Spectrum of HRCT findings among asymptomatic and recovered COVID-19 patients: how did they impact the clinical decision?

Abstract

BackgroundDecisions about asymptomatic COVID-19 patients are always critical, either during initial screening or during recovery. Spread of infection will be inevitable if those patients were left non-isolated. This study aimed not only to survey spectrum of HRCT findings of COVID-19 among asymptomatic and recovered patients but also to record unexpected results and document their impact upon the clinical decision.ResultsThe study was retrospectively conducted, during June and July 2020, on 120 patients proved with COVID-19, during initial HRCT screening or delayed following announcement of recovery. All patients were completely asymptomatic. They included 72 males and 48 females (60%:40%). Their age ranged from 10 to 58 years (mean 35.95 ± 12.25 SD). HRCT was analyzed by three expert consultant radiologists in consensus. Among asymptomatic initially screened COVID-19 patients, additional to GGOs, bilateral consolidative changes were unexpectedly found together with secondary fibrosis (23.3% and 10%). HRCT results significantly impacted the clinical decision (P < 0.0001); PCR had to be repeated with home isolation (43.3%). Infected health care providers had to stop their duty immediately (20%). Isolated hospitalization replaced routine ward admission (25%). Cautious surgical interference was performed using full personal protective equipment (PPE) (8.3%). Among asymptomatic recovered COVID-19 patients, unexpected large lesions (> 3 cm) were found (70%). Near 50% of lung volume was persistently affected (10%). Secondary fibrosis was striking (33%). Encysted hydro-pneumothorax persisted for a whole month (1.7%). “No-isolation” decision remained unchanged because of clinical and laboratory stability; however, steroids were prescribed to speed lung recovery.ConclusionHRCT findings among asymptomatic and recovered COVID-19 patients can be unexpected and can definitely impact the clinical decision.