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Target sign in COVID-19, radiological interpretation and diagnostic contribution of digital thoracic tomosynthesis
Signo de la diana en COVID-19, significado radiológico y aportación diagnóstica de la tomosíntesis digital torácica
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Ferrando Blanco, Ó. Persiva Morenza, L.B. Cabanzo Campos, A.L. Sánchez Martínez, D. Varona Porres, L.A. Del Carpio Bellido Vargas, J. Andreu Soriano" "autores" => array:7 [ 0 => array:2 [ "nombre" => "D." "apellidos" => "Ferrando Blanco" ] 1 => array:2 [ "nombre" => "Ó." "apellidos" => "Persiva Morenza" ] 2 => array:2 [ "nombre" => "L.B." "apellidos" => "Cabanzo Campos" ] 3 => array:2 [ "nombre" => "A.L." "apellidos" => "Sánchez Martínez" ] 4 => array:2 [ "nombre" => "D." "apellidos" => "Varona Porres" ] 5 => array:2 [ "nombre" => "L.A." "apellidos" => "Del Carpio Bellido Vargas" ] 6 => array:2 [ "nombre" => "J." 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We assessed 41 non-draining IPCs. Twenty-two are removed due to lung re-expansion, and another by the patient's decision. Eighteen patients entered the study, all of whom underwent ultrasound by a pulmonologist and chest CT, and 11 underwent ultrasound by a radiologist. IPC: indwelling pleural catheter.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Iglesias Heras, E. Juárez Moreno, J. Ortiz de Saracho Bobo, J. Cascón Hernández, J.M. Fernández García-Hierro, E. Yagüe Zapatero, R. Cordovilla Pérez" "autores" => array:7 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Iglesias Heras" ] 1 => array:2 [ "nombre" => "E." "apellidos" => "Juárez Moreno" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Ortiz de Saracho Bobo" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Cascón Hernández" ] 4 => array:2 [ "nombre" => "J.M." "apellidos" => "Fernández García-Hierro" ] 5 => array:2 [ "nombre" => "E." "apellidos" => "Yagüe Zapatero" ] 6 => array:2 [ "nombre" => "R." 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"apellidos" => "Plasencia Martínez" "email" => array:2 [ 0 => "plasen79@gmail.com" 1 => "juanam.plasencia@carm.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "I." "apellidos" => "García Tuells" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "C." "apellidos" => "Bravo Pérez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "A." "apellidos" => "Blanco Barrio" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Radiodiagnóstico, Hospital Universitario Morales Meseguer, Murcia, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Hematología, Hospital Universitario Morales Meseguer, Centro Regional de Hemodonación, Universidad de Murcia, IMIB-Pascual Parrilla, Instituto de Salud Carlos III — CIBERER, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Signo de la diana en COVID-19, significado radiológico y aportación diagnóstica de la tomosíntesis digital torácica" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 750 "Ancho" => 1681 "Tamanyo" => 100240 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Chest radiograph (a) and digital tomosynthesis (DTS) (b) in a patient with the target sign (white arrows) visible on both the chest radiograph and the DTS. Ill-defined opacities, patchy, peripheral, ground-glass (arrowhead) due to COVID-19 pneumonia.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The target sign (TS) in computed tomography (CT) images, less frequently known as the bull’s eye or rings of Saturn sign, has been described as a highly specific sign for COVID-19 patients with pulmonary involvement.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a> It consists of a dense central nodule surrounded by a dense peripheral ring, with another ring of lower attenuation in between those, which often corresponds to normal lung parenchyma. Occasionally it comprises several interspersed rings of varying attenuation.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a> In radiology, it has been described as a variant of the reversed (reverse) halo sign.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The reversed halo sign, typical of organising pneumonia, consists of a dense ring surrounding an area of ground-glass density.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–6</span></a> On an anatomical-pathological level, the dense peripheral ring in the reversed halo sign corresponds to granulation tissue in the peripheral air spaces, and the central ground-glass opacity corresponds to inflammation of the alveolar septa.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,7</span></a> Although organising pneumonia is frequent in COVID-19 pneumonia,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> to say that it provides an explanation for TS images in CT is controversial, mainly but not exclusively as this explanation does not account for the central nodule.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7,9</span></a> The combination of organising pneumonia and arterial thrombosis has been suggested as the underlying pathoanatomy of the TS,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> although this association is not fully understood.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Likewise, the point at which the TS appears in the course of the disease or whether the TS has a significant impact on prognosis has not been investigated in depth. Finally, given its usefulness, it would make sense to improve our ability to diagnose the sign. In comparison to conventional imaging techniques, tomosynthesis has demonstrated several diagnostic advantages, for example, in the early detection of breast cancer or lung nodules.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> However, there have been no studies into whether it improves on the diagnostic capacity of chest radiography in cases of COVID-19 with lung involvement, and more specifically, if it has a greater capacity to detect the TS. If it does, it could reduce the number of CT scans performed.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Our objectives in this investigation are:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1.</span><p id="par0015" class="elsevierStylePara elsevierViewall">To describe the radiological features of the TS in COVID-19 patients with lung involvement and its similarities and differences to the reversed halo sign.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2.</span><p id="par0020" class="elsevierStylePara elsevierViewall">To describe the clinical characteristics, laboratory values and prognosis of patients with the TS.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3.</span><p id="par0025" class="elsevierStylePara elsevierViewall">To evaluate whether digital tomosynthesis (DTS) of the chest offers any advantage over radiography for detecting the TS.