Computed Tomography Results of Patients with COVID-19: Typical and Atypical Findings

Yıl 2020, Cilt: 4 Sayı: 3, 109 - 116, 12.12.2020

Muhammed Alpaslan , Sercan Özkaçmaz , Yeliz Dadalı , İlyas Dündar

https://doi.org/10.46332/aemj.792717

Öz

Purpose: We aimed to investigate typical and atypical thorax computed tomography (CT) findings of COVID-19 pa-tients.

Material and Methods: Thorax CT scans of the patients with reverse-transcriptase polymerase chain reaction (RT-PCR) confirmed diagnosis of COVID-19 between March 2020 and April 2020 were reviewed retrospectively. The frequencies of ground-glass opacity, consolidation, prominence of bronchovascular marking, fibrosis, nodule, septal thickening, reversed halo, pleural effusion and, mediastinal lymphadenopathy were examined. Lesions were classified into the following categories: bilateral/unilateral involvement, peripheral/central involvement, upper/middle/lower lobe involvement.

Results: A total of 53 patients (Mean age 48,38±20,97) with RT-PCR confirmed COVID-19 was enrolled in the study. 14 (26%) patients showed no finding on Thorax CT. Among the remaining 39 patients (74%) with findings on CT, ground-glass opacity was detected in 85%, consolidation in 56%, ground glass density consolidation in 59%, promi-nent bronchovascular markings in 28% who have findings on computed tomography. Among atypical findings, nodule was seen in 20 %, septal thickening in 30%, fibrosis in 10%, pleural effusion in 8%, air bronchograms in 18%, re-versed halo sign in 5% of the patients. Mediastinal lymphadenopathy was not observed. Lesions tended to be multifo-cal and peripheral as they commonly located bilaterally in middle and lower lobes.

Conclusion: Thorax CT is a very important diagnostic aid for COVID-19 patients. Categorizing parenchymal involve-ment into typical and atypical findings may facilitate the diagnostic process.

Anahtar Kelimeler

ground-glass opacity, Computed Tomography, coronavirus

COVID-19 Tanılı Hastalarımızın Bilgisayarlı Tomografi Sonuçları: Tipik ve Atipik Bulgular

Öz

Amaç: Bu çalışmada COVID-19 tanısı alan hastaların toraks bilgisayarlı tomografi (BT) sonuçlarını inceleyip, tipik ve atipik bulguları literatür eşliğinde sunmayı amaçladık.

Araçlar ve Yöntem: Hastanemize mart ve nisan aylarında başvuran ve reverse transkriptaz-polimeraz zincir reaksiyo-nu (RT-PZR) ile COVID-19 tanısı alan hastaların toraks BT’leri retrospektif olarak değerlendirildi. Akciğer parankim bulgularından buzlu cam sahaları, konsolidasyon, vasküler genişleme, fibrozis, nodül, septal kalınlaşma (crazy pa-ving), ters halo, plevral effüzyon ve mediastinal LAP bulguları araştırıldı. Parankimdeki tutulum yerine göre bilateral-unilateral, periferik-santral, üst-orta-alt loblardaki odak sayılarına göre lezyonların dağılımı değerlendirildi.

Bulgular: PCR pozitif olan 53 hastanın (ortalama yaş 48,38±20,97) 14’ünde (% 26) toraks BT’de bulgu yoktu. BT’de bulgusu olan 39 hastada (%74), tipik bulgulardan buzlu cam sahası (%85), konsolidasyon (%56), buzlu cam ve konso-lidasyon birlikteliği (%59), vasküler genişleme (%28) izlendi. Atipik bulgulardan nodül (%20), septal kalınlaşma (%30), fibrozis (%10), plevral efüzyon (%8), hava bronkogramı (%18), ters halo bulgusu (%5) saptandı. Hastalarımız-da mediastinal LAP saptanmadı. Toraks BT’de bilateral, orta ve alt zonlarda periferik yerleşimli multifokal odaklar tipik tutulum şekliydi. 14 hastada toraks BT negatif olup herhangi bir bulguya rastlanmadı.

Sonuç: Toraks BT, COVID-19 hastaları için tanıya yardımcı çok önemli bir yöntem olup parankim tutulumunun tipik ve atipik bulgular şeklinde kategorize edilerek değerlendirilmesi tanı sürecini kolaylaştırabilir.

