Role of imaging (X-ray & HRCT) chest in diagnosis, management and prognosis of COVID-19 pneumonia

Abstract

Objective: Our main aim is to have accurate diagnosis using chest x-ray as preliminary investigation in a developing country like India. However HRCT chest is indicated for moderate, severe cases & follow up of patient. The radiological findings are correlated with RT-PCR test & clinical features of covid-19 pneumonia cases. The case fatality rate in India has declined to 1.94% due to increase in testing rate, taking precautions like mask wearing & sanitizing hands frequently, maintaining social distancing & increase number of dedicated covid hospital in each district of India. Methods: The clinical features, laboratory & radiological findings were analyzed in 250 covid-19 patients and confirmed by RT-PCR, from 10th May 2020 to 31th August 2020, admitted in our dedicated covid-19 hospitals of G.S. Medical College, Hapur, NCR, India. Results: The common clinically findings reported in covid-19 pneumonia cases were fever, sore throat, cough, breathlessness, Myalgia, loss of smell & taste. The initial investigation x-ray chest were done of all patients, 45% patients showed ground glass opacities as haziness. Out of the 250 patients, 32% patients showed bilateral patchy opacities involving peripheral lung. While 68% patients showed bilateral basal lung involvement.62% patients revealed peripherally lesions in Sub pleural area & bilateral basal region. The CT. lesions were located both in peripheral & central location (32%). C.T severity scoring (CTSS) is strongly recommended to assess progression or regression of GGO’s & consolidative lesions, at the time of admission & follow up. C.T findings are seen as ground glass opacities, (uni / bilateral), presence of nodules, round & cystic changes, consolidation, reticular pattern, crazy- paving pattern, pleural thickening / effusion, lymphadenopathy, bronchiolectasis.On HRCT CHEST, 78% patients were reported as multi focal, multiple ground glass opacities located in Sub pleural, mid & basal region. 31% patients showed uni or bilateral patchy consolidation.52% showed bilateral patchy peripheral location. C.T. severity scores of I.C.U patients were found higher as compare to patients from isolation ward.Conclusion: X-ray chest plays an initial role in level 1 & level 2 cases with mild findings while HRCT chest is recommended in moderately affected & ICU patients (severe) cases with or without co-morbidities like diabetes, hypertension, COPD, > 60 yrs of age with positive findings in x ray chest involving bilateral 4 or 5 lobes and having strong clinical features.- There is crucial role of HRCT chest in diagnosis of covid-19 pneumonia, particularly for those patients, who have a negative RT-PCR initially. - The important role of HRCT chest in diagnosis, severity scoring and for Management of patients, in Prognosis & follow- up.