Novel coronavirus pneumonia: Clinical manifestation and computed tomography features

To the editor,

In December 2019, a novel coronavirus (2019 novel coronavirus, 2019-nCoV) infection1, 2, 3 was reported in Wuhan, Hubei. On February 7, 2020, the novel coronavirus was named by the National Health Commission of the People's Republic of China as Xinguanfeiyan, with an English name of “Novel Coronavirus Pneumonia” (NCP).^{4 , 5}

Clinical data and CT image characteristics of 23 patients with NCP treated in the First Affiliated Hospital of Zhengzhou University, Xinyang Central Hospital and Zhumadian Central Hospital were analyzed and summarized.

This study is a retrospective study. A total of 23 patients with NCP admitted to the First Affiliated Hospital of Zhengzhou University, Xinyang Central Hospital and Zhumadian Central Hospital and who had tested positive for 2019-nCoV from January 11, 2020 to February 1, 2020 were included as the subjects. The clinical and CT features of these 23 patients were analyzed.

All 23 patients with NCP had fever; of these patients, three (13.0%) had a high fever, 10 (43.4%) had a moderate fever, and 10 (43.4%) had a low fever. All patients exhibited varying degrees of cough, expectoration, sore throat, and headache. Seventeen patients (73.9%) were from Wuhan, and six patients (26.1%) had not been to Wuhan.

All 23 patients underwent chest CT non-enhanced scanning. Their imaging findings are shown in Table 1 . The early CT images revealed single or multiple ground-glass shadows (GGS) in one or both of the lungs (Fig. 1 A and B). CT of the progressive stage lesions revealed an increase in the number of lesions, enlargement of scope, and increase in the density of the lesions. Some of the lesions had fused into large areas, which gradually involved multiple lobes of two lungs (Fig. 1C and D). CT of severe stage lesions revealed diffuse lesions in both lungs. The density was uneven, the lesions were mainly consolidated, and there were ground-glass-like increased density shadows, which were mostly accompanied by fiber streak shadows (Fig. 1E and F).

Table 1.

Table of characteristics of different stages in CT images of COVID-19 patients.

Stage	Case	Lesion location			Number of lesions		Lesions border		Lesions form			Lesion density
		Left lung	Right lung	Two lungs	Single	Multiple	Clear	Blurred	Pulmonary subsegment	Pulmonary segment	Lung lobe	Ground glass opacity	Consolidation	Mixed
Early period	6	1	2	3	3	3	4	2	2	4		6
Progressive period	13			13		13		13		2	11	11		2
Critical period	4			4		4		4			4			4

Fig. 1.

A & B: This is a 44-year-old female NCP patient. Early chest CT revealed multiple GGO with thickening of blood vessels in both lungs. C & D: This is a 56-year-old female NCP patient. Progressive chest CT revealed multiple patchy GGO and consolidation in both lungs, increased density and fibrosis. E & F: This is a 65-year-old male NCP patient. Chest CT revealed diffuse lesions in both lungs, with uneven density, high ground glass density shadows and consolidation shadows coexisting, air bronchogram could be seen in the lesions.

The epidemiological history of NCP differs from the above diseases. However, it is currently also peak flu season; therefore, the flu must be excluded. At the present time, when imaging findings such as exudation, consolidation, and nodules are found in the lung, the diagnosis of suspected cases or clinically confirmed cases is made according to the Novel Coronavirus Pneumonia Diagnosis and Treatment Plan (fifth trial version, revised version) published by the National Health Commission; in addition, based on the epidemiological history, clinical characteristics, and imaging findings, a novel coronavirus nucleic acid test is needed for the final diagnosis.

This study has the following limitations: first, it was a retrospective study, not a randomized controlled trial, and there was no control group; therefore, there is a certain risk of bias. Secondly, this study was a single-center clinical trial, and the included sample size was small, which means that further multi-center clinical trials with larger sample sizes are needed. Finally, in this study, the risk factors for NCP were not analyzed, and additional research is needed in this regard.

Declaration of competing interest

The authors declare that they have no competing interests.

Funding

None.

Ethics approval and consent to participate

The present study met the requirements of the Declaration of Helsinki of the World Medical Association. As this study did not require any intervention or experiment related to patients, no informed consent was required after review by the Ethics Committee of our hospital.

Appendix A. Supplementary data

The following is the Supplementary data to this article: