Multiple Ground-glass Opacities Research Articles

Analyses of the clinical features of 13 corona virus disease 2019 non-survivors

Objective To investigate the clinical features of 13 fatal cases of corona virus disease 2019 (COVID-19). Methods The clinical data of 13 patients who died of COVID-19 in Central Theater General Hospital, China, between January 4, 2020, and February 24, 2020, were analyzed retrospectively. The data reviewed included clinical manifestations, laboratory test results, radiographic features and dinical treatment plan. The cellular immune function, the expression of inflammatory factors, and lactate level in deceased patients at different stages of the disease were analyzed. Results Of those who died, the patients consisted of 10 men and 3 women. The age of those who died was (74±19) years, and 10(76.9%) patients were over 70 years old. For the patients who died, 9 presented with underlying diseases, 6(46.2%) of whom had more than 2 diseases. On admission, the chest computed tomography (CT) for 8 patients (61.5%) mainly showed multiple patchy ground-glass opacities. When the disease progressed, the ground-glass opacities rapidly developed into diffuse lesions in both lungs. The lymphocyte and CD3+, CD4+, and CD8+ T lymphocyte counts in the peripheral blood of 13 patients were significantly lower than normal levels and decreased more substantially during the disease course based on the levels when admitted (P<0.01). Additionally, the interleukin (IL)-6, D-dimer, C-reactive protein (CRP), lactic acid levels gradually increased, and most peaked before death. The cause of death for most patients was acute respiratory distress syndrome (ARDS) with type I respiratory failure. Three patients eventually developed multiorgan deficiency syndrome (MODS). Conclusions The risk factors of death for COVID-19 patients included older men, more underlying diseases, poor cellular immune function and over-expression of inflammatory factors. The main cause of death in patients with COVID-19 was ARDS, which led to respiratory failure and MODS. DOI: 10.11855/j.issn.0577-7402.2020.05.03

Chest CT Findings in Two Highly Suspected Cases of Coronavirus Disease 2019 (COVID-19): Avoid Overdiagnosis During Clinical Procedures

Introduction: The early diagnosis of coronavirus disease 2019 (COVID-19) is important for disease treatment and control. Chest CT has a high sensitivity for the diagnosis of COVID-19, and it is considered an important tool for COVID-19 detection in epidemics. Case Presentation: We report two cases of suspected patients. Due to the special nature of the patient’s work, the patients were suspected of having COVID-19 infection. Chest CT images showed multiple ground-glass opacities in the bilateral lungs. However, the final diagnosis was not COVID-19 infection. Conclusions: The CT scan plays an important role in the early detection of COVID-19, but imaging manifestations of viral pneumonia have similar CT findings. This reminds us to avoid overdiagnosis during clinical procedures.

Chest computed tomography findings of coronavirus disease 2019 (COVID-19) pneumonia.

ObjectiveTo retrospectively analyze the chest computed tomography (CT) features in patients with coronavirus disease 2019 (COVID-19) pneumonia.MethodsFrom January 9, 2020, to February 26, 2020, totally 56 laboratory-confirmed patients with COVID-19 underwent chest CT. For 40 patients, follow-up CT scans were obtained. The CT images were evaluated for the number, type and distribution of the opacity, and the affected lung lobes. Furthermore, the initial CT scan and the follow-up CT scans were compared.ResultsForty patients (83.6%) had two or more opacities in the lung. Eighteen (32.7%) patients had only ground-glass opacities; twenty-nine patients (52.7%) had ground-glass and consolidative opacities; and eight patients (14.5%) had only consolidation. A total of 43 patients (78.2%) showed two or more lobes involved. The opacities tended to be both in peripheral and central (30/55, 54.5%) or purely peripheral distribution (25/55, 45.5%). Fifty patients (90.9%) had the lower lobe involved. The first follow-up CT scans showed that twelve patients (30%) had improvement, 26 (65%) patients had mild-moderate progression, and two patients (5%) had severe progression with “white lungs.” The second follow-up CT showed that 22 patients (71%) showed improvement compared with the first follow-up CT, four patients (12.9%) had aggravated progression, and five patients (16.1%) showed unchanged radiographic appearance.ConclusionsThe common CT features of COVID-19 pneumonia are multiple lung opacities, multiple types of the opacity (ground-glass, ground-glass and consolidation, and consolidation alone), and multiple lobes especially the lower lobe involved. Follow-up CT could demonstrate the rapid progression of COVID-19 pneumonia (either in aggravation or absorption).Key Points • The predominant CT features of COVID-19 pneumonia are multiple ground-glass opacities with or without consolidation and, with both lungs, multiple lobes and especially the lower lobe affected. • CT plays a crucial role in early diagnosis and assessment of COVID-19 pneumonia progression. • CT findings of COVID-19 pneumonia may not be consistent with the clinical symptoms or the initial RT-PCR test results.

