Chest CT Manifestations Research Articles

Exploring the prevalence and chest CT predictors of Long COVID in children: a comprehensive study from Shanghai and Linyi.

COVID-19 constitutes a pandemic of significant detriment to human health. This study aimed to investigate the prevalence of Long COVID following SARS-CoV-2 infection, analyze the potential predictors of chest CT for the development of Long COVID in children. A cohort of children who visited the respiratory outpatient clinics at Shanghai Children's Medical Center or Linyi Maternal and Child Health Care Hospital from December 2022 to February 2023 and underwent chest CT scans within 1 week was followed up. Data on clinical characteristics, Long COVID symptoms, and chest CT manifestations were collected and analyzed. Multivariate logistic regression models and decision tree models were employed to identify factors associated with Long COVID. A total of 416 children were included in the study. Among 277 children who completed the follow-up, the prevalence of Long COVID was 23.1%. Chronic cough, fatigue, brain fog, and post-exertional malaise were the most commonly reported symptoms. In the decision tree model for Long COVID, the presence of increased vascular markings, the absence of normal CT findings, and younger age were identified as predictors associated with a higher likelihood of developing Long COVID in children. However, no significant correlation was found between chest CT abnormality and the occurrence of Long COVID. Long COVID in children presents a complex challenge with a significant prevalence rate of 23.1%. Chest CT scans of children post-SARS-CoV-2 infection, identified as abnormal with increased vascular markings, indicate a higher risk of developing Long COVID.

Clinical efficacy and safety of Xuanfei Touxie Fang as a complementary medicine in the treatment of SARS-CoV-2 Omicron variant: A retrospective study

IntroductionTo explore the clinical efficacy and safety of Xuanfei Touxie Fang (XFTXF) as a complementary medicine in the treatment of SARS-CoV-2 Omicron variant. MethodsA retrospective study of 317 patients with ordinary symptoms admitted to our hospital from December 2022 to February 2023 were divided into the observation group (n = 224) and the control group (n = 93). The observation group was treated with Xuanfei Touxie Fang combined with conventional treatment and the control group treated with conventional treatment alone. Recovery time of symptoms, length of hospital stay, clinical cure rate and recovery rate of chest CT manifestations were compared between the two groups. ResultsThe time to recover from fever (median: 1 vs 3 days) and the length of hospital stay (median: 7 vs 9 days) of the observation group after treatment were significantly shorter than the control group. The difference was statistically significant (P < 0.05). The clinical cure rate (68.3% vs 54.84 %) and the recovery rate of chest CT manifestations (87.95% vs 66.67 %) of the observation group after treatment were higher than the control group. The difference was statistically significant (P < 0.05). There was no adverse reactions during the treatment for two groups. The difference was no statistically significant (P > 0.05). DiscussionNumerous studies have demonstrated that Xuanfei Touxie Fang, which is frequently used in respiratory diseases, has anti-coronavirus effects by inhibiting viral replication, release, penetration, and RNA synthesis. Therefore, we treated COVID-19 with it and evaluated its safety and effectiveness. ConclusionsXuanfei Touxie Fang as a complementary medicine has a significant effect in the treatment of COVID-19, which can reduce the duration of fever and the length of hospital stay, improve the clinical cure rate and recovery rate of chest CT manifestations.

Clinical features and prognostic analysis of checkpoint inhibitor pneumonitis in patients with non-small cell lung cancer

