COVID-19 PNÖMONİSİNİN TORAKS BT BULGULARI VE KLİNİK SEMPTOMLAR İLE İLİŞKİSİ

Year 2022, Volume: 23 Issue: 1, 88 - 94, 17.01.2022

Nurdan Fidan , Esra Ümmühan Mermi Yetiş , Alev Günaldı , Mehmet Atasoy

https://doi.org/10.18229/kocatepetip.885860

Abstract

AMAÇ: Bu çalışmada koronavirüs hastalığı 2019 (COVID-19) ile enfekte 185 hastanın ilk başvuru sırasındaki toraks bilgisayarlı tomografi (BT) bulgularının değerlendirilmesi ve demografik veriler ile ilişkisinin sunulması amaçlandı.
GEREÇ VE YÖNTEM: Mart - Temmuz 2020 tarihleri arasında, başvuru esnasında çekilmiş toraks BT incelemesi olan, gerçek zamanlı ters transkriptaz-polimeraz zincir reaksiyonu (RT-PCR) testi ile COVID-19 tanısı doğrulanmış, hastanemizde yatırılarak takip ve tedavi edilen 185 ardışık hasta çalışmaya alındı. Hastaların demografik verileri, başvuru sırasındaki şikayetleri, RT-PCR sonuçları elektronik tıbbi kayıtlarından ve BT incelemeleri PACS sisteminden retrospektif olarak tarandı. Lezyon paterni olarak buzlu cam alanı, konsolidasyon ya da buzlu cam görünümü ile birlikte konsolidasyon bulgusu olması tutulum varlığı olarak kabul edildi. Tutulum tarafı, dağılımı, yaygınlığı, plevraya uzaklığı değerlendirildi. Hava bronkogramı, vasküler dilatasyon, subplevral bant formasyonu, kaldırım taşı bulgusu, traksiyon bronşektazisi, fibroatelektazi, ters halo işareti, tomurcuklu ağaç görünümü, komşu plevrada kalınlaşma, plevral effüzyon, kavitasyon, mediastinal lenfadenopati gibi diğer ek bulguların varlığı kaydedildi.
BULGULAR: Olguların yaşları 18 ile 87 arasında değişmekte olup 86’sı (%46,5) kadın ve 99’u (%53,5) erkekti. Olguların %69’unda buzlu cam görünümü ve/veya konsolidasyon bulgusu varken %31’inde BT tutulum bulgusu yoktu ve %28 olguda BT tamamen normaldi. %80’inde bilateral, %87’sinde multilober tutulum görüldü. Buzlu cam görünümü ve/veya konsolidasyona eşlik eden en sık bulgular subplevral bant (%27) ve fibroatelektazi (%25) iken, tomurcuklu ağaç görünümü, kavitasyon, ters halo işareti ve plevral kalınlaşma en az görülen BT bulgularıdır.
SONUÇ: Bizim çalışmamız semptomların başlangıç evresinde toraks BT’de bilateral ,periferal veya yamalı multilober buzlu cam alanlarının yaygın olduğunu ancak buna azımsanmayacak oranda konsolidasyonların eşlik ettiğini göstermiştir. Bu bulgulara en sık subplevral bant, fibroatelektazi, kaldırım taşı bulgusu ve vasküler dilatasyon gibi daha geç dönem bulguları eşlik etmektedir. RT-PCR testi sonuçlanmamış olduğunda ya da yanlış negatiflik durumunda bu bulgular COVID-19 lehine yüksek şüpheli olarak değerlendirilmeli, gerekli izolasyon ve erken tedaviye başlanmalıdır.

