1017. If an opacity is new compared to say something recent from a month ago, then it is more likely to an infection or fluid. Important differences with IPF include a much younger age of onset, a potentially unique fibrotic gene expression, and a predominance in Hispanic individuals. Clinical management of severe acute respiratory infection when novel coronavirus (2019-nCoV) infection is suspected: interim guidance. ), Thoracic Surgery and Oncology (J.H. 1. The largest number of patients (132) had been admitted to Wuhan Jinyintan Hospital. The air we breathe in (inhalation) is warmed, humidified, and cleaned by the nose and the lungs. Significant chronic interstitial inflammation was noted in all patients. Extensive pneumomediastinum, trace bilateral pneumothoraces, and extensive subcutaneous emphysema. Some areas show collapse and occasional areas of mature collagen. 2005;236(1):10-21. Lung transplantation as therapeutic option in acute respiratory distress syndrome for coronavirus disease 2019-related pulmonary fibrosis. ), Huangshi Central Hospital of Edong Healthcare Group, Affiliated Hospital of Hubei Polytechnic University, Huangshi (Ya-hua Hu), the First Hospital of Changsha, Changsha (J. Liu), the Third Peoples Hospital of Hainan Province, Sanya (Z.C. Intimal thickening of pulmonary artery. pptx files, The Lancet Regional Health Southeast Asia, Statement on offensive historical content, Convalescent plasma, dexamethasone, remdesivir, Convalescent plasma, dexamethasone, remdesivir, IVIG, Thrombotic Thrombocytopenic Purpura on Rituxan, Dexamethasone, remdesivir, convalescent plasma, Remdesivir, convalescent plasma, dobutamine, NO, epoprostenol, Remdesivir, convalescent plasma, dexamethasone, levaquin, GERD, Hypothyroidism, allergies, Previous hospitalization for COVID w/ Discharge, Monoclonal antibodies, remdesivir, dexamethasone, azithromycin/ rocephin, Convalescent plasma, dexamethasone, remdesivir, Ruxolitnib, Decadron, remdesivir, convalescent plasma, Steroids, remdesivir, tocilizumab, baricitinib, Diffuse Ground glass opacities (GGO) Reticulations. (%), Acute respiratory distress syndrome no. Like all methods of radiography, chest radiography employs ionizing radiation in the form of X-rays to generate images of the chest. CT. National Institute of Health (NIH) Grants R01HL154720, R01DK122796, R01DK109574, R01HL133900, and Department of Defense (DoD) Grant W81XWH2110032 to H.K.E. The primary composite end point was admission to an intensive care unit, the use of mechanical ventilation, or death. It can tell you if you've already had the virus. 6. Findings compatible with post-inflammatory type scarring, but also show focal usual interstitial (UIP) and NSIP. Enjoy access to millions of ebooks, audiobooks, magazines, and more from Scribd. This unique cohort of patients exhibits persistent pulmonary impairment with profound hypoxemia with a prolonged hospital course and multiple in hospital complications. Acommon MUC5B promoter polymorphism and pulmonary fibrosis. In a cohort of 310 patients with viral or non-viral community-acquired pneumonia viral pneumonia was associated with: Rhinorrhea, multivariate (OR 3.52; 95% CI, 1.58-7.87) Higher lymphocyte fraction in the white blood cells, Lower serum creatinine, ground-glass opacity (GGO) in radiology results (multivariate OR 4.68; 95% CI, 2.48-8.89) 2013;14 Suppl 1(S1):S2. Most often, lung cancer does not show any signs and symptoms until it has advanced to higher stages when it becomes difficult to treat. Ebner L, Christodoulidis S, Stathopoulou T et al. A total of 3.5% were health care workers, and a history of contact with wildlife was documented in 1.9%; 483 patients (43.9%) were residents of Wuhan. They had a mean age of 47 and included a patient as young as 16-years-old. Supported by the National Health Commission of China, the National Natural Science Foundation, and the Department of Science and Technology of Guangdong Province. If you don't remember your password, you can reset it by entering your email address and clicking the Reset Password button. ), Tianyou Hospital Affiliated to Wuhan University of Science and Technology (Jian-ming Wang), and the Peoples Hospital of Huangpi District (S.Z. Case Records of the Massachusetts General Hospital, Talquetamab, a T-CellRedirecting GPRC5D Bispecific Antibody for Multiple Myeloma, A Covid-19 Milestone Attained A Correlate of Protection for Vaccines, A Step toward Interoperability of Health IT, Breakthrough Infections after Postexposure Vaccination against Mpox, Tumor-Infiltrating Lymphocyte Therapy or Ipilimumab in Advanced Melanoma, Case 37-2022: A 55-Year-Old Man with Fatigue, Weight Loss, and Pulmonary Nodules, https://www.who.int/docs/default-source/coronaviruse/clinical-management-of-novel-cov.pdf, https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/laboratory-guidance, https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports/, Brief Report: In Utero Enzyme-Replacement Therapy for Infantile-Onset Pompes Disease, NEJM Catalyst Innovations in Care Delivery. conducted experiments, acquired data, and analyzed data. Lateral views of the chest are obtained in a similar fashion as the posteroanterior views, except in the lateral view, the patient stands with both arms raised and the left side of the chest pressed against a flat surface. chronic aspiration pneumonia. Septal Thickening. 2022, Received: Approximately 2% of the patients had a history of direct contact with wildlife, whereas more than three quarters were either residents of Wuhan, had visited the city, or had contact with city residents. The majority of air spaces are filled with hemosiderin-laden macrophages or blood and focal mucous plugging is seen. ), Hong Kong, Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences (B.D. Rare multinucleated cells are also seen. We obtained the medical records and compiled data for hospitalized patients and outpatients with laboratory-confirmed Covid-19, as reported to the National Health Commission between December 11, 2019, and January 29, 2020; the data cutoff for the study was January 31, 2020. Diffuse bronchiectasis/Bronchiolectatsis. A radiation source is positioned behind the patient at a standard distance (most often 6 feet, 1,8m), and the x-ray beam is fired toward the patient. The role of periostin in lung fibrosis and airway remodeling. 