Objective: To describe the clinical characteristics of patients with non-small cell lung cancer (NSCLC) who developed checkpoint inhibitor pneumonitis (CIP) and to explore potential prognostic factors. Methods: NSCLC patients who were complicated with CIP after immune checkpoint inhibitors (ICIs) therapy in our institute were enrolled in this study from 1 July 2018 to 30 November 2022. Clinical data of NSCLC-CIP patients were collected, including clinical and radiological features and their outcomes. Results: Among the 70 enrolled NSCLC-CIP patients, there were 57 males (81%) and 13 females (19%). The mean age at the diagnosis of CIP was (65.2±6.3) years. There were 46 smokers (66%), 26 patients (37%) with emphysema, 19 patients (27%) with previous interstitial lung disease, and 26 patients (37%) with a history of thoracic radiation. The mean interval from the first application of checkpoint inhibitor to the onset of CIP was (122.7±106.9) days (range: 2-458 days). The main chest CT manifestations were coincided with non-specific interstitial pneumonia (NSIP) pattern and organizing pneumonia (OP) pattern. Most patients had grade 2 (21 cases) or grade 3 (34 cases) CIP. Seventeen patients had been concurrent with other immune-related adverse events such as rash, hepatitis, colitis, and thyroiditis. Half of the enrolled patients (36 patients/51%) had fever, and most patients had elevated C-reactive protein (52 patients/72%) and all patients had elevated erythrocyte sedimentation rate (70 patients/100%). Serum lactate dehydrogenase was elevated in 34 CIP patients. Prednisone≥1 mg·kg-1·d-1 (or equivalent) was the most commonly used initial treatment in CIP patients (50 patients/71.4%). Complications with pulmonary infections (OR=4.44, P=0.03), use of anti-fungal drugs (OR=5.10, P=0.03) or therapeutic dose of sulfamethoxazole (OR=4.86, P=0.04), longer duration of prednisone≥1 mg·kg-1·d-1 (or equivalent) (Z=-2.33, P=0.02) were probable potential risk factors for poor prognosis. Conclusions: Older males with smoking history might be predisposed to develop NSCLC-CIPs after ICIs therapy. NSIP pattern and OP pattern were common chest CT manifestations. Complications with pulmonary infections (especially fungal infection or Pneumocystis jirovecii pneumonia), longer duration, longer duration of high-dose corticosteroids were likely potential risk factors for poor prognosis.

Clinical Characteristics of Lung Abscess Caused by Streptococcus Constellatus Infection.

This study aimed to understand the clinical characteristics of pulmonary abscess caused by Streptococcus constellatus infection. The clinical manifestations, laboratory examination, drug sensitivity, chest CT manifestations, and treatment and prognosis of patients with pulmonary abscess caused by Streptococcus constellatus infection were retrospectively collected and analyzed. A total of 9 cases of pulmonary abscess caused by Streptococcus constellatus infection were confirmed; one case was confirmed by traditional cultures, while metagenomic next-generation sequencing (mNGS) confirmed the other 8 cases. All of the 9 patients had different degrees of cough, sputum, fever, chest pain, and/or dyspnea, and the physical examination showed fast breathing, reduced respiratory sound, or moist rales on the affected side. In laboratory tests, 8 patients had elevated white blood cells and hypoproteinemia upon admission. Blood gas analysis showed an oxygenation index < 300. The antimicrobial susceptibility testing results in 1 patient with culture-confirmed pathogen diagnosis showed that Streptococcus constellatus was susceptible to ampicillin, penicillin G, cefotaxime, ceftriaxone, cefepime, meropenem, chloramphenicol, linezolid, levofloxacin, and vancomycin and resistant to tetracycline and clindamycin. Relevant antibiotic resistance genes were not detected by mNGS in the 8 patients with negative culture and positive mNGS results. A chest CT showed lung consolidation or cavity formation in 9 patients admitted to the hospital, and 5 patients had pleural effusion. 3 cases were admitted to the respiratory intensive care unit (RICU) and 6 cases were admitted to the general ward. There were 3 cases of nasal catheter oxygen inhalation, 1 case of mask oxygen inhalation, and 5 cases of non-invasive ventilator assisted ventilation. All patients received penicillin or respiratory quinolones anti-infection therapy, and 3 cases were treated with a thoracic closed drainage tube. All patients were discharged from the hospital after improvement, and the hospital stay was 15 - 23 days. Patients with pulmonary abscess caused by Streptococcus constellatus infection have an urgent condition and rapid progression. It is helpful to use mNGS combined with traditional culture as soon as possible to identify the pathogenic bacteria. Penicillin antibiotics should be the first choice for pulmonary abscess caused by a suspected Streptococcus constellatus infection. If a patient´s condition worsens during the treatment, especially for patients who have lesions involving the interlobar fissure or pleura, compressive atelectasis caused by pleural fluid formation or an increase in the amount of pleural effusion needs to be highly suspected.

