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Résumé: Les auteurs rapportent le cas d'un patient de 49 ans qui présentait une détresse respiratoire aigüe avec un syndrome infectieux et une perturbation du système de la coagulation. L'angiotomodensitométrie thoracique objectivait une embolie pulmonaire bilatérale et des images en verre dépoli faisant évoquer une association à l'infection Covid-19. Cette dernière a été confirmée par la mise en évidence du coronavirus lors du test virologique. The authors report the case of a 49-year-old patient who had an acute respiratory distress with an infectious syndrome and biology of the coagulation system. The thoracic angiotomodensitometry had targeted bilateral pulmonary embolism and ground-glass opacity evoking an association with Covid-19 infection, confirmed by the detection of the coronavirus with the virology test. [ABSTRACT FROM AUTHOR]

Introduction: COVID-19 has spread rapidly since its emergence in China and is currently a global health issue. Its definitive diagnosis is made by PCR on nasopharyngeal swabs. However, this diagnostic test has low sensitivity with delayed results. Hence, thoracic computed tomography represents an interesting alternative. The aims of this study were to assess the frequency of computed tomography (CT) lesions suggestive of COVID-19 and to compare the results of CT and PCR test., Methods: a prospective study carried out over15 working days and involved 47 patients. These patients were recruited based on the presence of at least 2 clinical signs of COVID-19. Chest CT without contrast according to the "LOW-DOSE" protocol was performed. A PCR test on nasopharyngeal swabs was done in patients with signs suggestive of COVID on CT. A serological test was performed in case of a discrepancy between the CT and PCR results., Results: thoracic CT was abnormal in 38 patients and normal in 9 patients. Lesions suggestive of COVID-19 have been identified in 32 patients. Two patients had lesions of non-specific pneumonia. Tuberculosis lesions were visualized in 3 patients. One patient had lesions of interstitial pneumonia. The mean DLP was 59 mGy.cm with extremes of 25 and 95 mGy.cm. Ground-glass opacity was present in 100% of COVID-19 suspects on CT. The results of the PCR test were the same than CT in 12 patients. The positive predictive value for CT was 37.5%. In 20 patients with COVID lesions on CT, the PCR test was negative with a false positive rate of 62.5%. In the patients with negative PCR test, 4 had a serological test for COVID-19 and this test was positive in 3., Conclusion: low-dose chest CT can reduce radiation exposure in COVID-19 patients who are at risk of cumulative dose due to repetitive exam. CT can identify lesions suggestive of COVID-19. It also enables the triage of patients by identifying other diagnoses., Competing Interests: Les auteurs ne déclarent aucun conflit d’intérêts., (Copyright: Ibrahima Niang et al.)

Background: Combined pulmonary fibrosis and emphysema (CPFE) is a rare entity of unknown etiology. It usually occurs in the context of smoking and, less commonly, connective tissue disease. However, it has been rarely previously described in the context of vasculitis., Observation: We report a case of CPFE occurring in a 44-year-old man, who was a light smoker without any previous medical history. He presented with fever, chronic cough and breathlessness that progressively evolved to acute respiratory failure. At the initial evaluation, CT scan showed emphysema and patchy bilateral areas of ground-glass opacity. Three years later, the patient simultaneously developed a honeycomb fibrosis and a microscopic polyangiitis with renal involvement justifying the introduction of an immunosuppressive treatment in combination with high dose of systemic corticosteroids. After a stabilization period of 6years, the patient gradually developed chronic respiratory failure with moderate pulmonary hypertension requiring long-term oxygen therapy and nocturnal non-invasive ventilation., Conclusion: The association of microscopic polyangiitis to CFPE suggests that autoimmune diseases may have a common pathogenic role in the development of emphysematous and fibrotic lesions in CPFE., (Copyright © 2015 SPLF. Published by Elsevier Masson SAS. All rights reserved.)