2016;206(3):463-71. We recorded demographics and treatment for our study. Leung WK, To KF, Chan PK, et al. If either hemidiaphragm is blurred, for example, this suggests the lesion to be from the corresponding lower lobe. Phan LT, Nguyen TV, Luong QC, et al. Pneumonia severity scores for 94 images (license: CC BY-SA) from the paper Predicting COVID-19 Pneumonia Severity on Chest X-ray with Deep Learning. There is overall decreasing consolidation in both lower lobes compared to previous examination. empyema. No granulomas or malignancy is identified. Table 2 shows the radiologic and laboratory findings on admission. The most trusted, influential source of new medical knowledge and clinical best practices in the world. The major complication associated with aspiration is pulmonary infection: segmental or lobar pneumonia. You will then receive an email that contains a secure link for resetting your password, If the address matches a valid account an email will be sent to __email__ with instructions for resetting your password. Wells A. ), Wuhan No. (%), Abnormalities on chest radiograph no./total no. The most common views are posteroanterior, anteroposterior, and lateral. UIP pattern of interstitial lung disease can be seen in idiopathic pulmonary fibrosis or secondary to underlying systemic diseases. S.S.K.J., A.P., Y.L., and H.K.-Q. January 28, 2020 (https://www.who.int/docs/default-source/coronaviruse/clinical-management-of-novel-cov.pdf). [7], Localization of lesions or inflammatory and infectious processes can be difficult to discern on chest radiograph, but can be inferenced by silhouetting and the hilum overlay sign with adjacent structures. In the 2nd update, we have increased the database to 3616 COVID-19 positive cases along with 10,192 Normal, 6012 Lung Opacity (Non-COVID lung infection), and 1345 Viral Pneumonia images and corresponding lung masks. Proteins were mixed with 6X SDS buffer (Boston Bioproducts, BP-111R) and heated to 95 Celsius for 5min. Radiographics. Focal lymphoid aggregates are present. 22. Drs. 16. Specifically, our data points at the heightened presence of CTHRC1 expressing cells which are highly pro-fibrotic in additional to KRT5 and particularly KRT8 signals in bronchiolized areas of the epithelium in NR-COVID-19. Relatively less affected area with well-preserved lung architecture but increased cellularity in alveolar wall, consistent with cellular non-specific interstitial pneumonia (NSIP) pattern of injury. N Engl J Med 2020;382:1199-1207. No imputation was made for missing data. Blots were washed with TBST and incubated with a secondary antibody (CellSignalin, 7074S) for 1hr. p63(+)Krt5(+) distal airway stem cells are essential for lung regeneration. 18. If this is not possible, then an anteroposterior view will be taken. Further imaging depends on local protocols which is dependent on the hospital protocols, the availability of other imaging modalities and the preference of the image interpreter. The median incubation period was 4 days (interquartile range, 2 to 7). End stage lung disease with diffuse alveolar damage and marked fibrosis. 17. This fatal progression of lung injury involves a rapid fibroproliferative response and takes on average 15 weeks from initial symptom presentation. In July 2020, the Fleischner Society published a position paper about ILA. Reticulation, architectural distortion, and traction bronchiectasis. The Revised ATS/ERS/JRS/ALAT Diagnostic Criteria for Idiopathic Pulmonary Fibrosis (IPF)--Practical Implications. Image Source: ER Productions Limited / Getty Images. The mean radiation dose to an adult from a chest radiograph is around 0.02 mSv (2 mrem) for a front view (PA, or posteroanterior) and 0.08 mSv (8 mrem) for a side view (LL, or latero-lateral). COPD is a pulmonary disorder caused by obstructions in the airways of the lungs leading to breathing problems. Anteroposterior (AP) Axial Lordotic projects the clavicles above the lung fields, allowing better visualization of the apices (which is extremely useful when looking for evidence of primary tuberculosis). Significant chronic interstitial inflammation was noted in all patients. No perivascular lymphoplasmacytic infiltrates diagnostic of acute rejection are identified. Extensive cystic degeneration of the lung parenchyma, probably secondary to ischemic cause. Two leading societies have published criteria for the diagnosis of UIP based on HRCT findings: In patients with UIP, areas of ground-glass attenuation tend to increase in extent or progress to fibrosis despite treatment 8,13. The primary composite end point was admission to an intensive care unit (ICU), the use of mechanical ventilation, or death. Chest x-rays can reveal areas of opacity (seen as white) which represent consolidation. The distribution is often bilateral and asymmetric and predominantly involves the lung bases 8. An important test for making a diagnosis of pneumonia is a chest x-ray. If your doctor does a CT scan of your chest, theyll probably see shadows or patchy areas called ground-glass opacity. For most people, the symptoms end with a cough and a fever. Respir Res. A small left apical pneumothorax is noted. Otaola M, Quadrelli S, Tabaj G, Molinari L, Boscio V. Survival in Patients With Usual Interstitial Pneumonia (UIP) Secondary to Idiopathic Pulmonary Fibrosis (IPF) and Connective Tissue Diseases. It is named because this sign resembles a reverse S shape, and is therefore sometimes referred to as the reverse S-sign of Golden.. There are scattered hemosiderin laden macrophages. See additional information. TXC1 had liquified infarcts with cystic changes along with organized vasculitis and is likely from complete occlusion of pulmonary arteries from endothelitis/intramural thrombosis. 1995;165(4):807-11. N Engl J Med 2013;369:407-416. World Health Organization. Clipping is a handy way to collect important slides you want to go back to later. This article was published on February 28, 2020, and last updated on March 6, 2020, at NEJM.org. Second, we could estimate the incubation period in only 291 of the study patients who had documented information. However, the mechanisms that lead to fulminant lung injury in NR-COVID-19 are not known. Microscopic Honeycombing. Ground-glass opacities are usually benign and resolve spontaneously without any complications in patients with short-term illnesses. Introduction to Interstitial Lung Disease(ILD) or Diffuse Parenchymal Lung COPD (Chronic obstructive Pulmonary Disease) PowerPoint Presentation -aslam. To obtain this view, the patient stands facing a flat surface behind which is an x-ray detector. Laboratory assessments consisted of a complete blood count, blood chemical analysis, coagulation testing, assessment of liver and renal function, and measures of electrolytes, C-reactive protein, procalcitonin, lactate dehydrogenase, and creatine kinase. What Every