Clinical characteristics of tracheobronchial Talaromyces marneffei infection in non-HIV-infected patients in South China

Objectives Tracheobronchial Talaromyces marneffei (T. marneffei) infections among non-HIV-infected patients are rare. To improve understanding, we analysed the clinical features, immune mechanisms, treatment, and prognosis. Methods Data on hospitalized patients with tracheobronchial T. marneffei infections from September 2013 to May 2022 were collected. The clinical and imaging features were analysed. Results Nineteen patients were enrolled, with a median age of 52 years (45–62 years). The most common symptoms were cough, expectoration, fever, weight loss, and anaemia. The total white blood cell and neutrophil counts, erythrocyte sedimentation rate, C-reactive protein, procalcitonin and globulin were increased, and the serum albumin levels were decreased. Chest CT manifestations included patchy shadows, masses, obstructive atelectasis, cavities, pleural effusion, and hilar and mediastinal lymphadenopathy. The fibreoptic bronchoscopy findings included masses, polyps or nodules with mucosal oedema, hypertrophic bulges, lumen stenosis or obstruction, and purulent secretions. T. marneffei infection was confirmed in 10 patients by positive culture, in five by both culture and metagenomic next-generation sequencing (mNGS), in two by mNGS, in one by culture and pathology and in 1 by histopathology. BALF (15/19, 78.9%) had the highest culture positive rate, followed by sputum (3/19), bronchial mucosa (1/1), lung biopsy (1/2); 36.8% of the patients were coinfected with other pathogens. For induction therapy, 7, 6, 2, and 4 patients received voriconazole, amphotericin B, voriconazole combined with amphotericin B, and fluconazole therapy, respectively, and 26.3% received treatment combined with nebulization and/or administration of amphotericin B under fibreoptic bronchoscopy. Four patients were treated for underlying diseases or coinfection, 31.6% were cured, 42.1% improved, and 26.3% died. Conclusions T. marneffei infection is common in the tracheobronchial airway tissue or secretions, and bronchoscopy has important diagnostic and treatment value. Antifungal therapy, including systemic therapy, involves triazoles and amphotericin administration, and aerosol inhalation and administration of amphotericin B under bronchoscopy are important.

Impact of Vaccination and the Omicron Variant on COVID-19-related Chest CT Findings: A Multicenter Study.

Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) omicron variant has a higher infection rate than previous variants but results in less severe disease. However, the impacts of omicron and vaccination on chest CT findings are difficult to evaluate. Purpose To investigate the impact of vaccination status and predominant variant on chest CT findings, diagnostic and severity scores in multicenter sample of consecutive patients referred to emergency departments for proven COVID-19. Materials and Methods This retrospective, multicenter study included adults referred to 93 emergency departments with SARS-CoV-2 infection according to RT-PCR and known vaccination status between July 2021 and March 2022. Clinical data and structured chest CT reports including semiquantitative diagnostic and severity scores following the French Society of Radiology-Thoracic Imaging Society guidelines were extracted from a teleradiology database. Observations were divided into 'delta-predominant', 'transition', and 'omicron-predominant' periods. Associations between scores and variant and vaccination status were investigated with Chi-square tests and ordinal regressions. Multivariable analyses evaluated the influence of omicron variant and vaccination status on the diagnostic and severity scores. Results Overall, 3876 patients were included (median age: 68 years [Q1-Q3: 54-80], 1695 females). Diagnostic and severity scores were associated with the predominant variant (delta- versus omicron-predominant, Chi-square=112.4 and 33.7, both P<.001) and vaccination (Chi-square=243.6 and 210, both P<.001) and their interaction (Chi-square=4.3, P=.04 and Chi-square=28.7, P<.001, respectively). In multivariable analyses, omicron variant was associated with lower odds of typical CT findings than delta variant (OR=0.46, P<.001). Two and three vaccine doses were associated with lower odds of demonstrating typical CT findings (OR=0.32 and OR=0.20, both P<.001), and of having high severity score (OR=0.47 and OR=0.33, both P<.001), compared with unvaccinated patients. Conclusion Both the omicron variant and vaccination were associated with less typical chest CT manifestations for COVID-19 and lesser extent of disease. See also the editorial by Yoon and Goo in this issue.