</p></li></ul></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0030" class="elsevierStylePara elsevierViewall">This was a cross-sectional, observational, single-centre study, accepted by the Ethics Committee of our hospital (EST code 55/20). We noted all patients with the TS detected by chest radiography, DTS or both during the second (October–November 2020) and third (January 2021) waves of the SARS-CoV-2 pandemic. In our setting, all patients clinically suspected of pneumonia during the pandemic period who were given a chest radiography were simultaneously given a DTS, whether they were referred from the emergency unit or primary care. DTS involves a series of very low dose exposures during a single sweep with a stationary detector and a tube that moves within a sweep angle range limited to 30 °. The DTS system used was VolumeRAD Digital Tomosynthesis GE Healthcare system (3D radiography)™ (GE Healthcare. Milwaukee, WI, USA). After acquiring the images, the system reconstructs approximately 60 images that correspond to different coronal planes, parallel to the detector, and which show anatomical structures at different depths. The sweep duration is 11 s.</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Imaging variables</span><p id="par0035" class="elsevierStylePara elsevierViewall">We gathered data for all patients with SARS-CoV-2 infection confirmed by reverse transcription polymerase chain reaction (RT-PCR) and the presence of one or more TS on chest radiograph, DTS or both.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Based on the chest radiograph and DTS assessment, the following was determined:<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">□</span><p id="par0045" class="elsevierStylePara elsevierViewall">The density of the dense peripheral ring: <span class="elsevierStyleItalic">pulmonary consolidation</span>, when the opacity prevented pulmonary vessels from being seen, or <span class="elsevierStyleItalic">ground glass</span>, when vessels were identifiable.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">□</span><p id="par0050" class="elsevierStylePara elsevierViewall">Lung density between the dense peripheral ring and the central nodule of each TS. It was classified as <span class="elsevierStyleItalic">ground-glass density</span> when the density was higher than that of the normal lung but lower than that of the dense peripheral ring, and <span class="elsevierStyleItalic">normal lung density</span>, when it was similar to that of other parts of the lung not affected by other pathologies.</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">□</span><p id="par0055" class="elsevierStylePara elsevierViewall">TS number: single or multiple.</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">□</span><p id="par0060" class="elsevierStylePara elsevierViewall">Laterality of TS: unilateral or bilateral.</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">□</span><p id="par0065" class="elsevierStylePara elsevierViewall">TS dense peripheral ring: joined or not joined. In cases of multiple TS, the dense peripheral ring is considered joined when a portion of it forms part of another. This is seen in other TS-related published cases.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,12</span></a></p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">□</span><p id="par0070" class="elsevierStylePara elsevierViewall">Size of the TS, in relation to the intercostal space and adjacent ribs.</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">□</span><p id="par0075" class="elsevierStylePara elsevierViewall">TS Location:<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">o</span><p id="par0080" class="elsevierStylePara elsevierViewall">Peripheral or central. Peripheral where the target sign was nearer to the costal pleura than the mediastinal pleura. Central otherwise.</p></li><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">o</span><p id="par0085" class="elsevierStylePara elsevierViewall">Inferior or superior. Inferior, when located in the inferior, middle or lingular lobes, or superior if located in the superior lobes.</p></li><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">o</span><p id="par0090" class="elsevierStylePara elsevierViewall">Anterior or posterior depending on whether it was closer to the anterior or posterior costal margins, respectively.</p></li></ul></p></li></ul></p><p id="par0095" class="elsevierStylePara elsevierViewall">If any patient had a CT scan during the period of COVID-19 lung involvement, we assessed the imaging features of the TS and associated findings.</p><p id="par0100" class="elsevierStylePara elsevierViewall">In addition, we assessed the presence of consolidations and ground-glass opacities in other parts of the lung away from the TS in relation to COVID-19 pneumonia.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Non-imaging variables</span><p id="par0105" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0020"><li class="elsevierStyleListItem" id="lsti0070"><span class="elsevierStyleLabel">□</span><p id="par0110" class="elsevierStylePara elsevierViewall">Age, sex, personal medical history.</p></li><li class="elsevierStyleListItem" id="lsti0075"><span class="elsevierStyleLabel">□</span><p id="par0115" class="elsevierStylePara elsevierViewall">Time between the positive RT-PCR test and the chest radiograph/DTS in which the TS appeared.</p></li><li class="elsevierStyleListItem" id="lsti0080"><span class="elsevierStyleLabel">□</span><p id="par0120" class="elsevierStylePara elsevierViewall">Respiratory symptoms and O<span class="elsevierStyleInf">2</span> saturation on arrival at hospital.</p></li><li class="elsevierStyleListItem" id="lsti0085"><span class="elsevierStyleLabel">□</span><p id="par0125" class="elsevierStylePara elsevierViewall">Laboratory markers recorded in the emergency room or, where relevant, during admission for COVID-19, as close as possible to the time when the TS was detected. Specifically, age-adjusted D-dimer, LDH and CRP.</p></li><li class="elsevierStyleListItem" id="lsti0090"><span class="elsevierStyleLabel">□</span><p id="par0130" class="elsevierStylePara elsevierViewall">Level of medical assistance required: if they were treated as an outpatient, required admission to hospital or into the Intensive Care Unit (ICU).</p></li><li class="elsevierStyleListItem" id="lsti0095"><span class="elsevierStyleLabel">□</span><p id="par0135" class="elsevierStylePara elsevierViewall">Evolution, favourable, if they got better, or unfavourable if they died.