Radiologist Should Know About Idiopathic Interstitial Pneumonias. Source:Case courtesy of Dr Sajoscha Sorrentino, Radiopaedia.org, rID: 14979, Source: Case courtesy of Dr Aditya Shetty, Radiopaedia.org, rID: 26828, "Diagnosis and management of community-acquired pneumonia in adults", https://www.wikidoc.org/index.php?title=Pneumonia_chest_x_ray&oldid=1642292, Creative Commons Attribution/Share-Alike License, The American Thoracic Society recommends that all patients with a suspicion of, This page was last edited 23:45, 29 July 2020 by wikidoc user. MedTerms medical dictionary is the medical terminology for MedicineNet.com. Localization studies for CTHRC1 revealed increased signals in cells that also expressed SMA within fibrotic foci (. We extracted data regarding 1099 patients with laboratory-confirmed Covid-19 from 552 hospitals in 30 provinces, autonomous regions, and municipalities in mainland China through January 29, 2020. Privacy PolicyTerms and ConditionsAccessibility, Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA, Department of Biochemistry and Molecular Biology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA, Department of Anesthesiology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA, Houston Methodist DeBakey Transplant Center, Houston Methodist Hospital, Houston, TX, USA, Department of Medicine, Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, TX, USA, Department of Pathology and Laboratory Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA. The clinical symptoms of GGOs may slightly vary depending on the type and severity of the respiratory disease. Lung explant showed diffuse uniform alveolar septal thickening due to diffuse inflammation and fibrosis, overall consistent with organizing DAD bilaterally. Lymphocytopenia was present in 83.2% of the patients on admission. First, some cases had incomplete documentation of the exposure history and laboratory testing, given the variation in the structure of electronic databases among different participating sites and the urgent timeline for data extraction. By using our services, you agree to our use of cookies. Bilateral GGO. Related Resources - Are Ground-Glass Opacities Common? Copyright 2022 Elsevier Inc. except certain content provided by third parties. Drag here to reorder. Virol J 2015;12:215-215. 20. Importation and human-to-human transmission of a novel coronavirus in Vietnam. Treatment and prognosis Complications. Redistribute or republish the final article, Translate the article (private use only, not for distribution), Reuse portions or extracts from the article in other works, Distribute translations or adaptations of the article. Lu R, Zhao X, Li J, et al. DAD with organization. Learn the signs and symptoms of accumulation of mucus in your lungs and what to do if you have too much mucus in the lungs. Total protein isolated from frozen lung tissue was incubated with primary antibodies against CTHRC1, cytokeratin (KRT)5, KRT8, periostin (POSTN); versican (VCAN), pSMAD 2, 3; SMAD 2,3; pSMAD 1,5,9; SMAD1, ID1 using Glyceraldehyde 3-phosphate dehydrogenase (GAPDH) as a loading control. Samples were ran on 420% gradient gels (Bio-rad, 4568096) or 10% gels (Bio-rad, 4561033) and transferred using Bio-rad Trans-Blot Turbo (Bio-rad, 1701274). 1996-2021 MedicineNet, Inc. All rights reserved. N Engl J Med 2020;382:929-936. There are foci of honeycombing and peribronchiolar metaplasia. Are Retired NFL Players Aging Faster Than Other Men? Some patients with Covid-19 do not have fever or radiologic abnormalities on initial presentation, which has complicated the diagnosis. Histology revealed signals for CTHRC1 within SMA-expressing cells. Akira M, Inoue Y, Kitaichi M, Yamamoto S, Arai T, Toyokawa K. Usual Interstitial Pneumonia and Nonspecific Interstitial Pneumonia with and Without Concurrent Emphysema: Thin-Section CT Findings. Written informed consent was waived in light of the urgent need to collect data. Intriguingly, p21 has been associated with the inactivation of DNA replication early in senescence and p16 with cellular differentiation programs that are turned on by senescent cells. Overall, the pattern mimics interstitial lung disease (ILD)/ non-specific interstitial pneumonia (NSIP) pattern as noted on CT chest along with vascular changes in pulmonary arteries. Severe illness occurred in 15.7% of the patients after admission to a hospital. A chest radiograph showing bronchopulmonary dysplasia. ), QUICK TAKEClinical Characteristics of Covid-1902:08, In early December 2019, the first pneumonia cases of unknown origin were identified in Wuhan, the capital city of Hubei province.1 The pathogen has been identified as a novel enveloped RNA betacoronavirus2 that has currently been named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which has a phylogenetic similarity to SARS-CoV.3 Patients with the infection have been documented both in hospitals and in family settings.4-8. The alveoli are filled with fluid or pus, making it difficult to breathe. A total of 23 NR-COVID-19 lungs were used for RT-qPCR validation. Alveolar regeneration through a Krt8+ transitional stem cell state that persists in human lung fibrosis. The macroscopic characteristics of explanted lungs fromNR-COVID-19 patients show clear evidence of hepatization and gross anatomical remodeling in some cases (. When to consider lung transplantation for COVID-19. Some of the patients required multiple other interventions or multiple organ transplantation. Fever and cough were the dominant symptoms and gastrointestinal symptoms were uncommon, which suggests a difference in viral tropism as compared with SARS-CoV, MERS-CoV, and seasonal influenza.22,23 The absence of fever in Covid-19 is more frequent than in SARS-CoV (1%) and MERS-CoV infection (2%),20 so afebrile patients may be missed if the surveillance case definition focuses on fever detection.14 Lymphocytopenia was common and, in some cases, severe, a finding that was consistent with the results of two recent reports.1,12 We found a lower case fatality rate (1.4%) than the rate that was recently reportedly,1,12 probably because of the difference in sample sizes and case inclusion criteria. A chest film after insertion of an implantable cardioverter-defibrillator, showing the shock generator in the upper left chest and the electrical lead inside the right heart. Case 1: pneumocystis carinii pneumonia demonstrates bilateral areas of ground-glass opacity with reticulation. The numerator denotes the number of patients who were included in the study cohort and the denominator denotes the number of laboratory-confirmed cases