Abstract
Coronavirus disease 2019 (COVID-19) is a novel infectious disease that spreads rapidly around the world and endangers global public health. Because of the lack of specificity of previously identified CT images, such as peripheral and subpleural ground glass opacities, early diagnosis is still a big challenge for radiologists. How to improve the accuracy of diagnosis and make diagnosis as early as possible is a problem concerned by the medical field. This article reports two important CT manifestations in COVID-19 patients, and investigates the pathogenesis and clinical significance of them. Single or multiple CT scans in COVID-19 patients confirmed at our hospital were retrospectively analyzed. The presence of vascular enlargement sign and bronchiolectasis sign on CT images were evaluated with the help of sophisticated post-processing techniques. A total of 14 patients (6 men and 8 women; mean ± standard deviation age: 41.51 ± 20.98 years) with 34 CT series were included. Vascular enlargement sign at a distribution of interior or the edge of pulmonary lesions was observed in all CT series (34/34, 100%). Bronchiolectasis sign was observed in 30 CT series (88%), with 4 series (4/7, 57.1%) in early stage, 16 series (16/16, 100%) in progressive stage, 5 series (5/5, 100%) in severe stage and 9 series (9/9, 100%) in absorption stage. The occurrence of bronchiolectasis sign in COVID-19 patients was significantly different between early stage and non-early stage (P=0.005). This study suggests that the vascular enlargement sign and bronchiolectasis sign are two important CT features in COVID-19 patients and may be of great significance in early diagnosis and guiding treatment decisions.
Highlights
In December, 2019, a series of coronavirus disease 2019 (COVID-19) cases emerged
The following computed tomography (CT) indicators were evaluated: (a) vascular enlargement sign, defined as the presence of dilated blood vessels in or around pulmonary lesions; (b) bronchiolectasis sign, defined as the dilated bronchioles in or around pulmonary lesions; and (c) disease severity based on radiologic findings: early stage, progressive stage, severe stage and absorptive stage [10]. In this retrospective study, we reported in detail the two important CT manifestations in COVID-19 patients, vascular enlargement sign and bronchiolectasis sign, and investigated their pathogenesis and clinical significance in combination with the latest autopsy pathology reports
Patient inclusion criteria were as follows: (a) Patients had a positive result of real-time reverse transcription polymerase chain reaction (RT-PCR) test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); (b) Patients underwent a single or multiple thin-section CT examinations at our hospital; (c) CT scans showed pulmonary abnormalities
Summary
In December, 2019, a series of coronavirus disease 2019 (COVID-19) cases emerged. As of early June, 2020, accumulatively six million cases with COVID-19 have been confirmed globally, of whom 370,000 died[7]. According to the Diagnosis and Treatment Plan for New Coronavirus Infected Pneumonia (Sixth Edition), radiologic findings, especially computed tomography (CT) manifestations, are of great significance in diagnosis and guiding therapeutic strategy[8]. With the accumulation of cases, a wider spectrum of radiologic findings has been reported, including crazy paving pattern, halo sign, reversed halo sign, cavity, etc[11,12,13,14]. We noticed the occurrence of vascular enlargement and bronchiolectasis in many COVID19 cases, may be helpful for early diagnosis and guiding treatment. The two signs have not been reviewed comprehensively with regard to the pathology and pathophysiology
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