Chest CT imaging characteristics of COVID-19 pneumonia in preschool children: a retrospective study

BackgroundRecently, the World Health Organization has declared the coronavirus disease 2019 (COVID-19) outbreak a public health emergency of international concern. So far, however, limited data are available for children. Therefore, we aimed to investigate the clinical and chest CT imaging characteristics of COVID-19 in preschool children.MethodsFrom January 26, 2020 to February 20, 2020, the clinical and initial chest CT imaging data of eight preschool children with laboratory-confirmed COVID-19 from two hospitals were retrospectively collected. The chest CT imaging characteristics, including the distribution, shape, and density of lesions, and the pleural effusion, pleural changes, and enlarged lymph nodes were evaluated.ResultsTwo cases (25%) were classified as mild type, and they showed no obvious abnormal CT findings or minimal pleural thickening on the right side. Five cases (62.5%) were classified as moderate type. Among these patients, one case showed consolidation located in the subpleural region of the right upper lobe, with thickening in the adjacent pleura; one case showed multiple consolidation and ground-glass opacities with blurry margins; one case displayed bronchial pneumonia-like changes in the left upper lobe; and two cases displayed asthmatic bronchitis-like changes. One case (12.5%) was classified as critical type and showed bronchial pneumonia-like changes in the bilateral lungs, presenting blurred and messy bilateral lung markings and multiple patchy shadows scattered along the lung markings with blurry margins.ConclusionsThe chest CT findings of COVID-19 in preschool children are atypical and various. Accurate diagnosis requires a comprehensive evaluation of epidemiological, clinical, laboratory and CT imaging data.

High resolution CT findings and clinical features of COVID-19 in Guangzhou

Objective To investigate the initial high resolution CT (HRCT) manifestations and clinical features of imported COVID-19 in Guangzhou. Methods A retrospective analysis of 91 COVID-19 patients admitted to the Guangzhou Eighth People's Hospital from January 22 to 30, 2020 was performed including 39 males and 52 females, with a median age of 50 (33-62) years,then their clinical features and HRCT characteristics were analyzed. Results The main clinical presentations included fever in 70 cases and cough in 57 cases(mainly dry cough in 39 cases). The first time HRCT showed that 24 cases with COVID-19 were normal, however other 67 cases were abnormal. The ground glass opacity in the lung on HRCT was found in 65 cases, including 64 cases with dilated blood vessel crossing the lesion, 50 cases with thickened adjacent pleura, and 47 cases with thickening of interstitial septum. The patchy opacity was seen in 42 cases, and no enlarged lymph nodes were observed in all patients. As for the lesion distribution, there were two cases with bilateral diffuse changes, 57 cases with multiple lesions, 8 cases with the lesion in only one lobe. The lesions were mainly located under the pleura area in 46 cases, including 39 cases in the lower lobe and other 7 cases in the upper lobe. And there were 13 cases without characteristic distribution in the lung. Conclusion The initial images of COVID-19 in Guangzhou mainly showed multiple ground glass opacity, which were mostly seen in the subpleural and lower lung fields, most of them with thickened pulmonary interstitium. Guangzhou has a higher proportion of COVID-19 patients with mild and general patients, and some confirmed patients show negative HRCT for the first time. Patients without HRCT changes should be reviewed in a timely manner. Key words: COVID-19; Tomography, X-ray computed

The implications of preliminary screening and diagnosis: Clinical characteristics of 33 mild patients with SARS-CoV-2 infection in Hunan, China.

In December 2019, coronavirus Disease 2019 (COVID-19) occurred in Wuhan, Hubei Province, China. The disease has rapidly spread from Wuhan to other regions. To describe the clinical manifestations and epidemiological characteristics of patients with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection in Hunan Province in 2020. From January 19 to February 7, 2020, 33 patients with positive in nucleic acid test of pharyngeal swab were retrospectively collected and analyzed. There are 33 COVID-19 patients (16 male, 17 female), and the median age was 46 years. Nineteen patients (48 %) were associated with a family cluster outbreak. Seventeen patients (52 %) had traveled or lived in Hubei Province. These patients are early mild cases, most common symptoms are fever [23 (70 %)] and cough [13 (39 %)]. Most patients' white blood cell counts are normal, while they manifest as significant reduction in lymphocytes [17/28 (61 %)]. The levels of c-reactive protein and erythrocyte sedimentation rate suggest a typical viral infection. Procalcitonin did not increase and D-dimer increased slightly. Lactate dehydrogenase (LDH) levels have elevated in most patients. CT images of these patients showed bilateral multiple plaques or nodular ground-glass opacities (68.4 %). Fecal nucleic acid results were positive in eight COVID-19 patients accompanied with diarrhea. Tear nucleic acid results were negative in six COVID-19 patients. And four asymptomatic patients were infected with SARS-CoV-2. The clinical symptoms, laboratory results and imaging reports of patients with COVID-19 in Hunan area are significantly different from those in Wuhan area. For non-Wuhan epidemic areas, more attention should be paid to nucleic acid test results of throat swabs and stools, and it is not easily to diagnose based on clinical symptoms and CT results. Reduced whole blood lymph count can be used as an adjuvant diagnosis of early SARS-CoV-2 infection. Attention should be paid to asymptomatic carriers, which is of great significance for the control of the global epidemic.