The diagnostic performance of endobronchial ultrasound with Xpert MTB/RIF Ultra in smear-negative pulmonary tuberculosis

ObjectiveThis study investigated the diagnostic performance of endobronchial ultrasound with Xpert MTB/RIF Ultra (Ultra) for detecting smear-negative pulmonary tuberculosis (TB).Methods143 patients suspected of sputum smear-negative pulmonary tuberculosis were enrolled in this study in Shanghai Pulmonary Hospital, China. These patients underwent endobronchial ultrasound with a guide sheath (EBUS-GS) or endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) based on their chest CT manifestations. We assessed the sensitivity and specificity of tissue specimens with Ultra in the TB group and non-TB group. Culture and clinical diagnosis were used as gold-standard for TB.ResultsAmong these 143 patients, 11 patients were culture-positive TB, 85 patients were diagnosed with culture-negative TB and 47 were with the non-TB diseases. Direct testing with microscopy (Acid-Fast Bacilli smear, AFB), liquid culture, pathology, Xpert MTB/RIF(Xpert) test and Ultra had a sensitivity of 8.3%, 11.5%, 42.7%, 64.6%, and 78.1% individually among all the TB patients. Ultra had a higher sensitivity than Xpert (P = 0.011). But Ultra had a specificity of 59.6% (95% CI 44.3–73.3), lower than that of Xpert (89.4%, 95% CI 76.1–96.0, P = 0.001). Ultra had the same sensitivity on specimens from EBUS-TBNA and EBUS-GS (P = 0.975). Ultra’s positive predictive value and negative predictive value were 79.8% and 57.1% respectively.ConclusionsTissue specimens from interventional bronchoscopy combined with Ultra provide a sensitive method for diagnosing smear-negative pulmonary tuberculosis, but its specificity was lower than Xpert.

Severe asthma as the initial clinical manifestation of IgG4-related disease: a retrospective clinical study

BackgroundRespiratory involvement is common in immunoglobulin G4-related disease (IgG4-RD). However, severe asthma as the initial clinical manifestation of IgG4-RD is rare and might be neglected by respiratory clinicians. We aimed to explore the clinical characteristics and prognoses of patients with immunoglobulin G4-related disease (IgG4-RD) manifesting as severe asthma.MethodsA retrospective analysis of the clinical characteristics and prognoses of patients with severe asthma who were eventually diagnosed with IgG4-RD was performed in the Peking Union Medical College Hospital from 2013 to 2019.ResultsTwelve patients (5males, 7 females) were included. The mean age at enrollment and age of asthma onset were 59.4 ± 10.1 and 53.8 ± 10.4 years, respectively. The mean duration of asthma symptoms was 5.7 ± 2.0 years. In all patients, the proportion (25.1 ± 10.3%) and count (2.0 ± 1.1) × 109/L of eosinophils in peripheral blood increased. Additionally, all patients exhibited elevated total immunoglobulin E [IgE, (1279.3 ± 1257.9) KU/L] and IgG4 (9155.8 ± 9247.6) mg/dL. Bronchial wall thickening (n = 11) and mediastinal/hilar lymphadenopathy (n = 11) were major chest CT manifestations. All were pathologically diagnosed through surgical biopsy; submandibular gland (n = 8), supraclavicular lymph node (n = 2), stomach (n = 1), rashes (n = 1), lacrimal gland (n = 1) and thoracoscopic lung (n = 1) biopsies were performed. Asthma was well controlled by oral glucocorticoids (GCs), but some patients relapsed during tapering (n = 11). The refractory condition was controlled after increasing the dosage of GCs and add-on immunosuppressants.ConclusionsFor patients with middle age-onset severe asthma with elevated eosinophils, total IgE and IgG4 levels and available salivary gland ultrasound imaging, ruling out IgG4-RD is recommended. GCs used in combination with immunosuppressants is recommended to prevent relapse.