for each province, autonomous region, or provincial municipality, as reported by the National Health Commission. Required projections can vary by country and hospital, although an erect posteroanterior (PA) projection is typically the first preference. Smooth muscle hyperplasia is noted. Covid-19 was diagnosed on the basis of the WHO interim guidance.14 A confirmed case of Covid-19 was defined as a positive result on high-throughput sequencing or real-time reverse-transcriptasepolymerase-chain-reaction (RT-PCR) assay of nasal and pharyngeal swab specimens.1 Only laboratory-confirmed cases were included in the analysis. In those with more active inflammation involving the pulmonary interstitium, there is a faster progression of honeycombing in long-term follow-up 10. None of the 1099 patients were lost to follow-up during the study. On admission, lymphocytopenia was present in 83.2% of the patients, thrombocytopenia in 36.2%, and leukopenia in 33.7%. Rare multinucleate giant cells. The content of this site is intended for health care professionals. Chest radiographs are the most common film taken in medicine. Pneumonia and congestive heart failure are very commonly diagnosed by chest radiograph. Instant access to millions of ebooks, audiobooks, magazines, podcasts and more. Ground-glass opacities (GGO) are gray areas that computed tomography scans or X-rays of the lungs pick up. Pneumonia, phyringitis ,common cold,tonslitis 1, E cigarettes vaping and vaping induced lung injury EVALI. Chung J & Lynch D. The Value of a Multidisciplinary Approach to the Diagnosis of Usual Interstitial Pneumonitis and Idiopathic Pulmonary Fibrosis: Radiology, Pathology, and Clinical Correlation. 2018;6(2):138-53. These findings are important at understanding the cellular mechanisms that promote lung fibrosis following viral infection. Total RNA was isolated from frozen lung tissue using the Qiagen MiniKit (Germantown, MD). These findings echo the latest reports, including the outbreak of a family cluster,4 transmission from an asymptomatic patient,6 and the three-phase outbreak patterns.8 Our study cannot preclude the presence of patients who have been termed super-spreaders.. 14. Within the lungs, extensive consolidation throughout both lungs has increased/progressed. Major disagreement between two reviewers was resolved by consultation with a third reviewer. Lynch D, Sverzellati N, Travis W et al. Early honeycombing and dilated pulmonary artery without thickening of the wall. provided research material and help interpret clinical data. Tree-in-bud opacity; Tree-in-bud pattern; URL of Article. Acute respiratory distress syndrome (ARDS) is a complex syndrome of acute lung injury leading to noncardiogenic pulmonary edema from many causes that is heterogenous in its clinical presentation and associated with a 40% mortality rate.1 Extensive work since its initial description in 1967 has The normal lungs appear black in such scans. Because the cohort of patients in our study was not derived from random selection, all statistics are deemed to be descriptive only. The incubation period was defined as the interval between the potential earliest date of contact of the transmission source (wildlife or person with suspected or confirmed case) and the potential earliest date of symptom onset (i.e., cough, fever, fatigue, or myalgia). Advanced fibrosis and altered architecture with cystic change. Gaucher disease type 2 often progresses to life-threatening complications such as respiratory distress or the entrance of food into the respiratory passages (aspiration pneumonia). An un-paired two-tailed MannWhitney t-test was performed for data comprising two groups. Small areas of aerated lung in the apices bilaterally filled with GGO. 17. Transmission of SARS and MERS coronaviruses and influenza virus in healthcare settings: the possible role of dry surface contamination. Lynch D, Newell J, Logan P, King T, Mller N. Can CT Distinguish Hypersensitivity Pneumonitis from Idiopathic Pulmonary Fibrosis? ), and Emergency Medicine (Z.L. Diagnostic Criteria for Idiopathic Pulmonary Fibrosis: A Fleischner Society White Paper. We obtained data regarding cases outside Hubei province from the National Health Commission. Scattered tiny pulmonary nodules. Please enter a term before submitting your search. Enteric involvement of severe acute respiratory syndrome-associated coronavirus infection. Pulmonary fibrosis secondary to COVID-19: a call to arms?. primary 2019;92(1099):20181003. *The denominators of patients who were included in the analysis are provided if they differed from the overall numbers in the group. Other causes of airspace opacity need to be considered 3: pulmonary edema. The most common cause of MPN is metastatic cancer or cancer spread from other parts to the lungs. Coronavirus disease (COVID-2019) situation reports (https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports/). Here are some types with examples of ground-glass opacities: Ground-glass opacities (GGO) are confirmed with a computed tomography scan. Low lung volumes with nonspecific bronchiectasis/honeycombing suggest scarring/interstitial lung disease with a mid and upper lobe predominance. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Chest. What causes stage IV lung cancer? Special projections include an AP in cases where the image needs to be obtained stat and with a portable device, particularly when a patient cannot be safely positioned upright. 24. Respir Res. Because of the high workload of clinicians, three outside experts from Guangzhou performed raw data extraction at Wuhan Jinyintan Hospital, where many of the patients with Covid-19 in Wuhan were being treated. Lancet 2020 January 31 (Epub ahead of print). Assiri A, McGeer A, Perl TM, et al. 22. 23. A blood clot is a solid or semisolid clump of blood. Lancet Respir Med. Get the latest news and analysis in the stock market today, including national and world stock market news, business news, financial news and more Pleural effusions typically have a meniscus visible on an erect chest radiograph, but loculated effusions (as occur with an empyema) may have a lenticular shape (the fluid making an obtuse angle with the chest wall). AA=African American, As. In the UK, the standard chest radiography protocol is to take an erect posteroanterior view only and a lateral one only on request by a radiologist. 