Single-center experience of simultaneous bilateral uni-portal video-assisted thoracoscopic surgery for multiple ground-glass opacities

BackgroundThere is an increasing incidence rate of ground-glass opacity (GGO), especially for multiple GGOs (≥2). Whether it is safe and feasible to have bilateral simultaneous surgical resection remains unknown. The purpose of this study is to summarize the experience of surgical resection of patients with multiple GGOs in our Hospital in recent years, and to discuss the above questions.MethodsClinical datas of patients who underwent one-stage bilateral uni-portal VATS resections of multiple pulmonary ground glass opacities and had routine pathological examination were collected from May 2016 to May 2019 in our hospital.ResultsA total of 34 patients underwent simultaneous bilateral surgical resection of multiple GGO lesions, 28 were women,6 were men, the average age of total patients was 57.9 ± 6.7 years. All patients underwent bilateral uni-portal video-assisted thoracoscopic surgery (Uni-portal VATS), the average intraoperative blood loss was 100.9 ± 67.7 ml, the average operation time was 140 ± 74.8 min, the average thoracic drainage time was 2.8 ± 3.1 days, and the average postoperative hospital stay was 4.2 ± 4.3 days. Postoperative complications including: 2 cases of infection, 3 cases of atrial fibrillation, and 5 cases of persistent air leakage for more than 3 days. All of them improved after treatment, and there were no serious complications and deaths in perioperative period. A total of 76 GGO lesions were resected, with a total malignancy rate of 81.6%, including 40 were pure GGO, of which 28 were malignant (70%), and the average diameter of them were 9.6 ± 3.8 mm; 36 were mixed GGO, of which 34 were malignant (94.4%), the average diameter of them were 15.6 ± 6.6 mm.Mean postoperative follow-up was 28.4 (range, 3–39) months. There was neither recurrence nor deaths at final follow-up.ConclusionThe malignancy rate of multiple GGOs is high. Therefore, when the lung function is allowed,one-stage bilateral uni-portal VATS can be considered. According to experience of main surgeon and the frozen biopsy, either sub-lobar resection or lobectomy was acceptable. The risk of postoperative complications and the prognosis were optimal.

The differential diagnosis of pulmonary infiltrates in cancer patients during the outbreak of the 2019 novel coronavirus disease

Objective: To investigate the principles of differential diagnosis of pulmonary infiltrates in cancer patients during the outbreak of novel coronavirus (2019-nCoV) by analyzing one case of lymphoma who presented pulmonary ground-glass opacities (GGO) after courses of chemotherapy. Methods: Baseline demographics and clinicopathological data of eligible patients were retrieved from medical records. Information of clinical manifestations, history of epidemiology, lab tests and chest CT scan images of visiting patients from February 13 to February 28 were collected. Literatures about pulmonary infiltrates in cancer patients were searched from databases including PUBMED, EMBASE and CNKI. Results: Among the 139 cancer patients who underwent chest CT scans before chemotherapy, pulmonary infiltrates were identified in eight patients (5.8%), five of whom were characterized with GGOs in lungs. 2019-nCoV nuclear acid testing was performed in three patients and the results were negative. One case was a 66-year-old man who was diagnosed with non-Hodgkin lymphoma and underwent CHOP chemotherapy regimen. His chest CT scan image displayed multiple GGOs in lungs and the complete blood count showed decreased lymphocytes. This patient denied any contact with confirmed/suspected cases of 2019-nCoV infection, fever or other respiratory symptoms. Considering the negative result of nuclear acid testing, this patient was presumptively diagnosed with viral pneumonia and an experiential anti-infection treatment had been prescribed for him. Conclusions: The 2019 novel coronavirus disease (COVID-19) complicates the clinical scenario of pulmonary infiltrates in cancer patients. The epidemic history, clinical manifestation, CT scan image and lab test should be taken into combined consideration. The 2019-nCoV nuclear acid testing might be applied in more selected patients. Active anti-infection treatment and surveillance of patient condition should be initiated if infectious disease is considered.

