Abstract
A large part of the world is presently in the grip of the coronavirus disease (COVID-19) by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 virus), declared a pandemic in March 2020. This document is a brief commentary of the imaging modalities used in the screening, diagnosis and management of COVID-19 pneumonia. Chest x-rays, especially portable, still form a part of majority of official guidelines, with reports of the suggestive radiologic features. The potential of CT scan and ultrasound is also realised, with earlier detection rate. Typical radiologic findings of bilateral, asymmetrical, crazy-paved ground glass opacification, consolidation, reverse halo sign, opacities, progressing to fibrosis are well described for both the X-ray and CT scan. Atypical findings include airway changes, pleural effusion, pulmonary nodules and acute pulmonary embolism. Absence of lymphadenopathy, pleural effusion and pneumothorax is notable. The role of portable lung ultrasound, reported to be useful in emergency, is yet to be established in the guidelines. Disinfection of the equipment is a major concern. Governmental guidelines still advocate X-ray despite professional societies increasingly recommending CT scan.
Highlights
Viruses have been known to cause severe respiratory disease
There is a growing body of evidence regarding the imaging of pulmonary damage on chest X-ray, CT scan, and lately ultrasound.[2,3,4,5,6,7,8]
The original version included only segmental and lobar topography, while Huang et al improvised it to include the radiographic patterns as well, to consider the changes in CT appearances from simple ground glass opacification to crazy-paving, and frank consolidation.[12]. They found that serial CT monitored the progress, and noted that all recovered and discharged patients had residual radiologic signs despite clinical recovery, and PCRnegative status.[12]. It was based on these predictive patterns that machine based models were developed and artificial intelligence was employed to differentiate COVID-19 pneumonia from the non- COVID community-acquired pneumonia on chest CT with 90 % sensitivity, and 96% specificity (p
Summary
Viruses have been known to cause severe respiratory disease. The rise of Coronaviridae, considered a minor pathogen a few decades ago, to a feared name is astounding. The symptoms are non-specific; clinical course is not following any reliably predictable or defined pattern varying from asymptomatic carrier status, to mild flu-like to a severe pneumonia. Nucleic acid testing availability is falling short of the affected numbers. To top it all, the other respiratory pathogens have not declined, producing a dire need to differentiate between the COVID and non-COVID pulmonary disease. Documented severe pneumonia was described, combined with respiratory distress, cardiac injury and other features of acute systemic injury.[1] Since there is a growing body of evidence regarding the imaging of pulmonary damage on chest X-ray, CT scan, and lately ultrasound.[2,3,4,5,6,7,8]
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