Common Chest Computed Tomography Research Articles

The Differential Diagnostic Value of Chest Computed Tomography for the Identification of Pathogens Causing Pulmonary Infections in Patients with Hematological Malignancies.

The role of chest computed tomography (CT) in distinguishing the causative pathogens of pulmonary infections in patients with hematological malignancies (HM) is unclear. The aim of our study was to compare and assess the clinical characteristics, radiologic features and potential differential diagnostic value of CT in HM patients and other different immune statuses patients with pulmonary infections. Patients were divided into immunocompetent (105 cases) and immunocompromised groups (99 cases) according to immune status. Immunocompromised patients included the HM group (63 cases) and the non-HM group (42 cases). The basic clinical data and CT findings were collected and statistically analyzed. Regarding the pathogen distribution, viral, Pneumocystis jirovecii and mixed infections were more common in the immunocompromised group than the immunocompetent (p < 0.01), but viral infections were more common in the HM group than in the non-HM group (p=0.013). Immunocompromised patients had more diverse CT findings and more serious lesions (mostly graded 2-4) than immunocompetent patients. The most common CT findings in HM patients were consolidation and ground-glass opacities (GGO), which were also found in the non-HM group. The overall diagnostic accuracy of CT was lower in immunocompromised patients than in immunocompetent patients (25.7% vs 50.5%, p< 0.01). CT had better diagnostic efficacy for fungi and Pneumocystis jirovecii in HM patients. CT diagnosis is less efficient in distinguishing the causative pathogens of HM patients. However, CT can help distinguish fungal pneumonia and Pneumocystis jirovecii pneumonia in HM patients. Our study might facilitate clinical decision-making in fungal pneumonia and Pneumocystis jirovecii pneumonia in HM patients.

A Cross-Sectional Study Conducted in Tehran, Iran, Analyzed the Typical Patterns of Primary Lung CT Scans in Critically Ill COVID-19 Patients Using a Semi-Quantitative Scoring System

Background: Given the ongoing COVID-19 global pandemic and the potential for respiratory failure in several COVID-19 patients, early diagnosis and timely treatment are of paramount importance. Objectives: In this context, we aimed to investigate the role of initial chest computed tomography (CT) in predicting the severity of COVID-19. Methods: The study, conducted at Imam Hossein Hospital between March 6, 2020, and May 6, 2020, was cross-sectional in nature. All patients diagnosed with severe to critical COVID-19 underwent high-resolution chest CT (HRCT), and the findings of the chest CT were meticulously analyzed using a semi-quantitative scoring system. Results: Out of 47 patients with severe to critical COVID-19, 72.4% were male, with a mean age of 62 ± 14 years. The most common chest CT findings were ground-glass opacity (55%) and consolidation (30%). Bilateral involvement was observed in all patients, with the most frequently affected areas being the peribronchovascular distribution (76%) and peripheral distribution (74%). Most patients had pulmonary involvement across all five lobes, with scores ranging from a minimum of 3.25 to a maximum of 21.25 (CI: 12 - 15; mean: 13.25). Conclusions: This study suggests a relationship between the initial chest CT scan findings and the severity of respiratory disease in COVID-19 patients. However, further studies are needed to confirm these findings.

Clinical and radiological features of a cluster of immunocompetent adolescents with varicella pneumonia: a descriptive study.

Varicella pneumonia is one of the most common and severe complications of chickenpox infection. This study aimed to describe the clinical and radiological features of varicella pneumonia in a cluster of immunocompetent adolescents. A retrospective analysis was conducted on a cohort of adolescent patients diagnosed with varicella pneumonia at Wuhan Jinyintan Hospital between February 2023 and May 2023. The clinical and imaging data were collected and analyzed. A total of 116 patients were divided into two groups by the absence (group 1, n=57) or presence (group 2, n=59) of lower respiratory symptoms for data comparison. Among 116 patients (median age, 16 years; 60 males), rash (100%) was the most prevalent clinical symptom. The most common respiratory symptom and sign were fever (42.2%) and coarse breath sounds (41.4%). Chest computed tomography (CT) performed within five days of symptoms onset revealed multiple (89.7%), peripheral (51.7%), and ill-defined (73.3%) lung nodules in most patients, which gradually improved 6-10 days after symptom onset. Group 2 had higher levels of interleukin-6 (P<0.001), C-reactive protein (P=0.02), serum amyloid-A protein (P=0.002), longer hospital stays (P=0.04), more involved lung lobes (P=0.02), and a higher incidence of multiple nodules (P=0.043) than those of group 1. In immunocompetent adolescents, clustered varicella pneumonia often presents as mild and more uniform in clinical and radiological presentations than sporadic cases. The most common CT findings were multiple pulmonary nodules. Patients with lower respiratory symptoms exhibited more severe clinical and radiological manifestations. Generally, it is not recommended that patients undergo frequent CT scans in a short period.

