Significance of chest computed tomography scan findings at time of diagnosis in patients with COVID-19 pneumonia

Abstract

Background and objectives: Many published reports demonstrated the cardinal hallmark of COVID-19 infection, such as bilateral ground glass opacities (GGO) with or without consolidation in posterior and peripheral lungs fields. Various CT algorithms including CT scoring system were used to assess quantitively and qualitatively the severity of COVID-19 pneumonia. The aim of this study was to summarize the significance of certain radiological features in evaluating Covid-19 pneumonia severity in Iraqi patients. Materials and methods: This was a cross sectional study conducted in Erbil tertiary hospitals in Iraq from June 2020, until August 2020. Review of chest CT scan for 132 patients was done and the main chest CT manifestations of patients with COVID-19 infection was reported. Then, CT scoring system was implicated in a quantitative comparison with radiological findings observed in chest CT examinations of patients having different disease severity at time of diagnosis. Results: The mean age of study sample was 51.08 ±14.2 years. The typical CT findings were consistent with mainly GGOs (78.8%) followed by consolidation. Atypical CT patterns according to previous reports were also observed including tree in bud, crazy paving, bronchiectasis, round organizing pneumonia, pulmonary nodules, mediastinal lymphadenopathy, cavitation and pleural thickening. Lung involvement was significantly more in the lower lobes than upper lobes. CT severity score was significantly higher in the lower lobes as well. Chest CT severity score (CT-SS) was significantly higher in cases with most common pathological lung changes (p < 0.001) except for tree in bud, crazy paving and cavitation. Conclusion: CT-SS is an essential examination tool in the diagnosis, disease severity evaluation and lobar extension of COVID-19 infection. High CT-SS are significantly associated with certain chest CT findings like GGOs, consolidation, bronchiectasis and interlobular septa thickening which reflects the seriousness of such CT findings in COVID-19 at time of diagnosis.