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.
KEY WORDS: Coronavirus disease 2019, computed tomography chest, pneumonia, severe acute respiratory syndrome coronavirus-2
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
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 (white 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 (black arrow) and lymphadenopathy (gray arrow).
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.
SUPPLEMENTARY APPENDIX CONTENTS
1. List of personnel for Temple University COVID-19 Research Group
Name Department
Aaron Mishkin Infectious Disease
Abbas Abbas TMS
Abhijit S Pathak Surgery
Abhinav Rastogi Admin
Adam Diamond Pharmacy
Aditi Satti TMS
Adria Simon Emergency Medicine
Ahmed Soliman TMS
Alan Braveman TMS
Albert J Mamary TMS
Aloknath Pandya TMS
Amy Goldberg Surgery
Amy Kambo TMS
Andrew Gangemi TMS
Anjali Vaidya Cardiology
Ann Davison TMS
Anuj Basil Cardiology
Bakhos, Charles T TMS
Bill Cornwell TMS
Brianna Sanguily TMS
Brittany Corso Internal Medicine
Carla Grabianowski TMS
Carly Sedlock Infectious Disease
Catherine Myers TMS
Catherine Myers TMS
Charles Bakhos TMS
Chenna Kesava Reddy Mandapati TMS
Cherie Erkmen TMS
Chethan Gangireddy Cardiology
Chih-ru Lin TMS
Christopher T Burks Lab Administration
Claire Raab Internal Medicine
Crabbe, Deborah Cardiology
Crystal Chen Internal Medicine
Daniel Edmundowicz Cardiology
Daniel Sacher TMS
Daniel Salerno TMS
Daniele Simon Emergency Medicine
David Ambrose TMS
David Ciccolella TMS
Debra Gillman TMS
Dolores Fehrle TMS
Dominic Morano TMS
Donnalynn Bassler TMS
Edmund Cronin Cardiology
Eduardo Dominguez TMS
Ekam Randhawa TMS
Ekamjeet Randhawa TMS
Eman Hamad Cardiology
Eman Hamad Cardiology
Eneida Male TMS
Erin Narewski TMS
Francis Cordova TMS
Frederic Jaffe TMS
Frederich Kueppers TMS
Fusun Dikengil TMS
Galli, Jonathan TMS
Gangemi, Andrew TMS
Garfield, Jamie TMS
Gayle Jones TMS
Gennaro Calendo TMS
Gerard Criner TMS
Gilbert D’Alonzo TMS
Ginny Marmolejos TMS
Gordon, Matthew TMS
Gregory Millio Internal Medicine
Gupta, Rohit TMS
Gustavo Fernandez TMS
Hannah Simborio TMS
Harwood Scott TMS
Heidi Shore-Brown TMS
Hernan Alvarado Respiratory Care
Ho-Man Yeung Internal Medicine
Ibraheem Yousef TMS
Ifeoma Oriaku TMS
Iris Jung-won Lee Nephrology
Isaac Whitman Cardiology
James Brown TMS
Jamie L. Garfield TMS
Janpreet Mokha TMS
Jason Gallagher School of Pharmacy
Jeffrey Stewart TMS
Jenna Murray TMS
Jessica Tang TMS
Jeyssa Gonzalez TMS
Jichuan Wu TMS
Jiji Thomas TMS
Jim Murrett Ultrasound Fellow
Joanna Beros TMS
John M. Travaline TMS
Jolly Varghese TMS
Jordan Senchak Internal Medicine
Joseph Lambert TMS
Joseph Ramzy TMS
Joshua Cooper Cardiology
Jun Song Medical Student
Junad Chowdhury TMS
Kaitlin Kennedy TMS
Karim B Ahmed TMS
Karim Loukmane TMS