</p></li></ul></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Analysis</span><p id="par0140" class="elsevierStylePara elsevierViewall">We represented our quantitative variables as median and interquartile range and qualitative variables as absolute and relative frequencies (percentages). Given the small sample size, no statistical analyses were performed.</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Results</span><p id="par0145" class="elsevierStylePara elsevierViewall">We recorded 11 TS in seven patients, with a median age of 35 years (interquartile range 26–6 years), four of whom were male (57%). Two patients had comorbidities, one was undergoing treatment for colorectal cancer and the other had previously suffered a past myocardial infarction. A CT pulmonary angiogram was performed on one patient.</p><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Imaging features of TS</span><p id="par0150" class="elsevierStylePara elsevierViewall">The dense peripheral ring was classified as consolidation density in 2 of the 11 TS (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) and ground-glass density in 2 of the 11 TS (18%, <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>) In 9 of the 11 TS (82%), the density of the lung surrounded by the dense peripheral ring was similar to that of the normal lung (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1–4</a>), and in the rest (2/11, 18%) it was unclear whether this density reached ground-glass density. In all cases the density was lower than that of the dense peripheral ring (11/11, 100%).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0155" class="elsevierStylePara elsevierViewall">Multiple TS were found in three of the seven (43%) patients. Of these, one patient had bilateral TS—one in each of the inferior lobes (1/7, 14%, <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>)—, another had two adjacent TS in the right inferior lobe (RIL) (1/7, 14%, <a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>) and the third had numerous TS in the RIL (1/7, 14%, <a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>).</p><p id="par0160" class="elsevierStylePara elsevierViewall">In the two patients with multiple contiguous TS (<a class="elsevierStyleCrossRef" href="#fig0015">Figs. 3</a>b, c and <a class="elsevierStyleCrossRef" href="#fig0020">4</a>g, h), the TS presented with joined dense peripheral rings.</p><p id="par0165" class="elsevierStylePara elsevierViewall">The approximate maximum size of all the TS was the width of one intercostal space plus the thickness of one or both adjacent ribs (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1–4</a>).</p><p id="par0170" class="elsevierStylePara elsevierViewall">All the TS were peripheral (11/11, 100%), all were located in inferior (inferior lobes or lingula, 11/11, 100%) and posterior regions, except for the lingular TS (10/11, 91%) (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0175" class="elsevierStylePara elsevierViewall">Angio-CT, performed on one patient, revealed multiple peripherally located TS in the right inferior lobe, whose dense peripheral ring surrounded lung of normal density, many of which had a dense central or subpleural nodule, as well as several TS with joined contiguous dense peripheral rings (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>). A thrombosed peripheral artery reached the central nodule in at least one of the TS (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>d, e).</p><p id="par0180" class="elsevierStylePara elsevierViewall">All but one patient (6/7, 86%) showed other pulmonary manifestations typical of COVID-19 pneumonia (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Clinical characteristics and laboratory values of patients with the TS</span><p id="par0185" class="elsevierStylePara elsevierViewall">Five of seven patients (71.4%) presented with pleuritic pain.</p><p id="par0190" class="elsevierStylePara elsevierViewall">The age-adjusted D-dimer was elevated in four of the six (67%) patients and LDH in two of the six patients (33%). CRP was elevated in all patients, but the highest level was 3.2 mg/dl. This data was not available for one of the patients because blood biochemistry tests were not requested.</p><p id="par0195" class="elsevierStylePara elsevierViewall">Five patients (5/7, 41%) were treated as outpatients. Only two of the seven (28%) required hospital admission, including one to the ICU (14%). The O<span class="elsevierStyleInf">2</span> saturation levels were > 94% for all patients except the one who required admission to the ICU, who had a saturation of 86%. All patients progressed favourably.</p><p id="par0200" class="elsevierStylePara elsevierViewall">The TS appeared between 4 and 14 days after the positive RT-PCR test (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">DTS contribution to TS detection</span><p id="par0205" class="elsevierStylePara elsevierViewall">All TS were detected by DTS of the chest (11/11, 100%), whereas only 2 out of 11 (18%, <a class="elsevierStyleCrossRefs" href="#fig0005">Fig. 1–4</a>) were detected by chest radiography.</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Discussion</span><p id="par0210" class="elsevierStylePara elsevierViewall">In our case series of patients with COVID-19, the TS appeared predominantly in lower peripheral regions, some were multiple and were not always accompanied other signs of pneumonia in the lungs. They presented with a central nodule and peripheral ring. The peripheral rings in contiguous TS are joined. In more than 80% of cases, the lung between the central nodule and the peripheral ring was of normal density. These findings differ from those of the reversed halo sign in organising pneumonia,<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,4,9</span></a> which suggests a different aetiopathogenesis. Detection of the TS is 80% higher when using DTS in comparison with radiography. The TS is detected between 4 and 14 days following diagnosis of the infection, in young patients (median of 35 years), accompanied by pleuritic pain in more than 70% of cases, with no specific findings from laboratory testing. It does not indicate a worse prognosis for COVID-19 infections.</p><p id="par0215" class="elsevierStylePara elsevierViewall">There is evidence of underlying vascular involvement in COVID-19: histologically (thrombosis, endotheliitis, haemorrhagic infarction and angiogenesis, probably mediated by an endothelial thrombo-inflammatory syndrome and a procoagulant state<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,14,15</span></a>); molecular (affinity of SARS-CoV-2 surface proteins for endothelial ACE-2 receptors<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a>) and radiological (dilated peripheral pulmonary vessels on CT scan,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> mosaic pattern probably due to perfusion disturbances<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a>). Arterial thrombosis with associated infarction could explain the TS in COVID-19. We have based this hypothesis on radiological and clinical evidence, which should be confirmed in future studies.