Clinical and Dynamic Computed Tomography Features of 24 Patients With Coronavirus Disease 2019.

To explore the clinical and dynamic computed tomography features of coronavirus disease 2019. We enrolled 24 patients with coronavirus disease 2019 treated at a regional center in Dezhou, China, from January 22 to February 5, 2020, and analyzed data retrospectively. Nineteen cases had close contact with people with coronavirus disease 2019, and five patients denied a travel history in Wuhan City or contact with patients having coronavirus disease 2019. Symptoms were fever, cough, chest tightness, dyspnea, fatigue, and muscle pain. Chest computed tomography showed multiple ground-glass opacities distributed along peribronchial bundles and subpleural areas, often accompanied by bronchiectasis, vascular thickening, and interlobular septal thickening after coronavirus disease 2019 progression. Coronavirus disease 2019 has certain clinical characteristics and typical computed tomography features.

Epidemiological and clinical features of 125 Hospitalized Patients with COVID-19 in Fuyang, Anhui, China

ObjectiveTo investigate the epidemiological and clinical features of patients with COVID-19 in Anhui province of China. MethodIn this descriptive study, we obtained epidemiological, demographic, manifestations, laboratory data and radiological findings of patients confirmed by real-time RT-PCR in the NO.2 People’s Hospital of Fuyang City from Jan 20 to Feb 9, 2020. Clinical outcomes were followed up to Feb 18, 2020. ResultsOf 125 patients infected SARS-CoV-2, the mean age was 38.76 years (SD, 13.799) and 71(56.8%) were male. Common symptoms include fever [116 (92.8%)], cough [102(81.6%)], and shortness of breath [57(45.6%)]. Lymphocytopenia developed in 48(38.4%) patients. 100(80.0%) patients showed bilateral pneumonia, 26(20.8%) patients showed multiple mottling and ground-glass opacity. All patients were given antiviral therapy. 19(15.2%) patients were transferred to the intensive care unit. By February 18, 47(37.6%) patients were discharged and none of patients died. Among the discharged patients, the median time of length of stay was 14.8 days (SD 4.16). ConclusionIn this single-center, retrospective, descriptive study, fever is the most common symptom. Old age, chronic underlying diseases and smoking history may be risk factors to worse condition. Certain laboratory inspection may contribute to the judgment of the severity of illness.

CT appearances and short-term changes of COVID-19 in subclinical period

Objective To explore the characteristics and short-term changes of high resolution CT (HRCT) in subclinical stage of COVID-19. Methods The HRCT images of 17 COVID-19 patients in subclinical stage were analyzed retrospectively in Union Hospital, Tongji Medical College, Huazhong University of Science and Technology and Wuhan Jinyintan Hospital from January 15 to 31, 2020. There were 4 males and 13 females, age ranged from 25.0 to 51.0 (39.8±7.5) years, who were closely contacted with other COVID-19 patients. The follow-up CT examination was performed within 3 to 6 days after the initial CT examination in all patients. Six patients were treated using anti-virus, anti-inflammation and symptomatic therapy, while the other 11 patients were untreated. The subclinical CT findings and short-term follow-up were analyzed, and the CT changes of short-term follow-up were summarized. Results The lesions of 17 COVID-19 patients were mainly located at the lower lobes of bilateral lungs (at the left lower lobe in 9 cases and at the right lower lobe in 10 cases in the subclinical stage, at the left lower lobe in 9 cases and at the right lower lobe in 11 cases in the short-term follow-up). The number of involved lung segments increased from 46 in the subclinical stage to 90 in the short-term follow-up. In the subclinical stage, the multiple lesions were found in 13 cases, while in the short-term follow-up, the number of cases with multiple lesions decreased by 7, however the cases with focal lesions increased by 6 and diffuse lesions by 4. The lesions were mainly distributed under the pleura (13 cases) or along the bronchovascular bundle(10 cases). In the short-term follow-up, the lesion in 1 case expanded from the subpleural area to neighbouring bronchovascular bundle. There were 3 main types of the lesions, including ground glass nodule, ground glass opacity and crazy-paving pattern. In the subclinical stage and short-term follow-up, the ground glass opacities were seen in all the 17 cases. In the short-term follow-up, the number of cases with ground glass nodules decreased by 4 and crazy-paving pattern increased by 4. In 6 patients after treatment, the multiple ground glass nodules became single one in 3 cases, and in other 3 cases the multiple ground glass opacities were getting smaller. However, the scope of lesions in 11 patients without treatment enlarged. Conclusion The HRCT features of the COVID-19 in subcilincal stage have some charicteristics, such as small ground glass nodule, ground glass opacity along the subpleural area or along the bronchovascular bundle, and the great changes can be seen in the short-term follow-up. Key words: COVID-19; Tomography, X-ray computed

Coronavirus-HKU1 Pneumonia and Differential Diagnosis with COVID-19.