Temporal Evolution of CT Findings in COVID-19 Patients: An Observational Study

Introduction: Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), presents a broad spectrum of clinical manifestations, from asymptomatic cases to severe pneumonia and acute respiratory distress syndrome (ARDS). Chest computed tomography (CT) has become a critical diagnostic tool, especially in regions with high disease prevalence. This study aims to assess the common CT findings, patterns of lung involvement, and severity of disease in RT-PCR positive COVID-19 patients to better understand and manage this pervasive disease. Materials and Methods: This observational cross-sectional study was conducted at Dr. Kamakshi Memorial Hospital, Chennai, from 2020 to 2021. The study included RT-PCR positive COVID-19 patients aged 18 to 95 years who presented to the fever clinic or COVID casualty and were referred to the radiology department for chest CT evaluation. Exclusion criteria included pregnancy, age under 18 years, and refusal to consent. Non-contrast chest CT scans were performed using a TOSHIBA Aquilion Lightening 16-slice CT machine. Scans were acquired in a single inspiratory breath-hold from the lung apex to the costophrenic angle. CT findings were analyzed and reported by two experienced radiologists, with discrepancies resolved through consensus. Results: Out of 349 patients, 213 (61%) were male and 136 (39%) were female, with a mean age of 47.7 years. The distribution of CT findings showed significant variability among the four groups. Group A had the highest percentage of normal CT scans (22%) and ground-glass opacities (52%). Group B exhibited a reduction in normal CT scans (9%) and an increase in ground-glass opacities (57%). Group C showed further decrease in normal CT scans (10.6%) with increased crazy paving (17.3%) and reticulation (14.6%). Group D had similar normal CT scans (10.8%) but significantly higher incidences of reticulation (24.3%) and ground-glass opacities (64%). Conclusion: This study highlights the critical role of chest CT in monitoring the progression of COVID-19 pneumonia. The findings demonstrate a clear temporal evolution of lung involvement, from ground-glass opacities in the early stages to more complex patterns such as crazy paving and reticulation in later stages.

Lung microwave ablation: Post-procedure imaging features and evolution of pulmonary ground-glass nodule-like lung cancer.

To retrospectively examine the imaging characteristics of chest-computed tomography (CT) following percutaneous microwave ablation (MWA) of the ground-glass nodule (GGN)-like lung cancer and its dynamic evolution over time. From June 2020 to May 2021, 147 patients with 152 GGNs (51 pure GGNs and 101 mixed GGNs, mean size 15.0 ± 6.3 mm) were enrolled in this study. One hundred and forty-seven patients underwent MWA procedures. The imaging characteristics were evaluated at predetermined time intervals: immediately after the procedure, 24-48 h, 1, 3, 6, 12, and ≥18 months (47 GGNs). This study population included 147 patients with 152 GGNs, as indicated by the results: 43.5% (66/152) adenocarcinoma in situ, 41.4% (63/152) minimally invasive adenocarcinoma, and 15.1% (23/152) invasive adenocarcinoma. Immediate post-procedure tumor-level analysis revealed that the most common CT features were ground-glass opacities (93.4%, 142/152), hyperdensity within the nodule (90.7%, 138/152), and fried egg sign or reversed halo sign (46.7%, 71/152). Subsequently, 24-48 h post-procedure, ground-glass attenuations, hyperdensity, and the fried egg sign remained the most frequent CT findings, with incidence rates of 75.0% (114/152), 71.0% (108/152), and 54.0% (82/152), respectively. Cavitation, pleural thickening, and consolidation were less frequent findings. At 1 month after the procedure, consolidation of the ablation region was the most common imaging feature. From 3 to 12 months after the procedure, the most common imaging characteristics were consolidation, involutional parenchymal bands and pleural thickening. At ≥18 months after the procedure, imaging features of the ablation zone revealed three changes: involuting fibrosis (80.8%, 38/47), consolidation nodules (12.8%, 6/47), and disappearance (6.4%, 3/47). This study outlined the anticipated CT imaging characteristics of GGN-like lung cancer following MWA. Diagnostic and interventional radiologists should be familiar with the expected imaging characteristics and dynamic evolution post-MWA in order to interpret imaging changes with a reference image.