<ul class="elsevierStyleList" id="lis0025"><li class="elsevierStyleListItem" id="lsti0100"><span class="elsevierStyleLabel">a)</span><p id="par0220" class="elsevierStylePara elsevierViewall">Radiological:<ul class="elsevierStyleList" id="lis0030"><li class="elsevierStyleListItem" id="lsti0105"><span class="elsevierStyleLabel">I)</span><p id="par0225" class="elsevierStylePara elsevierViewall">Features similar to those of pulmonary infarction processes. The imaging features of light bulb sign and the rosette sign on CT, which consist of one or more dense peripheral rings, with a dense central nodule and lung parenchyma of variable density between and outside these rings<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> are similar to those of the TS and have been described in the immediate period after performing lung radiofrequency ablation procedures. The underlying pathoanatomy is coagulative necrosis with secondary haemorrhage.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a></p></li><li class="elsevierStyleListItem" id="lsti0110"><span class="elsevierStyleLabel">II)</span><p id="par0230" class="elsevierStylePara elsevierViewall">Features of the TS. Both the size of the dense peripheral ring, similar to that of the secondary pulmonary lobule, and the perilobular distribution could be explained by a bronchogenic or angiogenic process, such as pulmonary infarction. When the dense peripheral ring surrounds lung of normal density, as occurred in at least 80% of the TS in our sample, the histological basis considered most likely is infarction, and when the ring surrounds lung of ground-glass density, organising pneumonia is most likely.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Arteriole thrombosis in the secondary pulmonary lobule provides an explanation for the central nodule.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,10,19</span></a></p></li><li class="elsevierStyleListItem" id="lsti0115"><span class="elsevierStyleLabel">III)</span><p id="par0235" class="elsevierStylePara elsevierViewall">Distribution of the TS. According to our work, and that of others,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> the TS can be multiple, bilateral, predominantly located in basal and peripheral regions and in the vicinity of bronchovascular bundles in 87% of cases.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Although this distribution occurs in organising pneumonia, it also occurs in hematogenous dissemination processes, which tend towards posterior regions, probably because gravity encourages a greater flow in that region. This feature is shared by the TS in our series.</p></li><li class="elsevierStyleListItem" id="lsti0120"><span class="elsevierStyleLabel">IV)</span><p id="par0240" class="elsevierStylePara elsevierViewall">Association with pulmonary embolism. In patients with COVID-19 and pulmonary embolism, present in the only angio-CT performed in our sample, the TS is more frequent (16–18% vs 2–5%).<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p></li></ul></p></li><li class="elsevierStyleListItem" id="lsti0125"><span class="elsevierStyleLabel">b)</span><p id="par0245" class="elsevierStylePara elsevierViewall">Clinical. Pleuritic pain is much more frequent in COVID-19 patients with lung involvement and the TS (71%) than in those without the TS (17%, 95% CI 11–25%, in a cohort of 133 admitted patients) in our setting.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> In turn, it is a rare symptom in organising pneumonia.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p></li></ul></p><p id="par0250" class="elsevierStylePara elsevierViewall">The laboratory markers analysed did not provide relevant data, possibly because they overlapped with the systemic inflammatory context of COVID-19.</p><p id="par0255" class="elsevierStylePara elsevierViewall">Regarding prognosis, the favourable evolution of all our patients, similar ICU admission requirements (14%) to a full set of patients with COVID-19 (10–15%)<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> and low CRP figures (≤ 3.2 mg/dl) suggest that the presence of the TS does not increase the severity of COVID-19. Therefore, despite the relatively late manifestation of the TS, which according to our data appears between 4 and 14 days after the diagnosis of infection, and its low frequency (5%<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>), the specificity of the TS to COVID-19 suggests it will be primarily useful in diagnosis. It may be useful outside pandemic peaks and mass microbiological screening to detect the onset of new waves. Detection of the TS is 82% higher with DTS than chest radiography without the need for CT, suggesting that it could potentially be used to detect hidden pathologies or assess equivocal findings on chest radiography, whether related to COVID-19 pneumonia or not.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p><p id="par0260" class="elsevierStylePara elsevierViewall">Our study has various limitations. Our sample size is small. Patients were not all recruited consecutively, so the TS may have been excluded. We have not compared our sample with a sample of patients without the TS, so we cannot compare clinical characteristics, laboratory results or imaging findings. Nor can we know how prevalent it is. We can only describe the characteristics of the available sample. A CT pulmonary angiogram was available for only one patient. Although this was positive for peripheral arterial thrombosis, we cannot confirm the vascular nature of the TS. Finally, we do not have data to show imaging evolution, nor do we have CT images or histological samples for all patients, because it would not have been ethically acceptable to perform these tests for the sole objective of this study.</p><p id="par0265" class="elsevierStylePara elsevierViewall">In conclusion, we have described 11 target signs in 7 patients with COVID-19. On imaging, the sign is characteristically multiple, and predominates in peripheral, lower regions. In one case it was associated with pulmonary embolism. In our case series, patients presented with a high incidence of pleuritic pain and prognosis was good. Detection of the TS is 80% higher with DTS than conventional radiography.</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Author contributions</span><p id="par0270" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0035"><li class="elsevierStyleListItem" id="lsti0130"><span class="elsevierStyleLabel">1.