CT-based severity assessment for COVID-19 using weakly supervised non-local CNN

Evaluating patient criticality is the foremost step in administering appropriate COVID-19 treatment protocols. Learning an Artificial Intelligence (AI) model from clinical data for automatic risk-stratification enables accelerated response to patients displaying critical indicators. Chest CT manifestations including ground-glass opacities and consolidations are a reliable indicator for prognostic studies and show variability with patient condition. To this end, we propose a novel attention framework to estimate COVID-19 severity as a regression score from a weakly annotated CT scan dataset. It takes a non-locality approach that correlates features across different parts and spatial scales of the 3D scan. An explicit guidance mechanism from limited infection labeling drives attention refinement and feature modulation. The resulting encoded representation is further enriched through cross-channel attention. The attention model also infuses global contextual awareness into the deep voxel features by querying the base CT scan to mine relevant features. Consequently, it learns to effectively localize its focus region and chisel out the infection precisely. Experimental validation on the MosMed dataset shows that the proposed architecture has significant potential in augmenting existing methods as it achieved a 0.84 R-squared score and 0.133 mean absolute difference.

Significance of Chest Computed Tomography Scan Findings at Time of Diagnosis in Patients with COVID-19 Pneumonia

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 &lt; 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.

Chest CT features of children infected by B.1.617.2 (Delta) variant of COVID-19.

BackgroundThis study aimed to explore the imaging characteristics, diversity and changing trend in CT scans of pediatric patients infected with Delta-variant strain by studying imaging features of children infected with Delta and comparing the results to those of children with original COVID-19.MethodsA retrospective, comparative analysis of initial chest CT manifestations between 63 pediatric patients infected with Delta variant in 2021 and 23 pediatric patients with COVID-19 in 2020 was conducted. Corresponding imaging features were analyzed. In addition, the changing trend in imaging features of COVID-19 Delta-variant cases were explored by evaluating the initial and follow-up CT scans.ResultsAmong 63 children with Delta-variant COVID-19 in 2021, 34 (53.9%) showed positive chest CT presentation; and their CT score (1.10 ± 1.41) was significantly lower than that in 2020 (2.56 ± 3.5) (P = 0.0073). Lesion distribution: lung lesions of Delta cases appear mainly in the lower lungs on both sides. Most children had single lobe involvement (18 cases, 52.9%), 14 (41.2%) in the right lung alone, and 14 (41.2%) in both lungs. A majority of Delta cases displayed initially ground glass (23 cases, 67.6%) and nodular shadows (13 cases, 38.2%) in the first CT scan, with few extrapulmonary manifestations. The 34 children with abnormal chest CT for the first time have a total of 92 chest CT examinations. These children showed a statistically significant difference between the 0–3 day group and the 4–7 day group (P = 0.0392) and a significant difference between the 4–7 day group and the more than 8 days group (P = 0.0003).ConclusionsThe early manifestations of COVID-19 in children with abnormal imaging are mostly small subpleural nodular ground glass opacity. The changes on the Delta-variant COVID-19 chest CT were milder than the original strain. The lesions reached a peak on CT in 4–7 days and quickly improved and absorbed after a week. Dynamic CT re-examination can achieve a good prognosis.

Chest CT Patterns from Diagnosis to 1 Year of Follow-up in Patients with COVID-19.