Comparison of Chest Computed Tomography (CT) Imaging Patterns and Severity among COVID-19 Patients during the First and Fourth Waves in Addis Ababa, Ethiopia

Background. Studies done globally had shown that chest imaging patterns of Corona virus disease 2019 (COVID-19) infection varied depending on the strains of the virus and the waves of the pandemic. There is no published literature done in Ethiopia to examine whether there is any difference in chest computed tomography (CT) findings of COVID-19 patients during the first and fourth waves. Thus, this study tries to fill the gap of knowledge in that regard. Objective. To describe and compare chest CT scan imaging pattern and assess the predictors of chest CT severity of the first and fourth wave of COVID-19 infection. Methods. An institution-based cross-sectional study was conducted on 200 polymerase chain reaction test confirmed COVID-19 patients who underwent chest CT scan imaging in two diagnostic centers in Addis Ababa city. Pioneer and Wudassie diagnostic centers were selected due to the high case load and availability of well-experienced cardiothoracic radiologists. Data were collected from July 1 to August 3, 2022, using a structured Google form sheet questionnaire. Binary logistic regression was performed, and statistical significance was assessed at a level of significance α = 0.05. Results. Comparatively higher proportion of patients from the first wave had positive chest CT finding than fourth wave (99% vs. 69%). Bilateral lung involvement and lower lobe predilection were seen for both waves of COVID-19. Ground glass opacity and consolidation were the most common CT features for both waves. Delayed chest CT features such as traction bronchiectasis were primarily seen among first-wave patients. Mean global CT severity score was higher for the first-wave patients (13.18 vs. 8.31), and the mean difference is statistically significant ( p &lt; 0.001). Duration of symptoms was a statistically significant predictor of CT severity during the first wave of COVID-19, and patients that presented later than 14 days had 4.12 times higher odds of being in the severe CT score category than those that presented less than 7 days (AOR = 4.12, p = 0.011). There was no statistically significant predictor of CT severity for the fourth wave in this study. Conclusion. Chest CT positivity was comparatively higher for first wave patients. Common features included bilateral involvement, lower lobe involvement, ground glass opacity, and consolidation. Mean chest CT severity was comparatively higher for the first wave than the fourth wave, and the duration of symptoms was a statistically significant predictor of the CT severity for first wave.

Evaluation of long-term sequelae by cardiopulmonary exercise testing 12 months after hospitalization for severe COVID-19

BackgroundCardiopulmonary exercise testing (CPET) is an important clinical tool that provides a global assessment of the respiratory, circulatory and metabolic responses to exercise which are not adequately reflected through the measurement of individual organ system function at rest. In the context of critical COVID-19, CPET is an ideal approach for assessing long term sequelae.MethodsIn this prospective single-center study, we performed CPET 12 months after symptom onset in 60 patients that had required intensive care unit treatment for a severe COVID-19 infection. Lung function at rest and chest computed tomography (CT) scan were also performed.ResultsTwelve months after severe COVID-19 pneumonia, dyspnea was the most frequently reported symptom although only a minority of patients had impaired respiratory function at rest. Mild ground-glass opacities, reticulations and bronchiectasis were the most common CT scan abnormalities. The majority of the patients (80%) had a peak O2 uptake (V′O2) considered within normal limits (median peak predicted O2 uptake (V′O2) of 98% [87.2–106.3]). Length of ICU stay remained an independent predictor of V′O2. More than half of the patients with a normal peak predicted V′O2 showed ventilatory inefficiency during exercise with an abnormal increase of physiological dead space ventilation (VD/Vt) (median VD/VT of 0.27 [0.21–0.32] at anaerobic threshold (AT) and 0.29 [0.25–0.34] at peak) and a widened median peak alveolar-arterial gradient for O2 (35.2 mmHg [31.2–44.8]. Peak PetCO2 was significantly lower in subjects with an abnormal increase of VD/Vt (p = 0.001). Impairments were more pronounced in patients with dyspnea. Peak VD/Vt values were positively correlated with peak D-Dimer plasma concentrations from blood samples collected during ICU stay (r2 = 0.12; p = 0.02) and to predicted diffusion capacity of the lung for carbon monoxide (DLCO) (r2 = − 0.15; p = 0.01).ConclusionsTwelve months after severe COVID-19 pneumonia, most of the patients had a peak V′O2 considered within normal limits but showed ventilatory inefficiency during exercise with increased dead space ventilation that was more pronounced in patients with persistent dyspnea.Trial registration: NCT04519320 (19/08/2020).