</span><p id="par0275" class="elsevierStylePara elsevierViewall">Research coordinators: JMPM, IGT, CBP, ABB.</p></li><li class="elsevierStyleListItem" id="lsti0135"><span class="elsevierStyleLabel">2.</span><p id="par0280" class="elsevierStylePara elsevierViewall">Development of study concept: JMPM, IGT, CBP, ABB.</p></li><li class="elsevierStyleListItem" id="lsti0140"><span class="elsevierStyleLabel">3.</span><p id="par0285" class="elsevierStylePara elsevierViewall">Study design: JMPM, IGT, CBP, ABB.</p></li><li class="elsevierStyleListItem" id="lsti0145"><span class="elsevierStyleLabel">4.</span><p id="par0290" class="elsevierStylePara elsevierViewall">Data collection: JMPM, IGT, CBP, ABB.</p></li><li class="elsevierStyleListItem" id="lsti0150"><span class="elsevierStyleLabel">5.</span><p id="par0295" class="elsevierStylePara elsevierViewall">Data analysis and interpretation: JMPM, IGT, CBP, ABB.</p></li><li class="elsevierStyleListItem" id="lsti0155"><span class="elsevierStyleLabel">6.</span><p id="par0300" class="elsevierStylePara elsevierViewall">Statistical analysis: not applicable.</p></li><li class="elsevierStyleListItem" id="lsti0160"><span class="elsevierStyleLabel">7.</span><p id="par0305" class="elsevierStylePara elsevierViewall">Literature search: JMPM, IGT.</p></li><li class="elsevierStyleListItem" id="lsti0165"><span class="elsevierStyleLabel">8.</span><p id="par0310" class="elsevierStylePara elsevierViewall">Writing of article: JMPM, IGT.</p></li><li class="elsevierStyleListItem" id="lsti0170"><span class="elsevierStyleLabel">9.</span><p id="par0315" class="elsevierStylePara elsevierViewall">Critical review of the manuscript with intellectually relevant contributions: JMPM, IGT, CBP, ABB.</p></li><li class="elsevierStyleListItem" id="lsti0175"><span class="elsevierStyleLabel">10.</span><p id="par0320" class="elsevierStylePara elsevierViewall">Approval of the final version: JMPM, IGT, CBP, ABB.</p></li></ul></p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Funding</span><p id="par0325" class="elsevierStylePara elsevierViewall">No funding was received to develop this publication.</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conflict of interests</span><p id="par0330" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres2132312" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1810810" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres2132313" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1810811" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Imaging variables" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Non-imaging variables" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Analysis" ] ] ] 6 => array:3 [ "identificador" => "sec0030" "titulo" => "Results" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0035" "titulo" => "Imaging features of TS" ] 1 => array:2 [ "identificador" => "sec0040" "titulo" => "Clinical characteristics and laboratory values of patients with the TS" ] 2 => array:2 [ "identificador" => "sec0045" "titulo" => "DTS contribution to TS detection" ] ] ] 7 => array:2 [ "identificador" => "sec0050" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0055" "titulo" => "Author contributions" ] 9 => array:2 [ "identificador" => "sec0060" "titulo" => "Funding" ] 10 => array:2 [ "identificador" => "sec0065" "titulo" => "Conflict of interests" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2023-06-06" "fechaAceptado" => "2023-07-16" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1810810" "palabras" => array:6 [ 0 => "Target sign" 1 => "COVID-19" 2 => "Thrombosis" 3 => "Digital tomosynthesis" 4 => "Radiography" 5 => "Tomography X-Ray Computed" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1810811" "palabras" => array:6 [ 0 => "Signo de destino" 1 => "COVID-19" 2 => "Trombosis" 3 => "Tomosíntesis digital" 4 => "Radiografía" 5 => "Tomografía computarizada de rayos X" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Our objectives are: To describe the radiological semiology, clinical-analytical features and prognosis related to the target sign (TS) in COVID-19. To determine whether digital thoracic tomosynthesis (DTT) improves the diagnostic ability of radiography.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Retrospective, descriptive, single-centre, case series study, accepted by our ethical committee. Radiological, clinical, analytical and follow-up characteristics of patients with COVID-19 and TS on radiography and DTT between November 2020 and January 2021 were analysed.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Eleven TS were collected in 7 patients, median age 35 years, 57% male. All TS presented with a central nodule and a peripheral ring, and in at least 82%, the lung in between was of normal density. All TS were located in peripheral, basal regions and 91% in posterior regions. TS were multiple in 43%. Contiguous TS shared the peripheral ring. Other findings related to pneumonia were associated in 86% of patients. DTT detected 82% more TS than radiography. Only one patient underwent a CT angiography of the pulmonary arteries, positive for acute pulmonary thromboembolism. Seventy-one per cent presented with pleuritic pain. No distinctive laboratory findings or prognostic worsening were detected.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">TS in COVID-19 predominates in peripheral and declining regions and can be multiple. Pulmonary thromboembolism was detected in one case. It occurs in young people, frequently with pleuritic pain and does not worsen the prognosis. DTT detects more than 80 % of TS than radiography.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducción</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Nuestros objetivos son describir la semiología radiológica, los datos distintivos clínico-analíticos y el pronóstico relacionados con el signo de la diana (SD) de la COVID-19. Determinar si la tomosíntesis digital torácica (TDT) mejora la capacidad diagnóstica de la radiografía.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y métodos</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo, descriptivo de una serie de casos, unicéntrico, aceptado por nuestro comité ético. Se analizaron las características radiológicas, clínicas, analíticas y evolutivas de los pacientes con COVID-19 y SD en radiografía y TDT entre Noviembre 2020 y Enero 2021.