HomeRadiology: Cardiothoracic ImagingVol. 2, No. 2 PreviousNext Case SeriesFree AccessPulmonary ImagingCoronavirus-HKU1 Pneumonia and Differential Diagnosis with COVID-19Elisa Pianura, Federica Di Stefano , Massimo Cristofaro, Ada Petrone, Nicoletta Fusco, Fabrizio Albarello, Daniele Lapa, Stefania Cicalini, Paolo Campioni, Vincenzo SchininàElisa Pianura, Federica Di Stefano , Massimo Cristofaro, Ada Petrone, Nicoletta Fusco, Fabrizio Albarello, Daniele Lapa, Stefania Cicalini, Paolo Campioni, Vincenzo SchininàAuthor AffiliationsFrom the IRCCS National Institute for Infectious Diseases (INMI) Lazzaro Spallanzani, Via Portuense 292, Rome 00149, Italy.Address correspondence to F.D.S. (e-mail: [email protected]).Elisa PianuraFederica Di Stefano Massimo CristofaroAda PetroneNicoletta FuscoFabrizio AlbarelloDaniele LapaStefania CicaliniPaolo CampioniVincenzo SchininàPublished Online:Apr 23 2020https://doi.org/10.1148/ryct.2020200162MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack Citations ShareShare onFacebookTwitterLinked In A 74-year-old woman, residing in Rome, was admitted on March 4, 2020, with fever and dry cough for 5 days. She had an epidemiologic link with her sister, who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Laboratorial studies revealed elevated C-reactive protein and normal white cell count with neutrophilia. Chest CT studies obtained at admission showed multiple ground-glass opacities in both upper and left lower lobes, with small pleural effusions (Fig 1a). The patient was negative for SARS-CoV-2 on three polymerase chain reaction (PCR) nasopharyngeal swab tests. Serological tests for SARS-CoV-2 were also negative. A subsequent analysis for other respiratory viruses was positive for human coronavirus HKU1 (HKU1-CoV), and follow-up CT performed after 2 weeks of therapy showed almost complete radiologic resolution (Fig 1b).Figure 1a: Images in 74-year-old woman with HKU1 coronavirus pneumonia. (a) CT scan performed at admission shows a large area of peripheral ground-glass opacity (arrow) in the lower left lobe and small pleural effusions (star). (b) The CT scan performed after 14 days shows almost complete resolution of the imaging findings.Figure 1a:Download as PowerPointOpen in Image Viewer Figure 1b: Images in 74-year-old woman with HKU1 coronavirus pneumonia. (a) CT scan performed at admission shows a large area of peripheral ground-glass opacity (arrow) in the lower left lobe and small pleural effusions (star). (b) The CT scan performed after 14 days shows almost complete resolution of the imaging findings.Figure 1b:Download as PowerPointOpen in Image Viewer Although chest CT has been used for diagnosing coronavirus disease 2019 (COVID-19) (Fig 2), it relies on relatively nonspecific signs, such as multifocal and peripheral ground-glass opacities, consolidations, and crazy paving, which can be also found in other viral pneumonias (1–3). We illustrate a case of HKU1-CoV pneumonia, a novel group 2 coronavirus discovered in January 2004, which has been also associated with community-acquired pneumonia (4). Given the pandemic setting of COVID-19, the current case underscores the confirmatory role of PCR and the need for considering alternative diagnoses, especially when the full clinical, laboratorial, and radiologic picture does not fit into the most common presentation. Noticeably, neutrophilia and pleural effusions have been infrequently seen at the initial presentation of COVID-19 (5).Figure 2a: Images in patient with coronavirus disease 2019 (COVID-19) pneumonia. (a, b) Typical CT aspect of COVID-19 pneumonia: initial phase of disease with areas of ground-glass opacity peripherally (arrow in a); severe phase of disease with diffuse crazy paving pattern (arrow in b). Pleural effusions are absent.Figure 2a:Download as PowerPointOpen in Image Viewer Figure 2b: Images in patient with coronavirus disease 2019 (COVID-19) pneumonia. (a, b) Typical CT aspect of COVID-19 pneumonia: initial phase of disease with areas of ground-glass opacity peripherally (arrow in a); severe phase of disease with diffuse crazy paving pattern (arrow in b). Pleural effusions are absent.Figure 2b:Download as PowerPointOpen in Image Viewer Disclosures of Conflicts of Interest: E.P. disclosed no relevant relationships. F.D.S. disclosed no relevant relationships. M.C. disclosed no relevant relationships. A.P. disclosed no relevant relationships. N.F. disclosed no relevant relationships. F.A. disclosed no relevant relationships. D.L. disclosed no relevant relationships. S.C. disclosed no relevant relationships. P.C. disclosed no relevant relationships. V.S. disclosed no relevant relationships.AcknowledgmentsCOVID 19 INMI Study Group.Author ContributionsAuthor contributions: Guarantors of integrity of entire study, E.P., F.D.S., M.C., A.P., N.F., F.A., P.C., V.S.; study concepts/study design or data acquisition or data analysis/interpretation, all authors; manuscript drafting or manuscript revision for important intellectual content, all authors; approval of final version of submitted manuscript, all authors; agrees to ensure any questions related to the work are appropriately resolved, all authors; literature research, E.P., F.D.S., M.C., A.P., N.F., F.A., D.L., P.C., V.S.; clinical studies, E.P., F.D.S., M.C., A.P., F.A., D.L., S.C., P.C., V.S.; experimental studies, E.P., F.D.S., M.C., A.P., F.A., D.L., P.C.; statistical analysis, E.P., F.D.S., M.C., A.P., F.A., P.C.; and manuscript editing, E.P., F.D.S., M.C., A.P., N.F., F.A., S.C., P.C., V.S.Keywords: Adults and Pediatrics, CT, Lung, Thorax Authors declared no funding for this work.