CT imaging findings in lung transplant recipients with COVID-19.

ObjectivesOur goal was to compare the chest computed tomography (CT) imaging findings of COVID-19 in lung transplant recipients (LTR) and a group of non-transplanted controls (NTC).MethodsThis retrospective study included 51 consecutive LTR hospitalized with COVID-19 from two centers. A total of 75 NTC were included for comparison. Images were classified regarding the standardized RSNA category, main pattern of lung attenuation, and longitudinal and axial distribution. Quantitative CT (QCT) analysis was performed to evaluate percentage of high attenuation areas (%HAA, threshold −250 to −700 HU). CT scoring was used to measure severity of parenchymal abnormalities.ResultsThe imaging findings of COVID-19 in LTR were significantly different from controls regarding the RSNA classification and pattern of lung attenuation. LTR had a significantly higher proportion of patients with an indeterminate pattern on CT (0.31 vs. 0.11, p = 0.014). The most frequent pattern of attenuation in LTR was predominantly consolidation (0.39 vs. 0.22, p = 0.144) followed by a mixed pattern of ground-glass opacities (GGO) and consolidation (0.37 vs. 0.20, adjusted p = 0.102). On the other hand, the most common pattern in NTC was GGO predominant (0.58 vs. 0.24 of LTR, p = 0.001). LTR had significantly more severe parenchymal disease measured by CT score and %HAA by QCT (0.372 ± 0.08 vs. 0.148 ± 0.06, p < 0.001).ConclusionThe most frequent finding of COVID-19 in LTR is a predominant pattern of consolidation. Compared to NTC, LTR more frequently demonstrated an indeterminate pattern according to the RSNA classification and more extensive lung abnormalities on QCT and semi-quantitative scoring.Key Points• The most common CT finding of COVID-19 in LTR is a predominant pattern of consolidation followed by a mixed pattern of GGO and consolidation, while controls more often have a predominant pattern of GGO.• LTR more often presents with an indeterminate pattern of COVID-19 by RSNA classification than controls; therefore, molecular testing for COVID-19 is essential for LTR presenting with lower airway infection independently of imaging findings.• LTR had more extensive disease by semi-quantitative CT score and increased percentage areas of high attenuation on QCT.

Residual Lung Parenchymal CT Changes in COVID-19 Patients and its Association with Common Predictors

Introduction: Chest computed tomography (CT) is used for the screening and diagnosis of COVID-19 pneumonia. The aim of the study is to study the prevalence of residual lung parenchymal CT changes in COVID-19 patients and its association with common predictors. Methods: Longitudinal study conducted at Shree Birendra Hospital in which diagnosed COVID-19 patients with initial CT scan showing COVID-19 related changes were retrospectively enrolled after ethics approval. The study period was from 15 February 2020 to 15 November 2021. Chest CT changes were evaluated and CT scan severity score (CT SS) assigned. Data was entered in Microsoft Excel and analysed in SPSS (Statistical Package for Social Sciences) version 16. Results: Males were more common (72.6%) among the 62 enrolled participants with the mean age 53.63 ± 15.05 years. Median interval between two scans was 137 days. Residual lung parenchymal CT changes were seen in 43 (69.4%) participants. Hypertension (25, 40.3%) and GGO (55, 88.7%) were the most common comorbidity and CT features respectively. The mean initial and final CT SS was 10.84 ± 5.87 and 3.55 ± 4.58 respectively (Total score 25, p = 0.001). Age was significantly associated with severity of CT score (p = 0.04). Conclusions: A large percentage of COVID-19 patients have chest CT changes after three months of initial chest CT scan. CT SS reduced significantly in the second scan. Similar studies with long term serial CT follow up of patients is recommended to be carried out in future.

