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Review
. Jul-Aug 2020;49(4):294-301.
doi: 10.1067/j.cpradiol.2020.04.001. Epub 2020 Apr 11.

Chest Imaging in Patients Hospitalized With COVID-19 Infection - A Case Series

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Free PMC article
Review

Chest Imaging in Patients Hospitalized With COVID-19 Infection - A Case Series

Roopa Bhat et al. Curr Probl Diagn Radiol. .
Free PMC article

Abstract

COVID-19 (Corona Virus Disease-19) is a zoonotic illness first reported in the city of Wuhan, China in December 2019, and is now officially a global pandemic as declared by the World Health Organization. The infection is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 infected patients can be asymptomatic carriers or present with mild-to-severe respiratory symptoms. Imaging, including computed tomography is not recommended to screen/diagnose COVID-19 infections, but plays an important role in management of these patients, and to rule out alternative diagnoses or coexistent diseases. In our multicenter case series, we outline the clinical presentations and illustrate the most common imaging manifestations in patients hospitalized with COVID-19.

Figures

FIG 1
FIG 1
(A) CXR with nonspecific peripheral and bilateral lower lung opacities (arrows). (B-D): Axial (B, C) and Sagittal (D) CT chest show bilateral lower lung predominant subpleural linear opacities (B) and scattered peripheral ground glass opacities (C). CXR, Chest radiograph.
FIG 2
FIG 2
(A-D) Serial CXRs: Day 1 (A) showing ill-defined focal patchy airspace opacities in the bilateral middle and lower lung zones (arrows). Three days later (B) the CXR shows worsening of lung disease (arrows). Day 5 CXR (C) shows progression of opacities with features of ARDS (arrows). Improving opacities day 10 of treatment (D). ARDS, acute respiratory distress syndrome; CXR, Chest radiograph.
FIG 3
FIG 3
(A-C) Serial CXRs: CXR at presentation (A) shows opacities in the right lower and left mid-lung zones (arrows). CXR (B) on the second day of admission shows mild worsening of bilateral pulmonary opacities (arrows). Day 5 (C) of admission shows stable bilateral pulmonary opacities (arrows). CXR, Chest radiograph.
FIG 4
FIG 4
(A-E) CXR Day 1 (A) shows bilateral mid and lower lung hazy opacities (arrows). CXR 3 hours later (B) shows worsened hazy and consolidative opacities bilateral mid and lower lung (arrows). Initial CT (C, D): Bilateral predominantly dependent consolidative opacities (asterisks). No effusions or cavitation. Follow-up CXR (E) day 6 shows a left-sided tension pneumothorax (arrows). CXR, Chest radiograph.
FIG 5
FIG 5
(A) Day 1 CXR – Right perihilar ill-defined opacities (arrow). (B-D) Day 1 CT Axial (B, C) and coronal (D) CT shows rounded GGO in the right lower lobe (arrows) with hazy opacities in the left lower lobe. (E-F) Serial CXRs. Day 6 (E) CXR worsening of multifocal opacities in both lungs suggestive of ARDS (white arrow). Day 9 of treatment with improvement in lung opacities (F). ARDS, acute respiratory distress syndrome; CXR, Chest radiograph; GGO, ground glass opacities.
FIG 6
FIG 6
(A-C) Serial CXRs: Day 1 (A) showing ill-defined patchy airspace opacities in the bilateral lower lungs (white arrows). Nine days later (B) the CXR shows worsening of lung disease (white arrows) in the mid and lower lung zones and progression of opacities with features of ARDS (white arrows). Interval extubation with improving opacities at the right lung base with new small right pleural effusion on day 16th of treatment (C). (D-F) Axial (D, E) and Coronal (F) CT chest with multifocal patches of mainly peripheral GGOs and mild septal thickening, predominantly within bilateral lower lobes with regions of peripheral consolidation. Reversed halo sign (arrow in F) is present in the lower lobes. Perilobular thickening (arrow in D) evident in the right upper lobe. ARDS, acute respiratory distress syndrome; CXR, Chest radiograph; GGO, ground glass opacities.
FIG 7
FIG 7
(A) CXR shows a vague ill-defined hazy opacity in the right lower lobe in a COVID positive patient. B-D Axial (B, C) and Coronal (D) CT chest show right lung multifocal mainly peripheral GGOS (arrows) and mild intralobularseptal thickening, most prominent in the subpleural distribution in the right lower lobe. Subtle left lower lobe GGOs are also noted (D). CXR, Chest radiograph; GGO, ground glass opacities.
FIG 8
FIG 8
(A) CXR shows biapical mass like densities with fibrosis (block arrows) from ongoing and sequelae of prior mycobacterial infection. An underlying neoplastic mass in the right upper lobe was in the differential. In addition, there are patchy bibasilar subtle opacities (white arrows). A CT chest was subsequently performed. (B-D): Axial (B, C) and Coronal (D) CT chest show multifocal peripheral patchy GGOs in right upper lobe and basal segments of both lower lobes. These findings of organizing pneumonia pattern are nonspecific and may be seen with atypical infection such as viral pneumonia among other etiologies. Note the right apical mass and bi-apical fibrosis from old and ongoing Mycobacterial infection in the coronal CT image (Block arrows on D). CXR, Chest radiograph; GGO, ground glass opacities.

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