Karthik Shenoy TMS
Kathleen Brennan TMS
Keith Johnson TMS
Kevin Carney TMS
Kraftin Schreyer Emergency Medicine
Kristin Criner Endo
Kumaran, Maruti Radiology Kumaran Maruti Radiology
Lauren Miller TMS
Laurie Jameson TMS
Laurie Johnson TMS
Laurie Kilpatrick TMS
Lii-Yoong Criner TMS
Lily Zhang TMS
Lindsay K Mcgann Hospitalist
Llera A Samuels TMS
Marc Diamond TMS
Margaret Kerper TMS
Maria Vega Sanchez TMS
Mariola Marcinkienwicz TMS
Maritza Pedlar TMS
Mark Aksoy TMS
Mark Weir TMS
Marla R. Wolfson TMS
Marla Wolfson TMS
Marron, Robert TMS
Martin Keane Cardiology
Massa Zantah TMS
Mathew Zheng TMS
Matthew Delfiner Internal Medicine
Matthew Gordon TMS
Maulin Patel TMS
Megan Healy Emergency Medicine
Melinda Darnell TMS
Melinda Darnell TMS
Melissa Navaro TMS
Meredith A. Brisco-Bacik Cardiology
Michael Bromberg Hematology
Michael Gannon Cardiology
Michael Jacobs TMS
Mira Mandal TMS
Nanzhou Gou TMS
Narewski, Erin TMS
Nathaniel Marchetti TMS
Nathaniel Xander TMS
Navjot Kaur TMS
Neil Nadpara Internal Medicine
Nicole Desai Internal Medicine
Nicole Mills TMS
Norihisa Shigemura Surgery
Ohoud Rehbini TMS
Oisin O’Corragain TMS
Oisin O’Corragain TMS
Omar Sheriff TMS
Oneida Arosarena Otolaryngology
Osheen Abramian TMS
Paige Stanley TMS
Parag Desai TMS
Parth Rali TMS
Patrick Mulhall Pulm
Pravin Patil Cardiology
Priju Varghese Internal Medicine
Puja Dubal TMS
Puja Dubal TMS
Puja Patel TMS
Rachael Blair TMS
Rajagopalan Rengan TMS
Rami Alashram TMS
Randol Hooper TMS
Rebecca A Armbruster Chief Medical Officer
Regina Sheriden TMS
Robert Marron TMS
Roberto Caricchio Rheumatology
Rogers Thomas TMS
Rohit Gupta TMS
Rohit Soans Surgery
Roman Petrov TMS
Roman Prosniak TMS
Romulo Fajardo Surgery
Ruchi Bhutani TMS
Ryan Townsend TMS
Sabrina Islam Cardiology
Samantha Pettigrew Internal Medicine
Samantha Wallace TMS
Sameep Sehgal TMS
Samuel Krachman TMS
Santosh Dhungana TMS
Sarah Hoang TMS
Sean Duffy TMS
Seema Rani TMS
Shapiro William TMS
Sheila Weaver TMS
Shelu Benny TMS
Sheril George TMS
Shuang Sun TMS
Shubhra Srivastava-Malhotra TMS
Stephanie Brictson TMS
Stephanie Spivack Infectious Disease
Stephanie Tittaferrante Internal Medicine
Stephanie Yerkes TMS
Stephen Priest Internal Medicine
Steve Codella TMS
Steven G Kelsen TMS
Steven Houser Research
Steven Verga TMS
Sudhir Bolla TMS
Sudhir Kotnala TMS
Sunil Karhadkar Surgery
Sylvia Johnson TMS
Tahseen Shariff TMS
Tammy Jacobs TMS
Thomas Hooper TMS
Tom Rogers TMS
Tony S. Reed Chief Medical Officer
Tse-Shuen Ku TMS
Uma Sajjan TMS
Victor Kim TMS
Whitney Cabey Emergency Medicine
Wissam Chatila TMS
Wuyan Li TMS
Zach Dorey-Stein TMS
Zach Dorey-Stein TMS
Zachariah Dorey-Stein TMS
Zachary D Repanshek Emergency Medicine
*TMS – Thoracic Medicine and Surgery
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