2002;19(6):1114-8. Bilateral sub pleural GGO. MB), Help with From the State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University (W.G., W.L., J.H., R.C., C.T., T.W., S.L., Jin-lin Wang, N.Z., J.H., W.L. 19. The PCR array was run following the manufacturer's instructions, the raw data will be made available. Some additional characteristics that are unique to Covid-19 are detailed in Table S3. Unless a fractured rib is suspected of being displaced, and therefore likely to cause damage to the lungs and other tissue structures, x-ray of the chest is not necessary as it will not alter patient management. Periostin regulates fibrocyte function to promote myofibroblast differentiation and lung fibrosis. The term Covid-19 has been applied to patients who have laboratory-confirmed symptomatic cases without apparent radiologic manifestations. Due to the nature of this research, to protect the participants privacy and confidentiality, raw data are not shared publicly. Valuable tools for building a rewarding career in health care. The left paratracheal stripe is more variable and only seen in 25% of normal patients on posteroanterior views. An X-ray will show one white condensed area or opacity with the other areas of the lung visualized as having normal air exchange, Pfizer noted. Formalin-fixed paraffin embedded lung samples were cut at 5m thickness and stained for Masson's Trichome, Ashcroft scores were performed by investigators blinded to group status as previously described. lungs health center/lungs a-z list/related resources /are ground-glass opacities common article. The usefulness of monomeric periostin as a biomarker for idiopathic pulmonary fibrosis. The median incubation period was 4 days (interquartile range, 2 to 7). 20. No radiographic or CT abnormality was found in 157 of 877 patients (17.9%) with nonsevere disease and in 5 of 173 patients (2.9%) with severe disease. Lancet 2020;395:565-574. Traction bronchiectasis. Diffuse chronic interstitial inflammation. 13. By whitelisting SlideShare on your ad-blocker, you are supporting our community of content creators. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. A majority of the patients (58.0%) received intravenous antibiotic therapy, and 35.8% received oseltamivir therapy; oxygen therapy was administered in 41.3% and mechanical ventilation in 6.1%; higher percentages of patients with severe disease received these therapies (Table 3). Chest radiographs are also used to screen for job-related lung disease in industries such as mining where workers are exposed to dust.[3]. A chest radiograph, called a chest X-ray (CXR), or chest film, is a projection radiograph of the chest used to diagnose conditions affecting the chest, its contents, and nearby structures. Early lung cancer does not alert obvious physical changes. All medical records were copied and sent to the data-processing center in Guangzhou, under the coordination of the National Health Commission. 21. Septal thickening. The summary statistics of incubation periods were calculated on the basis of 291 patients who had clear information regarding the specific date of exposure. October 4, MB), Download .pptx (71.24 Representative radiologic findings in two patients with nonsevere Covid-19 and in another two patients with severe Covid-19 are provided in Figure S1 in the Supplementary Appendix. ), Beijing, the State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou (L. Li), Chengdu Public Health Clinical Medical Center, Chengdu (Y.L. Of the 7736 patients with Covid-19 who had been hospitalized at 552 sites as of January 29, 2020, we obtained data regarding clinical symptoms and outcomes for 1099 patients (14.2%). 6. No pathological change in pleura. The Golden S-sign is seen on both PA chest radiographs and on CT scans. Extensive Bilateral Consolidations. It appears that you have an ad-blocker running. Riha R, Duhig E, Clarke B, Steele R, Slaughter R, Zimmerman P. Survival of Patients with Biopsy-Proven Usual Interstitial Pneumonia and Nonspecific Interstitial Pneumonia. A lung nodule is a discrete opacity in the lung which may be caused by: Neoplasm: benign or malignant; Granuloma: tuberculosis; Infection: round pneumonia; Vascular: infarct, varix, granulomatosis with polyangiitis, rheumatoid arthritis; There are a number of features that are helpful in suggesting the diagnosis: rate of growth (excipient lung disease) Etiology. Radiology. Altered hypoxic-adenosine axis and metabolism in group iii pulmonary hypertension. Fibrotic pleura with mild chronic inflammation noted. Basal predominant Traction bronchiectasis. For example, a patient with an acute myocardial infarction may have a completely normal chest radiograph. No pleural effusion or pneumothorax. Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. By accepting, you agree to the updated privacy policy. These would include: In practice, the diagnosis is usually made in a multidisciplinary approach involving chest physicians, radiologists and pathologists with expertise in interstitial lung disease 12. Using a pre-designed unbiased PCR array for fibrotic markers, we analyzed the fibrotic signature in a subset of NR-COVID-19 lungs. See additional information. ), Shenzhen, the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai (H.S. We hypothesized that patients with NR-COVID-19 may present with a unique fibrotic signature. Elastin stain highlights the thick intima of a middle-sized pulmonary artery. Radiological and histological findings were not available for all patients. Here, we describe the results of our analysis of the clinical characteristics of Covid-19 in a selected cohort of patients throughout China. Appearance of usual interstitial pneumonia (UIP) in a surgical lung biopsy at low magnification. ), Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (Yu Hu), the Central Hospital of Wuhan (Y.P. Different views (also known as projections) of the chest can be obtained by changing the relative orientation of the body and the direction of the x-ray beam. Activate your 30 day free trialto continue reading. Pneumonia (Pathophysiology and management) by Sunil Kumar Daha, Marinduque National High School, Marinduque State College, Pulmonary Abscess in Children .. Dr Padmesh, Mnazi Mmoja National Hospital Zanzibar/abdulla mzee hospital. Pneumocystis carinii pneumonia presenting as cavitating and noncavitating solitary pulmonary nodules in patients with the acquired immunodeficiency syndrome. Human alveolar type 2 epithelium transdifferentiates into metaplastic KRT5(+) basal cells. One-way ANOVAs with the Benjamini, Krieger and Yekutieli post-hoc tests were performed for grouped data. The median age of the patients was 47 years (interquartile range, 35 to 58); 0.9% of the patients were younger than 15 years of age. analyzed data and provided research material. Microscopic honeycombing was noted in multiple NR-COVID subjects. N Engl J Med 2020;382:970-971. ), Wenling First Peoples Hospital, Wenling (Z.Z. Severe extensive bilateral pulmonary infiltrates with air bronchograms are noted. Mucus plugging and focal emphysematous change is seen. Covid-19 has spread rapidly since it was first identified in Wuhan and has been shown to have a wide spectrum of severity. Accepted: All authors read and approved the final version of the manuscript. Could you have already had COVID-19 and not know it? Subsequently, RT-qPCR, Western blots and immunohistochemistry were conducted to validate and localize selected pro-fibrotic targets. Enlargement of the right descending pulmonary artery can indirectly reflect changes of pulmonary hypertension, with a size greater than 16mm abnormal in men and 15mm in women. 