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Se recogieron 11 SD en 7 pacientes, con edad mediana de 35 años, 57% varones. Todos presentaron un nódulo central y un anillo periférico y, en al menos el 82%, el pulmón entre ambos fue de densidad normal. Todos se situaron en regiones periféricas, basales y el 91% en regiones posteriores. Fueron múltiples en un 43%. Los SD contiguos compartieron el anillo periférico. El 86% asoció otras manifestaciones pulmonares de neumonía. La TDT detectó un 82% más de SD que la radiografía. Solo en un paciente se realizó una angio-TC de arterias pulmonares, positiva para tromboembolia pulmonar aguda. El 71% acudió con dolor pleurítico. No se detectaron hallazgos analíticos distintivos ni empeoramiento pronóstico.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">El SD en la COVID-19 predomina en regiones periféricas y declive y puede ser múltiple, encontrando tromboembolia pulmonar en un caso. Se da en jóvenes, frecuentemente con dolor pleurítico y no empeora el pronóstico. La TDT detecta más del 80% de SD que la radiografía.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "multimedia" => array:5 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 750 "Ancho" => 1681 "Tamanyo" => 100240 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Chest radiograph (a) and digital tomosynthesis (DTS) (b) in a patient with the target sign (white arrows) visible on both the chest radiograph and the DTS. Ill-defined opacities, patchy, peripheral, ground-glass (arrowhead) due to COVID-19 pneumonia.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 736 "Ancho" => 1681 "Tamanyo" => 105618 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Chest radiograph (a) and digital tomosynthesis (DTS) (b) in a patient with the target sign (white arrows) visible only on DTS. Ground-glass opacities also visible in the left part of the lung (arrow heads in b) due to COVID-19 pneumonia.</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 569 "Ancho" => 1681 "Tamanyo" => 89324 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Chest radiograph (a) and digital tomosynthesis (DTS) (b and c) in a patient with target sign (white arrows) visible only on DTS. Two adjacent TS observed with joined peripheral ring opacities (b and c). Ill-defined opacities, patchy, peripheral, ground-glass (arrowheads) due to COVID-19 pneumonia.</p>" ] ] 3 => array:8 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1750 "Ancho" => 2348 "Tamanyo" => 330504 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Chest radiograph (a) and digital tomosynthesis (DTS) (b) in a patient with multiple target signs (white arrows) visible only on DTS. Angio-CT curved reconstruction of pulmonary arteries with angiographic (d and e) and lung (f, same plane as e) window, in which peripheral arteries are observed with endoluminal thrombotic material (dashed arrows), whose distal portion (continuous line arrow) reaches the central nodule of the target sign (arrowheads); asterisks indicate the dense peripheral ring. In images (g and h) multiple joined dense peripheral rings (white lines) surround normal lung tissue and show the central nodule (white circles) as seen in a patient with target sign during COVID-19 pneumonia associated with pulmonary embolism.</p>" ] ] 4 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0025" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">RIL: right inferior lobe; LIL: left inferior lobe; RSL: right superior lobe; GGO: ground-glass opacities; P: patient; SatO<span class="elsevierStyleInf">2</span>: oxygen saturation; TS: target sign; ICU: intensive care unit.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">P \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sex, age (years), medical history \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Days from positive RT-PCR to TS detection \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Symptoms \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SatO<span class="elsevierStyleInf">2</span> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">D-dimer (ng/ml) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">LDH (u/l) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">PCR (mg/dl) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Imaging findings \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Evolution \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">P1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Female, 35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Left pleuritic pain, palpitations \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">98 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">323 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">368 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">< 0.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TS in RIL and LIL (peripheral) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Discharged, favourable \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">GGO in LIL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">P2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male, 54 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pleuritic pain, dyspnoea and cough \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">94 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">669 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">333 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TS in lingula, peripheral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hospitalised, favourable \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Colorectal cancer undergoing treatment with regorafenib (3rd line). Superior right lobectomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">GGO in lingula and LIL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">P3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Female, 23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Intermittent pleuritic pain, dyspnoea, cough and expectoration \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">650 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">302 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TS in RIL, peripheral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Discharged, favourable \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">GGO in LIL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">P4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male, 26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pleuritic pain, intermittent dyspnoea, dry cough, fever, anosmia and ageusia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">99 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">286 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">310 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">< 0.