BackgroundThe chest CT manifestations of COVID-19 from hospitalization to convalescence after 1 year are unknown.PurposeTo assess chest CT manifestations of COVID-19 up to 1 year after symptom onset.Materials and MethodsPatients were enrolled if they were admitted to the hospital because of COVID-19 and underwent CT during hospitalization at two isolation centers between January 27, 2020, and March 31, 2020. In a prospective study, three serial chest CT scans were obtained at approximately 3, 7, and 12 months after symptom onset and were longitudinally analyzed. The total CT score of pulmonary lobe involvement, ranging from 0 to 25, was assessed (score of 1–5 for each lobe). Univariable and multivariable logistic regression analyses were performed to explore independent risk factors for residual CT abnormalities after 1 year.ResultsA total of 209 study participants (mean age, 49 years ± 13 [standard deviation]; 116 women) were evaluated. CT abnormalities had resolved in 61% of participants (128 of 209) at 3 months and in 75% of participants (156 of 209) at 12 months. Among participants with chest CT abnormalities that had not resolved, there were residual linear opacities in 25 of the 209 participants (12%) and multifocal reticular or cystic lesions in 28 of the 209 participants (13%). Age 50 years or older, lymphopenia, and severe or aggravation of acute respiratory distress syndrome were independent risk factors for residual CT abnormalities at 1 year (odds ratios = 15.9, 18.9, and 43.9, respectively; P < .001 for each comparison). In 53 participants with residual CT abnormalities at 12 months, reticular lesions (41 of 53 participants [77%]) and bronchial dilation (39 of 53 participants [74%]) were observed at discharge and were persistent in 28 (53%) and 24 (45%) of the 53 participants, respectively.ConclusionOne year after COVID-19 diagnosis, chest CT scans showed abnormal findings in 53 of the 209 study participants (25%), with 28 of the 209 participants (13%) showing subpleural reticular or cystic lesions. Older participants with severe COVID-19 or acute respiratory distress syndrome were more likely to develop lung sequelae that persisted at 1 year.© RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Lee and Wi et al in this issue.

Chinese herbal medicine ("3 medicines and 3 formulations") for COVID-19: rapid systematic review and meta-analysis.

BackgroundTo evaluate the evidence behind claims that Chinese Herbal Medicine, specifically “three medicines and three formulations” (3M3F, comprising Jinhua Qinggan, Lianhua Qingwen, Xuebijing, Qingfei Paidu, Huashi Baidu, and Xuanfei Baidu), is an effective treatment for COVID‐19.MethodsWe searched PubMed, MEDLINE and CNKI databases, preprint servers, clinical trial registries and supplementary sources for Chinese‐ or English‐language randomized trials or non‐randomized studies with comparator groups, which tested the constituents of 3M3F in the treatment of COVID‐19 up to September 2020. Primary outcome was change in disease severity. Secondary outcomes included various symptoms. Meta‐analysis (using generic inverse variance random effects model) was performed when there were two or more studies reporting on the same symptom.ResultsOf 607 articles identified, 13 primary studies (6 RCTs and 7 retrospective non‐randomized comparative studies) with 1467 participants met our final inclusion criteria. Studies were small and had significant methodological limitations, most notably potential bias in assessment of outcomes. No study convincingly demonstrated a statistically significant impact on change in disease severity. Eight studies reported sufficiently similar secondary outcomes to be included in a meta‐analysis. Some statistically significant impacts on symptoms, chest CT manifestations, laboratory variables and length of stay were demonstrated, but such findings were sparse and many remain unreplicated.ConclusionsThese findings neither support nor refute the claim that 3M3F alters the severity of COVID‐19 or alleviates symptoms. More rigorous studies are required to properly ascertain the potential role of Chinese Herbal Medicine in COVID‐19.

