Ergeba Sheferaw, MD, MPH
Imaging Findings Associated With COVID-19
As the world grapples with the widespread Coronavirus infection, there have been several studies, mainly from China, describing the imaging characteristics associated with this disease. Even though laboratory testing is used to diagnose COVID-19, there are characteristic imaging findings on chest CT associated with this disease which radiologists should be aware of. However, these findings are not specific enough to allow chest CT to be used as a diagnostic tool. I will also briefly mention lung ultrasound findings associated with COVID-19.
In a retrospective study of 121 symptomatic patients in china, 56% of patient had a normal chest CT early in the course of the disease (0-2 days) (1). With longer duration of the disease, the percentage of abnormal cases increased. Bilateral peripheral ground glass opacities and consolidations were the most common findings seen on chest CT, sometimes with a rounded morphology. As the disease progresses, crazy paving and consolidation become more prevalent. Notably, pulmonary nodules and lymphadenopathy were absent while pleural effusion was only seen in one patient in this study.
An axial CT image obtained without intravenous contrast in a 36‐year‐old male (Panel A) shows bilateral ground‐glass opacities in the upper lobes with a rounded morphology (arrows).
An axial CT image obtained in a 44‐year‐old male (Panel B) shows larger groundglass opacities in the bilateral lower lobes with a rounded morphology (arrows).
An axial CT image obtained without intravenous contrast in a 42‐year‐old male in the “late” time group (10 days from symptom onset to this CT) shows bilateral consolidative opacities, with a striking peripheral distribution in the right lower lobe (solid arrows), and with a rounded morphology in the left lower lobe (dashed arrow).
Although majority of the literature focuses on chest CT findings, there is growing interest in the use of lung ultrasound particularly in low resource settings for patient management. The additional benefit of ultrasound is that it can be performed at bedside. I found one case report from Italy documenting the findings from a patient with confirmed COVID-19 (2). Lung ultrasound was performed with a portable convex probe (3.5 mHz) wireless connected to a tablet.
Finally, infection control within the radiology department during the COVID-19 outbreak is paramount to minimize further spread of the disease within the hospital and to improve the safety of the medical staff. The summary issued by the ACR is outlined on this graphic.
- Bernheim, Adam et al. Chest CT findings in Coronavirus Disease-19 (COVID-19): Relationship to duration of infection. Radiology. Published Online :Feb 20 2020https://doi.org/10.1148/radiol.2020200463
- Buensenso D. et. Al. Point of care lung ultrasound findings in novel coronavirus disease 19 pnemoniae: a case report and potential applications during COVID-19 outbreak. European Review for Medical and Pharmacological Sciences. 2020;24:2776-2780.
- Coronavirus (COVID-19) Outbreak: What the Department of Radiology Should KnowKooraki, Soheil et al. Journal of the American College of Radiology,