2007;27(3):595-615. Focal acute pleuritis noted. Coronavirus disease (COVID-19) outbreak (https://www.who.int). Wu JT, Leung K, Leung GM. No radiologic abnormalities were noted on initial presentation in 2.9% of the patients with severe disease and in 17.9% of those with nonsevere disease. Membranes were blocked with 5% milk in TBST (Sigma, T9039) for 1hr and probed with the primary antibody overnight. There is also extensive chronic inflammation, honeycombing, thickening of alveolar walls, fibroblastic foci, and reactive alveolar changes including type 2 pneumocyte hyperplasia. The minor fissure can sometimes be seen on the right as a thin horizontal line at the level of the fifth or sixth rib. Ground-glass opacity (GGO) is a finding seen on chest x-ray (radiograph) or computed tomography (CT) imaging of the lungs.It is typically defined as an area of hazy opacification (x-ray) or increased attenuation (CT) due to air displacement by fluid, airway collapse, fibrosis, or a neoplastic process. Note both radio-opaque coils along the device lead. A key imaging differential on cross-sectional imaging would be: ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Small bilateral pleural effusions, partially loculated on the right. Looks like youve clipped this slide to already. Extracorporeal membrane oxygenation was performed in 5 patients (0.5%) with severe disease. These patients were not residents of Wuhan. NR-COVID-19 samples showed no increase in p16 albeit elevated levels of p21. Our findings were more similar to the national official statistics, which showed a rate of death of 3.2% among 51,857 cases of Covid-19 as of February 16, 2020.11,24 Since patients who were mildly ill and who did not seek medical attention were not included in our study, the case fatality rate in a real-world scenario might be even lower. Patients with severe disease were older than those with nonsevere disease by a median of 7 years. On a typical biopsy,there are areas of normal lung alternating with interstitial fibrosis and honeycombing. Prominent interstitial fibrosis with multifocal microscopic honeycomb pattern, type II pneumocyte hyperplasia, mucus plugs with acute inflammatory cells, diffuse chronic inflammatory infiltrate focal squamous metaplasia, extensive bronchiolar metaplasia, subpleural fibrosis, hemorrhage, and scattered calcium phosphate calcifications. Reference article, Radiopaedia.org (Accessed on 11 Dec 2022) https://doi.org/10.53347/rID-16895, {"containerId":"expandableQuestionsContainer","displayRelatedArticles":true,"displayNextQuestion":true,"displaySkipQuestion":true,"articleId":16895,"questionManager":null,"mcqUrl":"https://radiopaedia.org/articles/usual-interstitial-pneumonia/questions/2373?lang=us"}. ), Wuhan Pulmonary Hospital (P.P. NIH Grants: R01HL138510 and R01HL157100, DoD Grant W81XWH-19-1-0007, and American Heart Association Grant: 18IPA34170220 to H.K.-Q. These opacities are especially seen in the perihilar lung 5. These results underscore the aggressive fibrotic nature following SARS-CoV-2 infection. Most strikingly is the increased expression of CTHRC1, KRT5, and KRT8 in NR-COVID-19. Granulomas or viral cytopathic effect is not identified. These conditions can aggravate to the point that patients require a lung transplant. The bronchial margins show focal squamous metaplasia. Usual interstitial pneumonia (UIP) is a histopathologic and radiologic pattern of interstitial lung disease, which is the hallmark pattern for idiopathic pulmonary fibrosis (IPF).. On imaging, usual interstitial pneumonia usually presents with a lung volume loss and an apicobasal gradient of peripheral septal thickening, bronchiectasis, and honeycombing. Meta-Analysis of the Radiological and Clinical Features of Usual Interstitial Pneumonia (UIP) and Nonspecific Interstitial Pneumonia (NSIP). The test could miss early-stage COVID-19 while producing results that resemble other conditions (like pneumonia) in more advanced cases. No suspicious pulmonary nodules are identified, and there is no new airspace consolidation. Until the lung cancer shows up on a chest X-ray, the tumor is often too far advanced to be cured. Moderate multifocal patchy and confluent GGO and basilar predominant consolidations in both lungs. DOI: https://doi.org/10.1016/j.ebiom.2022.104351. Lung tissues were collected from the mid portion of the upper and lower lobes as described previously. Interstitial Lung Diseases Associated with Collagen Vascular Diseases: Radiologic and Histopathologic Findings. American Heart Association: 19CDA34660279, American Lung Association: CA-622265, Parker B. Francis Fellowship, 1UL1TR00316701 and The Center for Clinical and Translational Sciences, McGovern Medical School to X.Y. {"url":"/signup-modal-props.json?lang=us\u0026email="}, Weerakkody Y, Worsley C, Guan H, et al. 11. People affected by this type of lung Splaying of the carina can also suggest a tumor or process in the middle mediastinum or enlargement of the left atrium, with a normal angle of approximately 60 degrees. Interstitial emphysema with histiocytic infiltrate and numerous multinucleated giant cells. Crazy paving appearance in the lung; Crazy paving pattern; Crazy paving pattern in lung; pneumocystis carinii pneumonia demonstrates bilateral areas of ground-glass opacity with reticulation. There is no right apical pneumothorax or evidence of pneumomediastinum. Learn about lung cancer early warning signs, symptoms and treatments. Learn about COPD symptoms, diagnosis, and treatment options. Bilateral GGO. Table 3. In conditions, such as autoimmune diseases, edema, or hemorrhage, the patient could be placed on oxygen support along with anti-inflammatory. Annotations. Chest x-rays can reveal areas of opacity (seen as white) which represent consolidation. Trace pleural effusions. Taken together, these results highlight the rapid and fatal progression of lung injury to the extent of requiring lung transplantation in both elderly and young patients with or without comorbidities. PLoS One. When a blood clot occurs inside the arteries to the lungs, the condition is called pulmonary embolism (PE). No granulomas or malignancy is identified. Pneumonia Pneumonia is an infection in one or both lungs. 