Keywords

COVID-19, Toraks BT, Pnömoni, Buzlu cam alanı

Supporting Institution

yok

Thanks

yok

RELATİON BETWEEN CHEST CT FİNDİNGS AND CLİNİCAL SYMPTOMS OF COVID-19 PNEUMONİA

Abstract

OBJECTIVE: In this study, it was aimed to evaluate the f chest computed tomography (CT) findings of 185 patients infected with the coronavirus disease 2019 (COVID-19) at the first admission and to present their relationship with demographic data.
MATERIAL AND METHODS: Between March and July 2020, 185 consecutive patients who were hospitalized, followed up and treated in our hospital, who were diagnosed with COVID-19 by real-time reverse transcriptase-polymerase chain reaction (RT-PCR) test and who had a chest CT examination taken at the time of admission were included in the study. The demographic data of the patients, complaints at the time of admission, RT-PCR results from their electronic medical records and chest CT examinations from the PACS system were scanned retrospectively. The presence of ground glass opacities, consolidation or both were accepted as the lesion pattern and as the presence of the involvement. The side, distribution, extent, and distance to the pleura of the involvement were evaluated. Other additional findings such as air bronchogram, vascular dilatation, subpleural band formation, crazy paving , traction bronchiectasis, fibroatelectasis, inverted halo sign, tree in bud appearance, pleural thickening, pleural effusion, cavitation, and mediastinal lymphadenopathy were recorded.
RESULTS: The ages of the cases ranged from 18 to 87 and 86 (46.5%) of them were female and 99 (53.5%) of them were male. While 69% of the cases had a ground-glass opacities and / or signs of consolidation, 31% of them did not have any involvement findings in the CT and CT was completely normal in 28% of the cases. Bilateral involvement was observed in 80% and multilobar involvement in 87%. The most common findings accompanying the ground glass opacities and/or consolidation are subpleural band (27%) and fibroatelectasis (25%), while the tree in bud appearance, cavitation, inverted halo sign and pleural thickening are the least common CT findings.
CONCLUSIONS: Our study has shown that bilateral, peripheral, multilobar ground glass opacities are common in chest CT in the initial phase of symptoms. However this is accompanied by consolidations to a considerable extent. These findings are most often accompanied by later findings such as subpleural band, fibroatelectasis, crazy paving finding and vascular dilatation. When the RT-PCR test is not completed or in case of false negativity, these findings should be considered as highly suspicious in favor of COVID-19, and necessary isolation and early treatment should be initiated.