Typical, rare and atypical CT findings in COVID-19 pneumonia: A pictorial review

Objectives: The objective of this pictorial review is to make radiologists and clinicians familiar with the typical, atypical and rare CT findings of COVID-19 pneumonia to help in diagnosis as well as in monitoring disease. Main text: Bilateral ground-glass opacities, whether isolated or coexisting with consolidations, and typically in basal, posterior and peripheral lungs are the key findings in COVID-19 pneumonia. With further analysis other typical, atypical and rare CT findings are described and we need to keep in mind that the radiological presentation is dynamic with a rapid evolutive phase, peaking at 10-11 days, and a subsequent absorption phase after 14 days with a decrease in opacities and increase in repairing signs. Conclusion: The presence of typical findings of COVID-19 pneumonia on a chest CT scan during the pandemic outbreak of SARSCoV-2 helps in diagnostic analysis. Chest CT scan has a reported sensitivity of 97-98% in times with a high pre-test probability. Some CT findings (crazy paving pattern and pleural effusion) as well as an increasing percentage of lung opacities are associated with a worse patient outcome, emphasizing the role of chest CT in determining the risk of disease progression. Furthermore chest CT scan is also useful in monitoring disease control. With these acknowledgement we want to give a useful overview of the chest CT manifestations in COVID-19 pneumonia to help decision making in daily practice. Keywords: COVID-19; SARS-CoV-2; tomography; X Ray computed; diagnosis.

Pulmonary cavitation in patients with COVID-19

Pulmonary cavitation in patients with COVID-19

Chest CT manifestations with emphasis on the role of CT scoring and serum ferritin/lactate dehydrogenase in prognosis of coronavirus disease 2019 (COVID-19)

BackgroundIn March 2020, the World Health Organization announced coronavirus disease 2019 (COVID-19) a pandemic, and because of the primary pulmonary manifestations of the disease, chest CT is essential in the evaluation of those patients. The aim of the study was to evaluate the role of chest CT findings and chest CT scoring along with serum ferritin and LDH in the prognosis of COVID-19 patients in a cohort of the Egyptian population.ResultsThis retrospective study included 250 patients with positive RT-PCR for COVID-19, 138 males [55.2%] and 112 females [44.8%], age range 17–82 years with median 49.5. Two hundred patients had a positive significant correlation between age, serum ferritin, serum LDH, and CT score. Bilateral affection was 88% while unilaterality was 12%, and peripheral chest CT findings were stratified as follows: mild [score from 1 to 10], 114 patients [57%]; moderate [score from 11 to 19], 65 patients [32.5%]; and severe [score from 20 to 25], 21 patients [10.5%]. In severe cases, males constitute 85.7% while females were only 14.3%. Statistical and central distribution was 67%, peripheral was 31%, and central was 2%. Ground glass opacity (GGO) was the highest pattern 39.2%, consolidation 31.2%, fibrosis 15.2%, and CP 13.7%, with lymph nodes only 0.6%. Fifteen cases [6%] were critical; all showed severe scores ranging from 21 to 23 with three times increase in serum ferritin and four times increase in LDH. A follow-up study done to 8 cases [3.2%] showed an increase in CT scoring, serum ferritin, and serum LDH.ConclusionChest CT findings are crucial for early diagnosis of COVID-19 disease especially for asymptomatic patients with old age and male sex considered risk factors for poor prognosis. Chest CT score, serum ferritin, and serum LDH help in predicting the short-term outcome of the patients aiming to decrease both morbidity and mortality.

A Comparative Study of Chest Computed Tomography Findings: 1030 Cases of Drug-Sensitive Tuberculosis versus 516 Cases of Drug-Resistant Tuberculosis