Anahtar Kelimeler

buzlu cam sahası, Bilgisayarlı Tomografi, koronavirüs

Kaynakça

• 1. Li Y, Xia L. Coronavirus Disease 2019 (COVID-19): Role of Chest CT in Diagnosis and Management. AJR Am J Roentgenol. 2020;214(6):1280-1286.
• 2. WHO. Naming the coronavirus disease (COVID-19) and the virus that causes it. 2020. https://www.who.int/emergencies/diseases/novel-coronavirus-technicalguidance/naming-the-coronavirus-disease-(covid-2019)-and-the-virus-that-causes-it Erişim tarihi: 22 Mart 2020.
• 3. WHO Director-General's opening remarks at the media briefing on COVID-19. 2020. https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19 Erişim tarihi: 30 Mart 2020.
• 4. WJ Guan, ZY Ni, Y Hu, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382 (18):1708-1720.
• 5. Hu Z, Song C, Xu C, et al. Clinical characteristics of 24 asymptomatic infections with COVID-19 screened among close contacts in Nanjing, China Sci China Life Sci. 2020;63(5):706-711.
• 6. Ai T, Yang Z, Hou H, et al. Correlation of Chest CT and RT-PCR Testing for Coronavirus Disease 2019 (COVID-19) in China: A Report of 1014 Cases. Radiology. 2020;296(2):32-40.
• 7. Li Y, Yao L, Li J, et al. Stability issues of RT-PCR testing of SARS-CoV-2 for hospitalized patients clinically diagnosed with COVID-19. J Med Virol. 2020;92(7):903-908.
• 8. 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):e4.
• 9. 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):e61.
• 10. 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):3306-3309.
• 11. Perlman S. Another Decade, Another Coronavirus. N Engl J Med. 2020;382(8):760-762.
• 12. Kanne JP, Little BP, Chung JH, Elicker BM, Ketai LH. Essentials for Radiologists on COVID-19: An Update-Radiology Scientific Expert Panel. Radiology. 2020;296(2):113-114.
• 13. Pan F, Ye T, Sun P, et al. Time Course of Lung Changes at Chest CT during Recovery from Coronavirus Disease 2019 (COVID-19). Radiology. 2020;295(3):715-721.
• 14. Chung M, Bernheim A, Mei X, et al. CT Imaging Features of 2019 Novel Coronavirus (2019-nCoV). Radiology.2020;295(1):202-207.
• 15. Kong W, Agarwal PP. Chest Imaging Appearance of COVID-19 Infection. Radiology: Cardiothoracic Imag-ing 2020;2(1):e200028
• 16. Bernheim A, Mei X, Huang M, et al. Chest CT Findings in Coronavirus Disease-19 (COVID-19): Relationship to Du-ration of Infection. Radiology. 2020;295(3):200463.
• 17. Bai HX, Hsieh B, Xiong Z, et al. Performance of Radiologists in Differentiating COVID-19 from Non-COVID-19 Viral Pneumonia at Chest CT. Radiology. 2020;296(2):46-54.
• 18. Franquet T. Imaging of pulmonary viral pneumonia. Radiology. 2011;260(1):18-39.
• 19. Kligerman S, Raptis C, Larsen B, et al. Radiologic, Patho-logic, Clinical, and Physiologic Findings of Electronic Cigarette or Vaping Product Use-associated Lung Injury (EVALI): Evolving Knowledge and Remaining Questions. Radiology. 2020;294(3):491-505.
• 20. Ellis SJ, Cleverley JR, Müller NL. Drug-induced lung disease: high-resolution CT findings. AJR Am J Roentgenol. 2000;175(4):1019-1024.
• 21. Nishino M, Hatabu H, Hodi FS. Imaging of Cancer Immunotherapy: Current Approaches and Future Directions. Radiology. 2019;290(1):9-22.
• 22. Obadina ET, Torrealba JM, Kanne JP. Acute pulmonary injury: high-resolution CT and histopathological spectrum. Br J Radiol. 2013;86(1027):20120614.
• 23. Akçay M, Özlü T, Yılmaz A. Radiological approaches to COVID-19 pneumonia. Turkish Journal of Medical Sciences. 2020;50(S1):604-610.
• 24. Yang W, Sirajuddin A, Zhang X, et al. The role of imaging in 2019 novel coronavirus pneumonia (COVID-19). Eur Radiol. 2020;30(9):4874-4882.
• 25. 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.
• 26. Falaschi Z, Danna PSC, Arioli R, et al. Chest CT accuracy in diagnosing COVID-19 during the peak of the Italian epidemic: A retrospective correlation with RT-PCR testing and analysis of discordant cases. Eur J Radiol. 2020;130:109192.
• 27. Caruso D, Zerunian M, Polici M, et al. Chest CT Features of COVID-19 in Rome, Italy. Radiology. 2020;296(2):79-85.
• 28. Meng H, Xiong R, He R, et al. CT imaging and clinical course of asymptomatic cases with COVID-19 pneumonia at admission in Wuhan, China. J Infect. 2020;81(1):33-39.
• 29. Ye Z, Zhang Y, Wang Y, et al. Chest CT manifestations of new coronavirus disease 2019 (COVID-19): a pictorial review. Eur Radiol. 2020;30(8):4381-4389.
• 30. 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 Ko-rea. Korean J Radiol. 2020;21(4):494-500.
• 31. Shi H, Han X, Jiang N, et al. Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study. Lancet Infect Dis. 2020;20(4):425-434.
• 32. Song F, Shi N, Shan F, et al. Emerging 2019 Novel Coro-navirus (2019-nCoV) Pneumonia. Radiology. 2020;295(1):210-217.
• 33. Carotti M, Salaffi F, Sarzi-Puttini P, et al. Chest CT fea-tures of coronavirus disease 2019 (COVID-19) pneumonia: key points for radiologists. Radiol Med. 2020;125(7):636-646.