Predicting clinical outcome with computed tomography severity score in COVID-19

Introduction: COVID-19 is a major public health burden in the world, and chest computed tomography (CT) is the ideal imaging modality to diagnose and monitor disease progression. Objectives: The objective was to review the common and uncommon chest CT findings of patients with COVID-19 and to correlate the CT findings with short-term prognosis. Methods: All patients who had laboratory-confirmed COVID-19 infection and underwent CT scan were reviewed. The imaging features and the distribution of abnormality were evaluated. A CT severity score (CT-SS) system out of 40 was used. Mann–Whitney U-test and Chi-square or Fisher's exact test were used for analysis. Two-sided P &lt; 0.05 was considered statistically significant. A receiver operating characteristic curve analysis was performed to calculate the CT-SS cutoff for hospital admission and intensive care unit (ICU) admission. Results: A total of 149 individuals were eligible. The most common imaging features were ground-glass opacities (GGO) (88%), septal thickening (70%), and reticulations (50%). The least common imaging features were pneumothorax (1%) and vascular enlargement (1%). The most common distributions of GGO were bilateral (92%) and multifocal (95%), with peripheral (100%) and lower lobe predominance (77%). A higher CT-SS had a significant association with longer hospital stay and ICU admission, with CT-SS of 18 and 10 being optimal cutoff, respectively. Conclusion: Our study is one of the few studies to correlate the imaging finding with clinical outcomes in the south Indian population. The common findings in our study were consistent with the literature. CT-SS plays an important role in predicting prognosis.

Early clinical and CT features of COVID-19 and community-acquired pneumonia from a fever observation ward in Ningbo, China.

We aimed to compare the early clinical manifestations, laboratory results and chest computed tomography (CT) images of COVID-19 patients with those of other community-acquired pneumonia (CAP) patients to differentiate CAP from COVID-19 before reverse transcription-polymerase chain reaction results are obtained. The clinical and laboratory data and chest CT images of 51 patients were assessed in a fever observation ward for evidence of COVID-19 between January and February 2020. 24 patients had laboratory-confirmed COVID-19, whereas 27 individuals had negative results. No statistical difference in clinical features was found between COVID-19 and CAP patients, except for diarrhoea. There was a significant difference in lymphocyte and eosinophil counts between COVID-19 and CAP patients. In total, 22 (91.67%) COVID-19 patients had bilateral involvement and multiple lesions according to their lung CT images; the left lower lobe (87.50%) and right lower lobe (95.83%) were affected most often, and all lesions were located in the peripheral zones of the lung. The most common CT feature of COVID-19 was ground-glass opacity, found in 95.83% of patients, compared to 66.67% of CAP patients. Diarrhoea, lymphocyte counts, eosinophil counts and CT findings (e.g. ground-glass opacity) could help to distinguish COVID-19 from CAP at an early stage of infection, based on findings from our fever observation ward.

Prognostic findings for ICU admission in patients with COVID-19 pneumonia: baseline and follow-up chest CT and the added value of artificial intelligence.

Infection with SARS-CoV-2 has dominated discussion and caused global healthcare and economic crisis over the past 18 months. Coronavirus disease 19 (COVID-19) causes mild-to-moderate symptoms in most individuals. However, rapid deterioration to severe disease with or without acute respiratory distress syndrome (ARDS) can occur within 1–2 weeks from the onset of symptoms in a proportion of patients. Early identification by risk stratifying such patients who are at risk of severe complications of COVID-19 is of great clinical importance. Computed tomography (CT) is widely available and offers the potential for fast triage, robust, rapid, and minimally invasive diagnosis: Ground glass opacities (GGO), crazy-paving pattern (GGO with superimposed septal thickening), and consolidation are the most common chest CT findings in COVID pneumonia. There is growing interest in the prognostic value of baseline chest CT since an early risk stratification of patients with COVID-19 would allow for better resource allocation and could help improve outcomes. Recent studies have demonstrated the utility of baseline chest CT to predict intensive care unit (ICU) admission in patients with COVID-19. Furthermore, developments and progress integrating artificial intelligence (AI) with computer-aided design (CAD) software for diagnostic imaging allow for objective, unbiased, and rapid assessment of CT images.

Pulmonary Sequelae in Patients After Recovery From Coronavirus Disease 2019: A Follow-Up Study With Chest CT.

