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Common and uncommon chest computed tomography findings at hospital admission with COVID-19 pneumonia


1 Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
2 Department of Radiology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA

Date of Submission20-May-2020
Date of Acceptance31-May-2020
Date of Web Publication16-Sep-2020

Correspondence Address:
Rohit Gupta,
Temple Lung Center, Temple University School of Medicine, 3401 North Broad Street, Parkinson Pavilion, 7th Floor, Philadelphia, PA 19140
USA
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/lungindia.lungindia_400_20

   Abstract 


COVID-19 pneumonia is a serious health issue in the current pandemic caused by SARS-CoV-2. PCR testing is limited due to a number of factors and imaging has role in decision-making for many of these patients. We present computed tomography chest images of patients hospitalized with suspicion of COVID-19 pneumonia and point out the common and uncommon features on imaging to assist management of these patients.

Keywords: Coronavirus disease 2019, computed tomography chest, pneumonia, severe acute respiratory syndrome coronavirus-2



How to cite this URL:
Gupta R, Kumaran M, Rali P. Common and uncommon chest computed tomography findings at hospital admission with COVID-19 pneumonia. Lung India [Epub ahead of print] [cited 2020 Dec 1]. Available from: https://www.lungindia.com/preprintarticle.asp?id=295235



The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is the seventh coronavirus causing human disease and is responsible for the current pandemic of coronavirus disease 2019 (COVID-19). While the diagnosis of COVID-19 is made by polymerase chain reaction (PCR) viral identification, this has been hampered by the test's availability, turnaround time, as well as low sensitivity. Chest CT has been used for early diagnosis of COVID-19 pneumonia: it has correlated well with PCR and in some cases better for a diagnostic yield in in conjunction with comprehensive assessment.[1],[2],[3] The spectrum of imaging findings may represent a temporal association of disease onset with timing of CT imaging as well as severity of disease (i.e., cytokine storm).[4],[5],[6] The common findings include peripheral, multifocal, sometimes diffuse subpleural ground-glass opacities (GGO) with or without consolidation, GGO with interlobular septal thickening (“crazy-paving”), and in the later phase, organizing pneumonia pattern and patchy atelectasis [Figure 1].[4],[7] These findings, in the right clinical scenario, should highly raise concern for COVID-19. On the other hand, uncommon findings include lobar consolidation, tree-in-bud nodules, cavitation, pleural effusion, and large lymphadenopathy and should raise concern for coexistent or alternate etiologies [Figure 2].[7],[8]
Figure 1: Non-contrast chest CT imaging from different patients who were hospitalized and subsequently diagnosed with COVID-19: (a) subpleural and peripheral GGO in right upper and lower lobes; (b) nodular consolidative density in left lower lobe (i) evolving into organizing pneumonia pattern (ii) on readmission for worsening symptoms a week later; (c) peripheral GGO with bronchocenteric consolidative opacities on coronal section; (d) diffuse ground glass opacification bilaterally with crazy-paving pattern (red arrow). GGO= groundglass opacities

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Figure 2: Non-contrast chest CT imaging from different patients who were hospitalized with a suspicion of COVID-19 but were found to have alternative etiology: (a) pleural effusions (R>L) and pericardial effusion (red arrow) in a patient admitted with uremia and fluid overload after missing dialysis; (b-d) nodular infiltrative change and right middle lobe atelectasis suggestive of post obstructive changes due to compression by hilar mass (blue arrow) and lymphadenopathy (orange arrow).

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Chest computed tomography has a value in detection as well as potentially in severity assessment of hospitalized patients with COVID-19 pneumonia. This will become clearer as understanding of this novel disease further improves and robust prospective trials become available.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Ai T, Yang Z, Hou H, Zhan C, Chen C, Lv W, et al. Correlation of chest CT and RT-PCR testing in coronavirus disease 2019 (COVID-19) in China: A report of 1014 cases. Radiology 2020:200642.  Back to cited text no. 1
    
2.
Fang Y, Zhang H, Xie J, Lin M, Ying L, Pang P, et al. Sensitivity of chest CT for COVID-19: Comparison to RT-PCR. Radiology 2020;200432.  Back to cited text no. 2
    
3.
Li Y, Xia L. Coronavirus disease 2019 (COVID-19): Role of chest ct in diagnosis and management. AJR Am J Roentgenol 2020;214:1280-6.  Back to cited text no. 3
    
4.
Bernheim A, Mei X, Huang M, Yang Y, Fayad ZA, Zhang N, et al. Chest CT findings in coronavirus disease-19 (COVID-19): Relationship to duration of infection. Radiology 2020;295:200463.  Back to cited text no. 4
    
5.
Mehta P, McAuley DF, Brown M, Sanchez E, Tattersall RS, Manson JJ, et al. COVID-19: Consider cytokine storm syndromes and immunosuppression. Lancet 2020;395:1033-4.  Back to cited text no. 5
    
6.
Liu T, Zhang J, Yang Y, Zhang L, Ma H, Li Z, et al. The Potential Role of IL-6 in Monitoring Coronavirus Disease 2019; 1 March, 2020.  Back to cited text no. 6
    
7.
Simpson S, Kay FU, Abbara S, Bhalla S, Chung JH, Chung M, et al. Radiological Society of North America Expert Consensus Statement on Reporting Chest CT Findings Related to COVID-19. Endorsed by the Society of Thoracic Radiology, the American College of Radiology, and RSNA. J Thorac Imaging 2020;e200152.  Back to cited text no. 7
    
8.
Bai HX, Hsieh B, Xiong Z, Halsey K, Choi JW, Tran TML, et al. Performance of radiologists in differentiating COVID-19 from viral pneumonia on chest CT. Radiology 2020;200823..  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2]



 

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