PurposeTo investigate the CT features of drug-resistant pulmonary tuberculosis (DR-PTB) and the diagnostic value of CT in DR-PTB diagnosis to provide imaging evidence for the timely detection of drug-resistant Mycobacterium tuberculosis.Materials and MethodsA total of 1546 cases of pulmonary tuberculosis (PTB) with complete clinical data, chest CT images and defined drug sensitivity testing results were consecutively enrolled; 516 cases of DR-PTB were included in the drug-resistant group, and 1030 cases of drug-sensitive pulmonary tuberculosis (DS-PTB) were included in the drug-sensitivity group. Comparative analyses of clinical symptoms and imaging findings were conducted. Univariate and logistic regression analyses were performed, a regression equation model was developed, and the receiver operating characteristic (ROC) curve was constructed.ResultsIn the univariate analysis, some features, including whole-lung involvement, multiple cavities, thick-walled cavities, collapsed lung, disseminated lesions along the bronchi, bronchiectasis, emphysema, atelectasis, calcification, proliferative lesions, encapsulated effusion, etc., were observed more frequently in the DR-PTB group than in the DS-PTB group, and the differences were statistically significant (p<0.05). Exudative lesions and pneumoconiosis were observed more frequently in the drug-sensitivity group than in the drug-resistant group (p<0.05). Logistic regression analysis indicated that whole-lung involvement, multiple cavities, thick-walled cavities, disseminated lesions along the bronchi, bronchiectasis, and emphysema were independent risk factors for DR-PTB, and exudative diseases were protective factors. The total prediction accuracy of the regression model was 80.6%, and the area under the ROC curve (AUC) was 82.6%.ConclusionChest CT manifestations of DR-PTB had certain characteristics that significantly indicated the possibility of drug resistance in tuberculosis patients, specifically when multifarious imaging findings, including multiple cavities, thick-walled cavities, disseminated lesions along the bronchi, whole-lung involvement, etc., coexisted simultaneously. These results may provide imaging evidence for timely drug resistance detection in suspected drug-resistant cases and contribute to the early diagnosis of DR-PTB.

Chinese Herbal Medicine Used With or Without Conventional Western Therapy for COVID-19: An Evidence Review of Clinical Studies.

Objective: To present the evidence of the therapeutic effects and safety of Chinese herbal medicine (CHM) used with or without conventional western therapy for COVID-19. Methods: Clinical studies on the therapeutic effects and safety of CHM for COVID-19 were included. We summarized the general characteristics of included studies, evaluated methodological quality of randomized controlled trials (RCTs) using the Cochrane risk of bias tool, analyzed the use of CHM, used Revman 5.4 software to present the risk ratio (RR) or mean difference (MD) and their 95% confidence interval (CI) to estimate the therapeutic effects and safety of CHM. Results: A total of 58 clinical studies were identified including RCTs (17.24%, 10), non-randomized controlled trials (1.72%, 1), retrospective studies with a control group (18.97%, 11), case-series (20.69%, 12) and case-reports (41.38%, 24). No RCTs of high methodological quality were identified. The most frequently tested oral Chinese patent medicine, Chinese herbal medicine injection or prescribed herbal decoction were: Lianhua Qingwen granule/capsule, Xuebijing injection and Maxing Shigan Tang. In terms of aggravation rate, pooled analyses showed that there were statistical differences between the intervention group and the comparator group (RR 0.42, 95% CI 0.21 to 0.82, six RCTs; RR 0.38, 95% CI 0.23 to 0.64, five retrospective studies with a control group), that is, CHM plus conventional western therapy appeared better than conventional western therapy alone in reducing aggravation rate. In addition, compared with conventional western therapy, CHM plus conventional western therapy had potential advantages in increasing the recovery rate and shortening the duration of fever, cough and fatigue, improving the negative conversion rate of nucleic acid test, and increasing the improvement rate of chest CT manifestations and shortening the time from receiving the treatment to the beginning of chest CT manifestations improvement. For adverse events, pooled data showed that there were no statistical differences between the CHM and the control groups. Conclusion: Current low certainty evidence suggests that there maybe a tendency that CHM plus conventional western therapy is superior to conventional western therapy alone. The use of CHM did not increase the risk of adverse events.

Radiological perspective of COVID-19 pneumonia: The early features and progressive behaviour on high-resolution CT.

SummarySince the outbreak of Coronavirus disease 2019 (COVID‐19) in China, many researchers have reported the chest CT manifestations of COVID‐19 pneumonia. High‐resolution CT (HRCT) of the lung can provide important clues to understand the progressive behaviour of COVID‐19 pneumonia. This pictorial essay discusses the early features and potential progressive behaviour of COVID‐19 on HRCT of the lung.

Spectrum of chest CT manifestations of coronavirus disease (COVID-19): A pictorial essay in rural population

Spectrum of chest CT manifestations of coronavirus disease (COVID-19): A pictorial essay in rural population