Objective: The pulmonary sequelae of coronavirus disease 2019 (COVID-19) have not been comprehensively evaluated. We performed a follow-up study analyzing chest computed tomography (CT) findings of COVID-19 patients at 3 and 6 months after hospital discharge.Methods: Between February 2020 and May 2020, a total of 273 patients with COVID-19 at the Shenzhen Third People's Hospital were recruited and followed for 6 months after discharge. Chest CT scanning was performed with the patient in the supine position at end-inspiration. A total of 957 chest CT scans was obtained at different timepoints. A semi-quantitative score was used to assess the degree of lung involvement.Results: Most chest CT scans showed bilateral lung involvement with peripheral location at 3 and 6 months follow-up. The most common CT findings were ground-glass opacity and parenchymal band, which were found in 136 (55.3%) and 94 (38.2%) of the 246 patients at 3 months follow-up, and 82 (48.2%) and 76 (44.7%) of 170 patients at 6 months follow-up, respectively. The number of lobes involved and the total CT severity score declined over time. The total CT score gradually increased with the increasement of disease severity at both 3 months follow-up (trend test P < 0.001) and 6 months follow-up (trend test P < 0.001). Patients with different disease severity represented diverse CT patterns over time.Conclusions: The most common CT findings were ground-glass opacity and parenchymal bands at the 3 and 6 months follow-up. Patients with different disease severity represent diverse CT manifestations, indicating the necessary for long-term follow-up monitoring of patients with severe and critical conditions.

Clinical and imaging findings of patients diagnosed with adenovirus-positive pneumonia during 2015-2019 in Shanghai, China.

This study was to describe the clinical characteristics, chest CT image findings, and potential role of T cells immunity in adenovirus positive pneumonia. In this retrospective study, medical records of 53 adult Adv+ patients who were admitted to the Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, from May 2015 to August 2019 were included. The presence of adenovirus and other respiratory viruses was detected using polymerase chain reaction of throat swabs samples. Clinical features and chest computed tomography (CT) findings were compared between patients with Adv+ pneumonia and Adv+ non-pneumonia. The top 3 most commonly occurring symptoms in Adv+ pneumonia patients were fever (66.7%), cough (63.3%), and tachypnea (16.7%). Patients with Adv+ pneumonia showed significantly higher rates of cough and fever and longer duration of hospitalization than patients with Adv+ non-pneumonia. In the Adv+ pneumonia group, consolidation (73.3%) was the most common imaging finding on chest CT scan, and the likelihood of involvement of bilateral lobes (60%) was high. Classical conspicuous consolidation with surrounding ground-glass opacity was observed in 5 (16.6%) patients with Adv+ pneumonia. Patients with Adv+ pneumonia showed a higher inhibition of T-cell immunity than did patients with Adv+ non-pneumonia, and counts of CD3+, CD4+, and CD8+ T-cells may predict the presence of pneumonia in Adv+ patients. With regard to Adv+ pneumonia, the most frequent symptoms were cough and fever, and the most common CT pattern was consolidation; classical CT findings such as consolidation with surrounding ground-glass opacity could also be observed. Furthermore, our data indicated the incidence of abrogated cellular immunity in patients with Adv+ pneumonia.

Chest Computed Tomography Findings in a Case Series of Coronavirus Disease 2019 (COVID-19) Patients at Siriraj Hospital

Background: Recent evidence has demonstrated the high sensitivity of chest computed tomography (CT) in coronavirus disease 2019 (COVID-19) case detection. However, considering the cost and infection control issues, the experience of chest CT for COVID-19 diagnosis in Thailand is still limited. Objective: To present the characteristics of chest CT findings in COVID-19 patients at Siriraj Hospital and compare them with other reports. Materials and Methods: The authors retrospectively reviewed the COVID-19 patients’ medical records between April and May 2020. All cases with the presence of chest CT performed during admission were recruited. Clinical data were retrieved from the patients’ medical records. All chest imaging results were reported by consensus between the authors. Results: From 103 cases, four cases with a chest CT scan during the admission were recruited. Consistent with previous reports, the common chest CT findings included a ground-glass opacity and consolidation with bilateral involvement. A round-shaped ground-glass opacity or consolidation was evidenced in half of the cases. The only case with the presence of chest CT scan, which was done 77 days after the onset of COVID-19 symptoms, revealed resolution of the abnormal findings. Conclusion: Chest CT findings in four COVID-19 cases at Siriraj Hospital are consistent with previous reports. Common findings include bilateral ground-glass opacity and consolidation. Keywords: COVID-19, SARS-CoV-2, Computed tomography, Case series

Post-discharge chest CT findings and pulmonary function tests in severe COVID-19 patients