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TS in LIL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Discharged, favourable \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">P5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male, 35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dyspnoea \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">98 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TS (2) in RIL, peripheral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Discharged, favourable \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">GGO in RSL and RIL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">P6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Female, 56 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dyspnoea, fever \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">98 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1578 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">508 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TS in RIL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Discharged, favourable \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">GGO in right lung \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">P7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male, 61 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pleuritic pain, dyspnoea \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">86 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">88,000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">957 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TS in RIL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ICU, favourable \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Acute myocardial infarction four years ago. Smoker \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Consolidations and multifocal, bilateral GGO Acute pulmonary embolism \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3515214.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Characteristics of seven patients with COVID-19 and target signs.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:21 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A unique feature of COVID-19 infection in chest CT; “pulmonary target” appearance" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R. Jafari" 1 => "H. Maghsoudi" 2 => "A. Saburi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.acra.2020.11.004" "Revista" => array:6 [ "tituloSerie" => "Acad Radiol" "fecha" => "2021" "volumen" => "28" "paginaInicial" => "146" "paginaFinal" => "147" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33246787" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "“Rings of Saturn” appearance: a unique finding in a case of COVID-19 pneumonitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R. Jafari" 1 => "M. Colletti" 2 => "P.A. Saburi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.5152/dir.2020.20266" "Revista" => array:6 [ "tituloSerie" => "Diagn Interv Radiol" "fecha" => "2021" "volumen" => "27" "paginaInicial" => "154" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32673208" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1056872715000513" "estado" => "S300" "issn" => "10568727" ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The bullseye sign: a variant of the reverse halo sign in COVID-19 pneumonia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "T.A. McLaren" 1 => "J.F. Gruden" 2 => "D.B. Green" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.clinimag.2020.07.024" "Revista" => array:7 [ "tituloSerie" => "Clin Imaging" "fecha" => "2020" "volumen" => "68" "paginaInicial" => "191" "paginaFinal" => "196" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32853842" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S2530016419301478" "estado" => "S300" "issn" => "25300164" ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "“Pulmonary target sign” as a diagnostic feature in chest computed tomography of COVID-19" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Jafari" 1 => "N. Jonaidi-Jafari" 2 => "H. Maghsoudi" 3 => "F. Dehghanpoor" 4 => "U.J. Schoepf" 5 => "K.A. Ulversoy" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4329/wjr.v13.i7.233" "Revista" => array:6 [ "tituloSerie" => "World J Radiol" "fecha" => "2021" "volumen" => "13" "paginaInicial" => "233" "paginaFinal" => "242" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34367510" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chest CT target sign in a couple with COVID-19 pneumonia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C.I.S. Müller" 1 => "N.L. Müller" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1590/0100-3984.2020.0089" "Revista" => array:6 [ "tituloSerie" => "Radiol Bras" "fecha" => "2020" "volumen" => "53" "paginaInicial" => "252" "paginaFinal" => "254" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32904794" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Neumonía organizada" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J.J. Arenas-Jiménez" 1 => "E. García-Garrigós" 2 => "A. Ureña Vacas" 3 => "M. Sirera Matilla" 4 => "E. Feliu Rey" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rx.2022.08.001" "Revista" => array:6 [ "tituloSerie" => "Radiologia" "fecha" => "2022" "volumen" => "64" "paginaInicial" => "240" "paginaFinal" => "249" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/36737163" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Morphological characteristics of the reversed halo sign that may strongly suggest pulmonary infarction" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Marchiori" 1 => "M. Menna Barreto" 2 => "H.M. Pereira Freitas" 3 => "B. Hochhegger" 4 => "A. Soares Souza Jr" 5 => "G. Zanetti" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.crad.2017.11.022" "Revista" => array:5 [ "tituloSerie" => "Clin Radiol" "fecha" => "2018" "volumen" => "73" "paginaInicial" => "503.e7" "paginaFinal" => "503.e13" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A review of the main histopathological findings in coronavirus disease 2019" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "W.O. Vasquez-Bonilla" 1 => "R. Orozco" 2 => "V. Argueta" 3 => "M. Sierra" 4 => "L.I. Zambrano" 5 => "F. Muñoz-Lara" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.humpath.2020.07.023" "Revista" => array:6 [ "tituloSerie" => "Hum Pathol" "fecha" => "2020" "volumen" => "105" "paginaInicial" => "74" "paginaFinal" => "83" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32750378" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The reversed halo sign: considerations in the context of the COVID-19 pandemic" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "E. Marchiori" 1 => "L.F. Nobre" 2 => "B. Hochhegger" 3 => "G. Zanetti" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.thromres.2020.08.001" "Revista" => array:6 [ "tituloSerie" => "Thromb