Multistage CT features of coronavirus disease 2019.

To determine imaging features of coronavirus disease 2019 (COVID-19) in different stages, and to provide foundations for early diagnosis and treatment. CT image data of 187 COVID-19 patients were analyzed in the period of hospitalization. CT scanning was performed on admission and repeated every 3 days. The improvement time of clinical symptoms and the image changes of follow-up CT were statistically analyzed. All 187 patients' nucleic acid test were positive to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The early CT images of lung in 187 cases (100%) showed multiple patchy and ground-glass opacities with fine mesh and consolidation shade, which mainly distributed in pulmonary band or under the pleura. In the progressive stage, the pulmonary lesions in 146 cases (78.1%) were mainly consolidation, accompanied by air bronchogram, thickening of blood vessels, and interstitial changes. Severe pulmonary CT images in 15 cases (8%) showed diffuse lesions in both lungs, displaying consolidation, or "white lung". The CT imaging features in 185 cases (98.9%) at the absorptive period showed that the lesions diminished and fibrogenesis. The imaging features of 6 times of lung CT examination in one case showed continuous progress. The original lesion in one case was obviously absorbed, but new lesions appeared under the pleura of both lungs at the third review of CT scanning. The changes of CT imaging lesions during follow-up were significantly different in different clinical symptoms improvement time (P< 0.01). Images of COVID-19 in various stages have special characteristics. The change of clinical symptoms is synchronous with the change of reexamination CT. Follow-up CT can reflect the trend of clinical changes. Repeat CT examination plays an important role in the early clinical diagnosis and the evaluation for the therapeutic effect on COVID-19 patient.

Coronavirus disease 2019: initial chest CT findings.

ObjectivesTo systematically analyze CT findings during the early and progressive stages of natural course of coronavirus disease 2019 and also to explore possible changes in pulmonary parenchymal abnormalities during these two stages.MethodsWe retrospectively reviewed the initial chest CT data of 62 confirmed coronavirus disease 2019 patients (34 men, 28 women; age range 20–91 years old) who did not receive any antiviral treatment between January 21 and February 4, 2020, in Chongqing, China. Patients were assigned to the early-stage group (onset of symptoms within 4 days) or progressive-stage group (onset of symptoms within 4–7 days) for analysis. CT characteristics and the distribution, size, and CT score of pulmonary parenchymal abnormalities were assessed.ResultsIn our study, the major characteristic of coronavirus disease 2019 was ground-glass opacity (61.3%), followed by ground-glass opacity with consolidation (35.5%), rounded opacities (25.8%), a crazy-paving pattern (25.8%), and an air bronchogram (22.6%). No patient presented cavitation, a reticular pattern, or bronchial wall thickening. The CT scores of the progressive-stage group were significantly greater than those of the early-stage group (p = 0.004).ConclusionsMultiple ground-glass opacities with consolidations in the periphery of the lungs were the primary CT characteristic of coronavirus disease 2019. CT score can be used to evaluate the severity of the disease. If these typical alterations are found, then the differential diagnosis of coronavirus disease 2019 must be considered.Key Points• Multiple GGOs with consolidations in the periphery of the lungs were the primary CT characteristic of COVID-19.• The halo sign may be a special CT feature in the early-stage COVID-19 patients.• Significantly increased CT score may indicate the aggravation of COVID-19 in the progressive stage.

Clinical features of severe pediatric patients with coronavirus disease 2019 in Wuhan: a single center's observational study.