PurposeTo evaluate chest computed tomography (CT) and pulmonary function test (PFT) findings in severe COVID-19 patients after discharge and correlate CT pulmonary involvement with PFT results. MethodsCOVID-19 patients admitted to our hospital between February 25 and May 2, 2020, were retrospectively included according to the following criteria: (a) COVID-19 defined as severe based on the WHO interim guidance (i.e., clinical signs of pneumonia plus respiratory rate > 30 breaths/min, severe respiratory distress, and/or SpO2 < 90 % on room air); (b) chest radiograph in the acute setting; (c) post-discharge unenhanced chest CT; and (d) post-discharge comprehensive PFT. Imaging findings were retrospectively evaluated in consensus by two readers, and volume of abnormal lung was measured on CT using 3D Slicer software. Differences between demographics, comorbidities, acute radiographic findings, PFT, and post-discharge clinical and laboratory data of patients with normal and abnormal CT findings were assessed by Mann-Whitney or Fisher tests, and the compromised lung volume-PFT association by Pearson correlation after removing possible outliers. ResultsAt a median of 105 days from symptom onset, 74/91 (81 %) patients had CT abnormalities. The most common CT pattern was combined ground-glass opacity and reticular pattern (46/74, 62 %) along with architectural distortion (68/74, 92 %) and bronchial dilatation (66/74, 89 %). Compromised lung volume had a median value of 15 % [11–23], was higher in dyspneic patients, and negatively correlated with the percentage of predicted DLCO, VA, and FVC values (r = -0.39, -0.5, and -0.42, respectively). These PFT parameters were significantly lower in patients with CT abnormalities. Impairment of DLCO and KCO was found in 12 (13 %) cases, possibly implying an underlying pulmonary vasculopathy in this subgroup of patients. ConclusionsMost severe COVID-19 survivors still had physiologically relevant CT abnormalities about three months after the disease onset, with an impairment of diffusion capacity on PFT. A pulmonary vasculopathy was suggested in a minor proportion of patients.

CT findings and dynamic imaging changes of COVID-19 in 2908 patients: a systematic review and meta-analysis.

Quick screening patients with COVID-19 is the most important way of controlling transmission by isolation and medical treatment. Chest computed tomography (CT) has been widely used during the initial screening process, including pneumonia diagnosis, severity assessment, and differential diagnosis of COVID-19. The course of COVID-19 changes rapidly. Serial CT imaging could observe the distribution, density, and range of lesions dynamically, monitor the changes, and then guide towards appropriate treatment. The aim of the review was to explore the chest CT findings and dynamic CT changes of COVID-19 using systematic evaluation methods, instructing the clinical imaging diagnosis. A systematic literature search was performed. The quality of included literature was evaluated with a quality assessment tool, followed by data extraction and meta-analysis. Homogeneity and publishing bias were analyzed. A total of 109 articles were included, involving 2908 adults with COVID-19. The lesions often occurred in bilateral lungs (74%) and were multifocal (77%) with subpleural distribution (81%). Lesions often showed ground-glass opacity (GGO) (68%), followed by GGO with consolidation (48%). The thickening of small vessels (70%) and thickening of intralobular septum (53%) were also common. The dynamic changes of chest CT manifestations showed that lesions were absorbed and improved gradually after reaching the peak (80%), had progressive deterioration (55%), were absorbed and improved gradually (46%), fluctuated (22%), or remained stable (26%). The review showed the common and key CT features and the dynamic imaging change patterns of COVID-19, helping with timely management during COVID-19 pandemic.

Chest CT abnormalities in COVID-19: a systematic review.

Computed tomography (CT) of the chest is one of the main diagnositic tools for coronavirus disease 2019 (COVID-19) infection. To document the chest CT findings in patients with confirmed COVID-19 and their association with the clinical severity, we searched related literatures through PubMed, MEDLINE, Embase, Web of Science (inception to May 4, 2020) and reviewed reference lists of previous systematic reviews. A total of 31 case reports (3768 patients) on CT findings of COVID-19 were included. The most common comorbid conditions were hypertension (18.4%) and diabetes mellitus (8.3%). The most common symptom was fever (78.7%), followed by cough (60.2%). It took an average of 5.6 days from symptom onset to admission. The most common chest CT finding was vascular enlargement (84.8%), followed by ground-glass opacity (GGO) (60.1%), air-bronchogram (47.8%), and consolidation (41.4%). Most lung lesions were located in the lung periphery (72.2%) and involved bilateral lung (76%). Most patients showed normal range of laboratory findings such as white blood cell count (96.4%) and lymphocyte (87.2%). Compared to previous published meta-analyses, our study is the first to summarize the different radiologic characteristics of chest CT in a total of 3768 COVID-19 patients by compiling case series studies. A comprehensive diagnostic approach should be adopted for patients with known COVID-19, suspected cases, and for exposed individuals.