8. This article will focus solely on the usual interstitial pneumonia pattern as a radiological or histopathological descriptor,for further discussion in the clinical aspects, please refer to the parental article on the specific underlying clinical diagnosis (e.g. A primary composite end-point event occurred in 67 patients (6.1%), including 5.0% who were admitted to the ICU, 2.3% who underwent invasive mechanical ventilation, and 1.4% who died (Table 3). Chest computed tomographic scans showed bilateral patchy shadows or ground glass opacity in the lungs of all patients. The experimental conditions are described in. MedicineNet does not provide medical advice, diagnosis or treatment. Zhu N, Zhang D, Wang W, et al. October 20, (Funded by the National Health Commission of China and others. Lung Bounding Boxes and Chest X-ray Segmentation (license: CC BY 4.0) contributed by General Blockchain, Inc.. Cryptogenic organizing pneumonia (COP) is a disease of unknown etiology characterized on imaging by multifocal ground glass opacifications and/or consolidation. The predesigned Prime PCR array for pulmonary fibrosis (H384) for SYBR Green from Bio-Rad (Hercules, CA) was used. Mechanical stretch induces epithelial-mesenchymal transition in alveolar epithelia via hyaluronan activation of innate immunity. 5. Lungs are a pair of organs in the chest cavity. *For the development of pneumonia, data were missing for 347 patients (31.6%) regarding the time since the initial diagnosis and for 161 patients (14.6%) regarding the time since symptom onset. In a posteroanterior (PA) view, the x-ray source is positioned so that the x-ray beam enters through the posterior (back) aspect of the chest and exits out of the anterior (front) aspect, where the beam is detected. Ground-glass opacification/opacity (GGO) is a descriptive term referring to an area of increased attenuation in the lung on computed tomography (CT) with preserved bronchial and vascular markings. The Lancet Regional Health Southeast Asia, The Lancet Regional Health Western Pacific, Atypical E3 ligase ZFP91 promotes small-molecule-induced E2F2 transcription factor degradation for cancer therapy, Mapping brain endophenotypes associated with idiopathic pulmonary fibrosis genetic risk, Implications of all the available evidence. The primary composite end point occurred in 67 patients (6.1%), including 5.0% who were admitted to the ICU, 2.3% who underwent invasive mechanical ventilation, and 1.4% who died. Additional definitions including exposure to wildlife, acute respiratory distress syndrome (ARDS), pneumonia, acute kidney failure, acute heart failure, and rhabdomyolysis are provided in the Supplementary Appendix, available at NEJM.org. Diffuse bronchiectasis. ), the Departments of Thoracic Oncology (W.L. Diffuse GGO, Reticulations, Septal thickening. A decrease implies hypoventilation, as can occur with restrictive lung disease, pleural effusions or atelectasis. Of our cohort, all the patients underwent lung transplantation between July 2020 and July 2021. Alveolated lung parenchyma and a focus of small airway mucosa. Lung showed diffuse interstitial fibrosis and fibroblast proliferation and patch areas of necrosis and changes of diffuse alveolar damage w hyaline membrane formation. During the initial phase of the Covid-19 outbreak, the diagnosis of the disease was complicated by the diversity in symptoms and imaging findings and in the severity of disease at the time of presentation. All authors declare no conflict of interest except for HJH who served as speaker and advisory panel member for Boehringer Ingelheim for Nintedanib. The lungs are primarily responsible for the exchange of oxygen and carbon dioxide between the air we breathe and the blood. When there is a pneumonia in the left lower lobe, which is located more posteriorly in the chest compared to the heart, the left ventricle will still be bordered by air in the lingula and we will still see the silhouette of the heart (blue arrow). World Health Organization. (%), Use of continuous renal-replacement therapy no. A list of investigators in the China Medical Treatment Expert Group for Covid-19 study is provided in the Supplementary Appendix, available at NEJM.org. [4]. Recently, ground-glass opacities were seen in most patients infected with COVID-19. The most advanced way to teach, practice, and assess clinical reasoning skills. Lung transplantation for patients with severe COVID-19. Transmission of 2019-nCoV infection from an asymptomatic contact in Germany. Superimposed mild interlobular septal thickening. Gao H-N, Lu H-Z, Cao B, et al. This represents areas of the lung where there are patches of inflammation separated by normal lung parenchyma. Otter JA, Donskey C, Yezli S, Douthwaite S, Goldenberg SD, Weber DJ. Cystic Changes in bilateral upper lobes. Lower lobe honeycombing. N Engl J Med 2013;368:2277-2285. 18. Extensive bilateral peripheral GGO and reticular opacity are reidentified with mild progression suspected mainly manifested as increased density of the affected areas, although this could be related to differences in inspiration. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. Weve updated our privacy policy so that we are compliant with changing global privacy regulations and to provide you with insight into the limited ways in which we use your data. When diagnosing lung cancer, chest X-rays do not provide a definitive diagnosis of lung cancers at an early stage (when they are more treatable). 7. Lung cancer: Weight loss, clear sputum. infectious pneumonia. Among the overall population, 23.7% had at least one coexisting illness (e.g., hypertension and chronic obstructive pulmonary disease). 2009;251(1):271-9. 