BackgroundAn outbreak of coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 was first detected in Wuhan, Hubei, China. People of all ages are susceptible to SARS-CoV-2 infection. No information on severe pediatric patients with COVID-19 has been reported. We aimed to describe the clinical features of severe pediatric patients with COVID-19.MethodsWe included eight severe or critically ill patients with COVID-19 who were treated at the Intensive Care Unit (ICU), Wuhan Children’s Hospital from January 24 to February 24. We collected information including demographic data, symptoms, imaging data, laboratory findings, treatments and clinical outcomes of the patients with severe COVID-19.ResultsThe onset age of the eight patients ranged from 2 months to 15 years; six were boys. The most common symptoms were polypnea (8/8), followed by fever (6/8) and cough (6/8). Chest imaging showed multiple patch-like shadows in seven patients and ground-glass opacity in six. Laboratory findings revealed normal or increased whole blood counts (7/8), increased C-reactive protein, procalcitonin and lactate dehydrogenase (6/8), and abnormal liver function (4/8). Other findings included decreased CD16 + CD56 (4/8) and Th/Ts*(1/8), increased CD3 (2/8), CD4 (4/8) and CD8 (1/8), IL-6 (2/8), IL-10 (5/8) and IFN-γ (2/8). Treatment modalities were focused on symptomatic and respiratory support. Two critically ill patients underwent invasive mechanical ventilation. Up to February 24, 2020, three patients remained under treatment in ICU, the other five recovered and were discharged home.ConclusionsIn this series of severe pediatric patients in Wuhan, polypnea was the most common symptom, followed by fever and cough. Common imaging changes included multiple patch-like shadows and ground-glass opacity; and a cytokine storm was found in these patients, which appeared more serious in critically ill patients.

Clinical features of 2019 novel coronavirus pneumonia in the early stage from a fever clinic in Beijing

Objective: To summarize and analyze the clinical and imaging characteristics of patients with 2019 novel coronavirus pneumonia in the early stage in Beijing. Methods: A retrospective analysis of clinical and imaging data of 9 patients with 2019 novel coronavirus infection diagnosed in one fever clinicic in Beijing from January 18, 2020 to February 3, 2020. Results: 5 male and 4 female was included in those 9 patients, whose median age was 36 years, and the age range from 15 to 49 years. 8 of these patients had no underlying disease and one suffered from diabetes. 7 patients had a history of travel to Wuhan City or Hubei Province, and one patient was a medical staff. Two family clustered was found. The incubation period was 1 to 6 days. The clinical manifestations were fever in 8 cases (8/9) , dry cough in 5 cases (5/9) , pharyngalgia in 4 cases (4/9) , fatigue in 4 cases (4/9) , body soreness in 4 cases (4/9) , and blocked or watery nose in 1 case (1/9) . Six patients (6/9) had abnormal cell peripheral blood, of which 3 (3/9) had an increased monocyte count, 2 (2/9) had a reduced lymphocyte, and 1 (1/9) had an increased leukocyte count, while the 3 patients had normal cell blood routines. The median of CRP was 16.3 mg/L, including 5 patients with slightly elevated (5/9) , 4 patients with normal values (4/9) . the results of procalcitonin test were negative in5 patients. Three patients were examined by chest X-ray examination, one of which was normal, one case showed infiltrates of right upper lung, and another showed in right lower lung. All patients underwent chest HRCT. And 7 cases (7/9) showed multiple ground glass exudation, including 5 cases (5/7) involved bilateral lungs, 2 cases (2/7) involved unilateral lung, 3 cases (3/7) with patchy consolidation, and 2 cases (2/9) showed no abnormality. Conclusions: The patents with 2019 novel coronavirus pneumonia in this study generally have an epidemiological history. The clinical manifestations are fever and cough. Peripheral white blood cell counts were most normal And PCT were all negative. Chest HRCT manifested as multiple ground-glass opacities with partly consolidation. Some patients had normal chest radiographs but HRCT showed pneumonia. Some patients had no pneumonia on chest HRCT.

CT manifestations of coronavirus disease-2019: A retrospective analysis of 73 cases by disease severity

PurposeTo report CT features of coronavirus disease-2019 (COVID-19) in patients with various disease severity. MethodsThe CT manifestations and clinical data of 73 patients with COVID-19 were retrospectively collected in 6 hospitals from Jan 21 to Feb 3, 2020. We analyzed the initial and follow-up CT features of patients with disease severity, according to the Guidelines for the Diagnosis and Treatment of New Coronavirus Pneumonia. ResultsSix patients (8%) were diagnosed as mild type pneumonia; these patients had no obvious abnormal CT findings or manifested mild changes of lung infection. All 43 patients (59 %) with common type presented unique or multiple ground-glass opacities (GGO) in the periphery of the lungs, with or without interlobular septal thickening. In the 21 patients (29 %) with severe type, extensive GGO and pulmonary consolidation were found in 16 cases (16/21, 76 %) and 5 cases (24 %), respectively. An extensive "white lung", with atelectasis and pleural effusion were found in critical type patients (3, 4%). On the resolutive phase of the disease, CT abnormalities showed complete resolution, or demonstrated residual linear opacities. ConclusionsDifferent CT features are seen according to disease severity, which can help COVID-19 stratification.

