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Einstein (São Paulo)

versão impressa ISSN 1679-4508versão On-line ISSN 2317-6385

Einstein (São Paulo) vol.18  São Paulo  2020  Epub 07-Out-2020 


Reply to: Temporal evolution of tomographic findings of pulmonary infection in COVID-19

Marcela Emer Egypto Rosa1

Marina Justi Rosa de Matos1

Renata Silveira Olimpio de Paula Furtado1

Vanessa Mizubuti Brito1

Lucas Tadashi Wada Amaral1

Gabriel Laverdi Beraldo1

Eduardo Kaiser Ururahy Nunes Fonseca1

Rodrigo Caruso Chate1

Rodrigo Bastos Duarte Passos1

Gustavo Borges da Silva Teles1

Murilo Marques Almeida Silva1

Patrícia Yokoo1

Elaine Yanata1

Hamilton Shoji1

Gilberto Szarf1

Marcelo Buarque de Gusmão Funari1

1Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.

Dear authors,

We thank you for your kind comments and agree upon the existing doubts about the real meaning of changes in images of the coronavirus disease (COVID-19) in the long term. Some authors bring an extrapolated reflection of other infections, including those related to outbreaks caused by other coronaviruses,(1) and indicate a potential persistence of some changes in images, including with repercussions in pulmonary function tests more than 10 years after the infectious insult.

However, the great case presented by the authors(2) showed that even some changes usually related to fibrosis can regress and, eventually, disappear. We have also observed some extensive lesions, sometimes with similar characteristics to those reported by the authors, which presented significant improvement during evolution. On the other hand, we have seen ground-glass opacities persisting for a long time in some patients. Although the progressive imaging behavior in COVID-19 is relatively predictable,(3,4) there are still cases that challenge this pattern.

In addition, other conditions sometimes overlap the infection caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Besides greater incidence of venous and arterial thromboses(5) described in these patients, we have also observed coinfection and superinfection, which are sometimes dramatic cases, generating imaging patterns that challenge the most classic aspects, as illustrated by us,(3) and also by other Brazilian authors.(4) Yet, we believe it is worth mentioning the higher incidence of barotrauma in these patients,(6) another factor that may contribute to pulmonary damage. All these complications can also influence in the progressive imaging changes of COVID-19 and have the potential to leave residual findings in the parenchyma.

Therefore, we consider appropriate that COVID-19 patients must maintain clinical follow-up by means of functional tests and eventual tomographic controls, particularly those with more severe and extensive cases and presenting complications in the course of the disease. This is an evolving subject, with vast potential for researches.


1. Salehi S, Reddy S, Gholamrezanezhad A. Long-term pulmonary consequences of coronavirus disease 2019 (COVID-19): What we know and what to expect. J Thorac Imaging. 2020;35(4):W87-W9. Review. [ Links ]

2. Araujo-Filho JA, Sawamura MV, Teixeira FB, Apanavicius A, Costa NA. Temporal evolution of tomographic findings of pulmonary infection in COVID-19 [letter]. einstein (São Paulo). 2020;18:eCE5974. [ Links ]

3. Rosa ME, Matos MJ, Furtado RS, Brito VM, Amaral LT, Beraldo GL, et al. COVID-19 findings identified in chest computed tomography: a pictorial essay. einstein (São Paulo). 2020;18:eRW5741. Review. doi:10.31744/einstein_journal/2020RW5741 [ Links ]

4. Farias LP, Fonseca EK, Strabelli DG, Loureiro BM, Neves YC, Rodrigues TP, et al. Imaging findings in COVID-19 pneumonia. Clinics (São Paulo). 2020;75:e2027. Review. [ Links ]

5. Klok FA, Kruip MJ, van der Meer NJ, Arbous MS, Gommers DA, Kant KM, et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res. 2020;191:145-7. [ Links ]

6. McGuinness G, Zhan C, Rosenberg N, Azour L, Wickstrom M, Mason DM, et al. High incidence of barotrauma in patients with COVID-19 infection on invasive mechanical ventilation. Radiology. 2020 Jul 1:202352. doi: 10.1148/radiol.2020202352. [Epub ahead of print]. [ Links ]

Received: July 27, 2020; Accepted: July 28, 2020

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