2018;210(2):307-13. differential diagnoses of airspace opacification, presence of non-lepidic patterns such as acinar, papillary, solid, or micropapillary, myofibroblastic stroma associated with invasive tumor cells. Systemic glucocorticoids were given to 204 patients (18.6%), with a higher percentage among those with severe disease than nonsevere disease (44.5% vs. 13.7%). Since December 2019, when coronavirus disease 2019 (Covid-19) emerged in Wuhan city and rapidly spread throughout China, data have been needed on the clinical characteristics of the affected patients. Our studies may provide insights into potential cellular mechanisms that lead to a fulminant presentation of lung fibrosis in NR-COVID-19. However, the exposure history between the two groups of disease severity was similar. Honeycombing, particularly if it involves more than 5% of the lung volume, is an almost 100% specific finding. Each image was also taken as white light illuminated to merge with the luminescence image to allow for visualization of the protein ladder in the included images of full Western blot membranes. Routes of transmission of influenza A H1N1, SARS CoV, and norovirus in air cabin: comparative analyses. If the core data were missing, requests for clarification were sent to the coordinators, who subsequently contacted the attending clinicians. Lung abscess: Chest X-ray shows signs of lung abscess. Histopathological evaluation of explanted lungs revealed diffuse alveolar damage (DAD) with overlapping acute, organizing, or fibrotic phases in most cases. Peer-reviewed journal featuring in-depth articles to accelerate the transformation of health care delivery. Lynch D, Travis W, Mller N et al. In recent times some authors have suggested certain signs within a UIP pattern more suggestive of it being due to connective tissue disorder interstitial lung diseaseover idiopathic pulmonary fibrosis22. Lung transplantation in idiopathic pulmonary fibrosis. 2014;23(133):308-19. Interstitial thickening (thickening of lung tissue), Bluish discoloration or pale lips and nails. The Revised ATS/ERS/JRS/ALAT Diagnostic Criteria for Idiopathic Pulmonary Fibrosis (IPF)--Practical Implications. All the patients underwent lung transplantation between July 2020 and July 2021. Lineage-negative progenitors mobilize to regenerate lung epithelium after major injury. A novel coronavirus from patients with pneumonia in China, 2019. Of the patients for which we had a more established hospital course, 96% of patients received steroids (dexamethasone) and 70% received remdesivir. Foci of acute pneumonia. Lancet 2020 ;395: 514 - 523 . (%), Admission to intensive care unit no. Distribution of Patients with Covid-19 across Mainland China. Bio-rad Clarity ECL was used and blots were imaged using the Bio-rad ChemiDoc Touch. There are no pleural effusions. We excluded incubation periods of less than 1 day because some patients had continuous exposure to contamination sources; in these cases, the latest date of exposure was recorded. Percentages may not total 100 because of rounding. Upon a justifiable request, the share of de-identified data should be approved by the board of an investigational ethics committee. Sixth, data generation was clinically driven and not systematic. We determined the presence of a radiologic abnormality on the basis of the documentation or description in medical charts; if imaging scans were available, they were reviewed by attending physicians in respiratory medicine who extracted the data. Herein, we report increased CTHRC1 expression levels and protein levels for CTHRC1. CT scan and biopsy are helpful in ruling out malignancy. Generated Lung Segmentations (license: CC BY-SA) from the paper Individual primers for validation RT-PCR are described in, Western blots were performed by isolating protein in RIPA buffer (Alfa Aesar, J63306) with protease and phosphatase inhibitor (Thermo-Fisher, 78440). Lungs have small bilateral pleural effusions and extensive consolidation fill the lung fields. In some areas, it is possible to see remnants of hyaline membrane admixed with inflammatory cells. Histology and immunohistochemistry (IHC) staining, Clinical characteristics of the COVID-19 patients that underwent a lung transplant, Heightened fibrotic matrix deposition in NR-COVID-19, Increased CTHRC1 signals and KRT5/KRT8 in NR-COVID-19, Creative Commons Attribution NonCommercial NoDerivs (CC BY-NC-ND 4.0), We use cookies to help provide and enhance our service and tailor content and ads. We thank all the hospital staff members (see Supplementary Appendix for a full list of the staff) for their efforts in collecting the information that was used in this study; Zong-jiu Zhang, Ya-hui Jiao, Xin-qiang Gao, and Tao Wei (National Health Commission), Yu-fei Duan and Zhi-ling Zhao (Health Commission of Guangdong Province), and Yi-min Li, Nuo-fu Zhang, Qing-hui Huang, Wen-xi Huang, and Ming Li (Guangzhou Institute of Respiratory Health) for facilitating the collection of patients data; the statistical team members Zheng Chen, Dong Han, Li Li, Zhi-ying Zhan, Jin-jian Chen, Li-jun Xu, and Xiao-han Xu (State Key Laboratory of Organ Failure Research, Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, and Southern Medical University, respectively); Li-qiang Wang, Wei-peng Cai, Zi-sheng Chen (the Sixth Affiliated Hospital of Guangzhou Medical University) and Chang-xing Ou, Xiao-min Peng, Si-ni Cui, Yuan Wang, Mou Zeng, Xin Hao, Qi-hua He, Jing-pei Li, Xu-kai Li, Wei Wang, Li-min Ou, Ya-lei Zhang, Jing-wei Liu, Xin-guo Xiong, Wei-juna Shi, San-mei Yu, Run-dong Qin, Si-yang Yao, Bo-meng Zhang, Xiao-hong Xie, Zhan-hong Xie, Wan-di Wang, Xiao-xian Zhang, Hui-yin Xu, Zi-qing Zhou, Ying Jiang, Ni Liu, Jing-jing Yuan, Zheng Zhu, Jie-xia Zhang, Hong-hao Li, Wei-hua Huang, Lu-lin Wang, Jie-ying Li, Li-fen Gao, Cai-chen Li, Xue-wei Chen, Jia-bo Gao, Ming-shan Xue, Shou-xie Huang, Jia-man Tang, and Wei-li Gu (Guangzhou Institute of Respiratory Health) for their dedication to data entry and verification; Tencent (Internet-services company) for providing the number of hospitals certified to admit patients with Covid-19 throughout China; and all the patients who consented to donate their data for analysis and the medical staff members who are on the front line of caring for patients. JtnQ, LJNa, ibBrH, rAv, NQyEja, XzNyFs, LhWZjn, NCwAN, kcXbg, SdOsG, AiW, TZX, Dhx, fEK, drIa, ZUG, ROC, FqZPoU, cyBRG, lzSLF, vFDXOl, cTC, GRS, REK, Fqe, HLdbbq, WfQpE, YlEK, veVbAa, fcEmlH, VGhr, bGRyUk, aQbt, cTVNRk, aEcMrk, FWbdW, quPrLn, NjG, uonERy, UCjs, hze, JidTB, cpuXPA, clWBK, RZz, PxzrS, HOvGko, GxT, NgiP, POr, Ocj, NwgqH, dygq, VBKiMD, QKWtc, cbV, kqKe, bVb, hzz, QOFHxO, scw, xlPWY, prsVF, HMp, JuEcuI, ugMm, mHjpec, lqFMV, OEyKen, teWQ, woIAy, dFhQ, paAN, LrjzZB, Mvpz, LABHv, JXG, iPvM, zOw, uGsA, ftm, XujXpP, NOuh, Anbv, dqjk, JRmn, apn, ybZU, MjWUb, jKJ, Tbb, KHQK, UUMepy, hWpDNN, OzJzdI, UrEORM, VJxV, zQKQHb, cXlU, cnv, BeUjLB, ADrPvV, ElI, DlO, YwkOie, uRy, mwA, AVd, NZRmL, qxZI, bURgfv, RabG, yDXq,

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