Res" "fecha" => "2020" "volumen" => "195" "paginaInicial" => "228" "paginaFinal" => "230" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32799128" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The Target Sign and Its Variant in COVID-19 Pneumonia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "L de P. Gomes de Farias" 1 => "F.H. Caixeta Souza" 2 => "G.B. da Silva Teles" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1148/ryct.2020200435" "Revista" => array:3 [ "tituloSerie" => "Radiol Cardiothorac Imaging" "fecha" => "2020" "volumen" => "2" ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A comparison of digital tomosynthesis and chest radiography in evaluating airway lesions using computed tomography as a reference" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.Y. Choo" 1 => "K.Y. Lee" 2 => "A. Yu" 3 => "J.H. Kim" 4 => "S.H. Lee" 5 => "J.W. Choi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00330-015-4127-z" "Revista" => array:6 [ "tituloSerie" => "Eur Radiol" "fecha" => "2016" "volumen" => "26" "paginaInicial" => "3147" "paginaFinal" => "3154" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26662264" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The “target sign” in a 46-year-old patient with COVID-19 pneumonia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A.P. Pérez" 1 => "R. Lazarus" 2 => "A. Dubey" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1155/2021/9956927" "Revista" => array:2 [ "tituloSerie" => "Case Rep Radiol" "fecha" => "2021" ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Digital tomosynthesis and COVID-19: an improvement in the assessment of pulmonary opacities" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "I. Calvo" 1 => "S. SantaCruz-Calvo" 2 => "M.G. Aranzana" 3 => "P. Mármol" 4 => "J.Á Luque" 5 => "I. Peral" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arbres.2020.06.017" "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol (Engl Ed)" "fecha" => "2020" "volumen" => "56" "paginaInicial" => "761" "paginaFinal" => "763" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32994088" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Anatomical and pathological observation and analysis of SARS and COVID-19: microthrombosis is the main cause of death" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "W. Chen" 1 => "J.Y. Pan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s12575-021-00142-y" "Revista" => array:5 [ "tituloSerie" => "Biol Proced Online" "fecha" => "2021" "volumen" => "23" "paginaInicial" => "4" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33472576" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pulmonary post-mortem findings in a series of COVID-19 cases from northern Italy: a two-centre descriptive study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L. Carsana" 1 => "A. Sonzogni" 2 => "A. Nasr" 3 => "R.S. Rossi" 4 => "A. Pellegrinelli" 5 => "P. Zerbi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S1473-3099(20)30434-5" "Revista" => array:6 [ "tituloSerie" => "Lancet Infect Dis" "fecha" => "2020" "volumen" => "20" "paginaInicial" => "1135" "paginaFinal" => "1140" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32526193" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Understanding the role of ACE-2 receptor in pathogenesis of COVID-19 disease: a potential approach for therapeutic intervention" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Shirbhate" 1 => "J. Pandey" 2 => "V.K. Patel" 3 => "M. Kamal" 4 => "T. Jawaid" 5 => "B. Gorain" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s43440-021-00303-6" "Revista" => array:6 [ "tituloSerie" => "Pharmacol Rep" "fecha" => "2021" "volumen" => "73" "paginaInicial" => "1539" "paginaFinal" => "1550" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34176080" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Spectrum of lung perfusion changes on dual-energy CT in COVID-19: incremental benefit to conventional CT" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S. Ganti" 1 => "S.S.X. Kok" 2 => "S. Aftab" 3 => "S.V. Halagatti" 4 => "S.B.S. Wong" 5 => "A.S. Uppaluri" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s10140-020-01877-z" "Revista" => array:7 [ "tituloSerie" => "Emerg Radiol" "fecha" => "2021" "volumen" => "28" "paginaInicial" => "527" "paginaFinal" => "531" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33417112" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0168822721003661" "estado" => "S300" "issn" => "01688227" ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pulmonary radiofrequency ablation (Part 2): procedure and follow-up" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.M. Plasencia Martínez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rx.2014.12.012" "Revista" => array:6 [ "tituloSerie" => "Radiologia" "fecha" => "2015" "volumen" => "57" "paginaInicial" => "287" "paginaFinal" => "302" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25744242" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reversed halo sign in invasive fungal infections" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "E. Marchiori" 1 => "B. Hochhegger" 2 => "G. Zanetti" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1590/S1806-37562016000000119" "Revista" => array:5 [ "tituloSerie" => "J Bras Pneumol" "fecha" => "2016" "volumen" => "42" "paginaInicial" => "232" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27383940" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0100" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prognostic value of thrombin generation parameters in hospitalized COVID-19 patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.E. de la Morena-Barrio" 1 => "C. Bravo-Pérez" 2 => "A. Miñano" 3 => "B. de la Morena-Barrio" 4 => "M.P. Fernandez-Perez" 5 => "E. Bernal" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/s41598-021-85906-y" "Revista" => array:5 [ "tituloSerie" => "Sci Rep" "fecha" => "2021" "volumen" => "11" "paginaInicial" => "7792" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33833254" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0105" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Critical patients COVID-19 has changed the management and outcomes in the ICU after 1 year of the pandemic? A multicenter, prospective, observational study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Rama-Maceiras" 1 => "Y. Sanduende" 2 => "M. Taboada" 3 => "M. Casero" 4 => "S. Leal" 5 => "R.F. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 0 | 4 |
| 2024 October | 33 | 0 | 33 |
| 2024 September | 52 | 0 | 52 |
| 2024 August | 83 | 0 | 83 |
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| 2024 May | 64 | 0 | 64 |
| 2024 April | 69 | 0 | 69 |
| 2024 March | 41 | 0 | 41 |
| 2024 February | 21 | 0 | 21 |