Clinical and imaging findings of patients diagnosed with adenovirus-positive pneumonia during 2015-2019 in Shanghai, China

This study was to describe the clinical characteristics, chest CT image findings and potential role of T cells immunity in adenovirus positive pneumonia. In this retrospective study, medical records of 53 adult Adv+ patients who were admitted to the Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, from May 2015 to August 2019 were included. Presence of adenovirus and other respiratory viruses was detected using by polymerase chain reaction of throat swabs samples. Clinical features and chest computed tomography (CT) findings were compared between patients with Adv+ pneumonia and Adv+ non-pneumonia. The top 3 most commonly occurring symptoms in Adv+ pneumonia patients were fever (66.7%), cough (63.3%), and tachypnea (16.7%). Patients with Adv+ pneumonia showed significantly higher rates of cough and fever and longer duration of hospitalization than patients with Adv+ non-pneumonia. In the Adv+ pneumonia group, consolidation (73.3%) was the most common imaging finding on chest CT scan, and the likelihood of involvement of bilateral lobes (60%) was high. Classical conspicuous consolidation with surrounding ground-glass opacity was observed in 5 (16.6%) patients with Adv+ pneumonia. Patients with Adv+ pneumonia showed a higher inhibition of T-cell immunity than did patients with Adv+ non-pneumonia, and counts of CD3+, CD4+, and CD8+ T-cells may predict the presence of pneumonia in Adv+ patients. With regard to Adv+ pneumonia, the most frequent symptoms were cough and fever, and the most common CT pattern was consolidation; classical CT findings such as consolidation with surrounding ground-glass opacity could also be observed. Furthermore, our data indicated the incidence of abrogated cellular immunity in patients with Adv+ pneumonia.

Lesions on CT scan in patients hospitalized for coronavirus pneumonia during the first wave of the SARS-CoV-2 pandemic at the University Clinics in Kinshasa (DRC)

Introductionl´objectif principal de cette étude, consiste à ressortir les aspects tomodensitométriques thoraciques (TDM) observés lors de la première vague de la pandémie à SARS-CoV-2 chez les patients hospitalisés pour pneumonie à COVID-19 aux Cliniques Universitaires de Kinshasa (CUK).Méthodesétude descriptive portant sur les examens TDM thoraciques des 26 patients hospitalisés pour pneumonie à COVID-19 aux CUK sur une période de 9 mois, allant de 17 mars au 17 novembre 2020. Un appareil TDM 16 barrettes de marque Hitachi a été utilisé chez tous nos patients. Après analyse, les lésions trouvées ont été réparties en lésions évocatrices et non évocatrices de l´infection à SARS-CoV-2.Résultatsl´âge médian des patients était de 53,02 ans. Le sexe masculin était le plus touché avec 76,9%. La détresse respiratoire était le symptôme clinique le plus rencontré avec 61,5%. Comme comorbidité, l´hypertension artérielle (HTA) et l´insuffisance rénale étaient les plus retrouvées avec 30% et 6%. Les opacités en Verre dépoli bilaterales avec prédominance périphérique étaient prédominantes (69,2%), suivies des condensations (57,7%) et des crazy paving (19,2%). Le stade sévère était le plus fréquemment rencontré (34,61%). L´embolie pulmonaire distale et proximale était la complication la plus fréquente (11,5%). Parmi les pathologies associées la pleurésie et l´HTA pulmonaire étaient les plus rencontrées (30%, 8%). La majorité de nos patients, ont présentés des lésions parenchymateuses pulmonaires correspondant au stade TDM précoce de la maladie (50%).Conclusionles lésions TDM évocatrices de COVID-19, observées aux CUK lors de la première vague sont dominées par les plages d´opacités en verre dépoli, suivies des condensations parenchymateuses non systématisées et des crazy paving. Les lésions atypiques moins observées, étaient constituées des condensations pseudo-nodulaires, d´atteinte unilatérale, d´atteinte péribronchovasculaire et d´infection sur le poumon remanié. Le stade TDM sévère était la plus fréquente. L´embolie pulmonaire proximale et distale était la complication la plus rencontrée. Les aspects trouvés corroborent majoritairement les observations de la littérature.