Keywords

COVID-19, Chest CT, Pneumonia, Ground glass opacity

References

• 1. Wu Y, Xu X, Chen Z, et al. Nervous system involvement after infection with COVID-19 and other coronaviruses. Brain Behav Immun. 2020;87:18-22.
• 2. World Health Organization Coronavirus disease (COVID-19) situation report 102. 2020. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports/
• 3. World Health Organization (2021) Coronavirus disease 2019 (COVID-19). World Health Organization, Geneva. https://www.who.int/emergencies/diseases/novel- coronavirus-2019.
• 4. Hasöksüz M, Kiliç S, Saraç F. Coronaviruses and SARSCOV-2. Turk J Med Sci. 2020;50(3):549-56.
• 5. Lai CC, Shih TP, Ko WC, Tang HJ, Hsueh PR. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): The epidemic and the challenges. Int J Antimicrob Agents. 2020;55(3):105924.
• 6. Guan WJ, Ni ZY, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382(18):1708-20.
• 7. Salehi S, Abedi A, Balakrishnan S, Gholamrezanezhad A. Coronavirus disease 2019 (COVID-19): A systematic review of imaging findings in 919 patients. AJR Am J Roentgenol. 2020;215(1):87-93.
• 8. Xie X, Zhong Z, Zhao W, Zheng C, Wang F, Liu J. Chest CT for typical 2019-nCoV pneumonia: relationship to negative RT-PCR testing. Radiology. 2020:296(2): E41-5.
• 9. Huang P, Liu T, Huang L, et al. Use of Chest CT in Combination with Negative RT-PCR Assay for the 2019 Novel Coronavirus but High Clinical Suspicion. Radiology. 2020;295(1):22-3.
• 10. Fang Y, Zhang H, Xie J, et al. Sensitivity of chest CT for COVID-19: comparison to RT-PCR. Radiology. 2020;296(2):E115-7.
• 11. Jin YH, Cai L, Cheng ZS, et al. A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version). Mil Med Res. 2020;7(1):4.
• 12. Li Z, Yi Y, Luo X, et al. Development and clinical application of a rapid IgM-IgG combined antibody test for SARS-CoV-2 infection diagnosis. Journal of Medical Virology. 2020;92(9):1518-24.
• 13. Hao W, Li M. Clinical diagnostic value of CT imaging in COVID-19 with multiple negative RT-PCR testing. Travel Med Infect Dis. 2020;34:101627.
• 14. Wang S, Kang B, Ma J, et al. A deep learning algorithm using CT images to screen for corona virus disease (COVID-19). Eur Radiol. 2021;24:1-9.
• 15. Zhai P, Ding Y, Wu X, Long J, Zhong Y, Li Y. The epidemiology, diagnosis and treatment of COVID-19. Int J Antimicrob Agents. 2020;55(5):105955.
• 16. Wong HYF, Lam HYS, Fong AH, et al. Frequency and Distribution of Chest Radiographic Findings in COVID-19 Positive Patients. Radiology. 2020; 296(2):E72-8.
• 17. Yoon SH, Lee KH, Kim JY, et al. Chest radiographic and CT findings of the 2019 novel coronavirus disease (COVID-19): analysis of nine patients treated in Korea. Korean J Radiol. 2020;21(4):494.
• 18. Kim JY, Choe PG, Oh Y, et al. The first case of 2019 novel coronavirus pneumonia imported into Korea from Wuhan, China: implication for infection prevention and control measures. J Korean Med Sci. 2020;35(5).
• 19. Pan Y, Guan H, Zhou S, et al. Initial CT findings and temporal changes in patients with the novel coronavirus pneumonia (2019-nCoV): a study of 63 patients in Wuhan, China. Eur Radiol. 2020;30(6):3306-9.
• 20. Han R, Huang L, Jiang H, Dong J, Peng H, Zhang D. Early Clinical and CT Manifestations of Coronavirus Disease 2019 (COVID-19) Pneumonia. AJR Am J Roentgenol. 2020;215(2):338-43.
• 21. Simpson S, Kay F.U, Abbara S, 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. Radiology: Cardiothoracic Imaging. 2020; 2(2):e200152.
• 22. RSNA Journals. Special focus:COVID-19, 2019 Novel Coronavirus. Cook, IL, USA: RSNA Journals; 2020.
• 23. Ye Z, Zhang Y, Wang Y, Huang Z, Song B. Chest CT manifestations of new coronavirus disease 2019 (COVID-19): a pictorial review. Eur Radiol. 2020;30:4381-9.
• 24. Hani C, Trieu NH, Saab I, Dangeard S, Bennani S, Chassagnon G. COVID-19 pneumonia: a review of typical CT findings and differential diagnosis. Diagn Interv Imaging. 2020;101:263-8.
• 25. Cömert SŞ, Kıral N. COVID-19 Pnömonisinin Radyolojik Bulguları. Southern Clinics of Istanbul Eurasia. 2020;31:16-22.
• 26. Pan F, Ye T, Sun P, et al. Time course of lung changes on chest CT during recovery from 2019 novel coronavirus (COVID-19) pneumonia. Radiology. 2020;295(3):715-21.
• 27. Akçay MŞ, Özlü T,Yilmaz A. Radiological approaches to COVID-19 pneumonia. Turkish Journal of Medical sciences. 2020;50:604-10.
• 28. Li Y, Xia L. Coronavirus disease 2019 (COVID-19): role of chest CT in diagnosis and management. AJR Am J Roentgenol. 2020;214(6):1280-6.
• 29. Zhao W, Zhong Z, Xie X, Yu Q, Liu J. Relation between chest CT findings and clinical conditions of coronavirus disease (COVID-19) pneumonia: a multicenter study. AJR Am J Roentgenol. 2020;214(5):1072-7.
• 30. Zheng Y, Wang L, Ben S. Meta-analysis of chest CT features of patients with COVID-19 pneumonia. J Med Virol. 2020;93(1):241-9.
• 31. Hu L, Wang C. Radiological role in the detection, diagnosis and monitoring for the coronavirus disease 2019 (COVID-19). Eur Rev Med Pharmacol Sci. 2020;24(8):4523-8.