Evidence for Gastrointestinal Infection of SARS-CoV-2

No abstract available Keywords: ACE2; Gastrointestinal Infection; Oral-Fecal Transmission; SARS-CoV-2.

A nomogram to predict invasiveness in lung adenocarcinoma presenting as ground glass nodule.

BackgroundAdenocarcinoma in situ, minimally invasive adenocarcinoma, and invasive adenocarcinoma (IA) can all appear as a ground glass opacity (GGO) on chest computed tomography (CT). However, their respective prognoses are considerably different. This study aimed to predict IA in radiological examinations of patients with GGO lesions.MethodsWe retrieved the clinical records and high-resolution CT (HRCT) images of 124 patients with GGO lesions, who underwent various lung resections between 2016 and 2017. Correlations between the imaging features of preoperative HRCT and the postoperative pathology were analyzed. Receiver-operating characteristic (ROC) curve analysis, chi-square test, and one-way analysis of variance and multiple logistic regression were performed. A nomogram was developed and analyzed using a multiple logistic model.ResultsThe maximum sensitivity and specificity were obtained at a cutoff value of −410 Hounsfield units (HU) for the mean CT value (m-CT), 10 mm for the maximum tumor dimension (MTD), and 0.25 for the consolidation tumor ratio (CTR). Further, there were significant differences in MTD, CTR, margin characteristics, air bronchogram, pleural indentation, and multiple GGOs (P<0.05). The independent predictive factors of IA included MTD [risk ratio (RR), 5.047; P=0.018], air bronchogram or vacuole sign (RR, 4.054; P=0.025), pleural retraction (RR, 4.742; P=0.008), and m-CT value (RR, 5.874; P =0.005). The scoring nomogram model was as follows: −3.50744 + 1.26374 × (MTD>10 mm=1) + 2.41978 × (m-CT value≥−410 HU=1) + 1.77779 × (with air bronchogram or vacuole sign=1) + 1.60913 × (with pleural retraction=1). The area under the ROC curve was 0.9. The cutoff score was −0.5502 with a sensitivity of 86.8% and a specificity of 78.9%.ConclusionsIA in patients with GGO lesions can be predicted by evaluating the MTD, m-CT value, air bronchogram, and pleural retraction on HRCT by using a nomogram model.

Anesthetic Management of Patients with COVID 19 Infections during Emergency Procedures

ObjectivesThe aim of the present study was to prevent cross-infection in the operating room during emergency procedures for patients with confirmed or suspected 2019 novel coronavirus (2019-nCoV) by following anesthesia management protocols, and to document clinical- and anesthesia-related characteristics of these patients.DesignThis was a retrospective, multicenter clinical study.SettingThis study used a multicenter dataset from 4 hospitals in Wuhan, China.ParticipantsPatients and health care providers with confirmed or suspected 2019-nCoV from January 23 to 31, 2020, at the Wuhan Union Hospital, the Wuhan Children's Hospital, The Central Hospital of Wuhan, and the Wuhan Fourth Hospital in Wuhan, China.InterventionsAnesthetic management and infection control guidelines for emergency procedures for patients with suspected 2019-nCoV were drafted and applied in 4 hospitals in Wuhan.Measurements and Main ResultsCross-infection in the operating rooms of the 4 hospitals was effectively reduced by implementing the new measures and procedures. The majority of patients with laboratory-confirmed 2019-nCoV infection or suspected infection were female (23 [62%] of 37), and the mean age was 41.0 years old (standard deviation 19.6; range 4-78). 10 (27%) patients had chronic medical illnesses, including 4 (11%) with diabetes, 8 (22%) with hypertension, and 8 (22%) with digestive system disease. Twenty-five (68%) patients presented with lymphopenia, and 23 (62%) patients exhibited multiple mottling and ground-glass opacity on computed tomography scanning.ConclusionsThe present study indicates that COVID 19–specific guidelines for emergency procedures for patients with confirmed or suspected 2019-nCoV may effectively prevent cross-infection in the operating room. Most patients with confirmed or suspected COVID 19 presented with fever and dry cough and demonstrated bilateral multiple mottling and ground-glass opacity on chest computed tomography scans.