COVID-19 Standard Report CT

Chest radiograph
Courtesy Dr. Michael David Kuo.
The chest film is insensitive early in the disease.
Here a comparison of a chest radiograph and CT image.
The ground glass opacities in the right lower lobe on the CT (red arrows) are not visible on the chest radiograph, which was taken 1 hour prior to the CT-study

Chest-films can be useful in the follow-up of the disease.

These x-rays are of a patient with COVID-19.

On admission to the hospital the chest film was normal.

Four days later the patient is on mechanical ventilation and there are bilateral consolidations on the chest film.

Chest film of a 83 year old male with mitral insufficiency, pulmonary hypertension and atrial fibrillation with COVID-19 infection.

Ground-glass opacification and consolidation in right upper lobe and left lower lobe (arrows).

A series of chest films of a 72-year-old woman admitted with acute respiratory failure, fever (38ºC) and dyspnoea.

She was tachypneic (30bpm), with lymphopenia and low oxygen saturation (SpO2 85%).

Patient presented to the emergency department two days earlier with fever (up to 38.6ºC), dry cough, odynophagia and general malaise.

She was discharged from hospital because she did not present alarm criteria at that time.

The patient required mechanical ventilation and was admitted to intensive care.

During her stay in ICU, poor evolution to respiratory distress syndrome and to multi-organic failure.

The patient died 24 hours later.

Imaging findings:

At admission: Ill-defined bilateral alveolar consolidation with peripheral distribution.

4 hours later: Radiological worsening, with affectation of lower lobes. Endotracheal tube and central venous line were required.

24 hours: Bilateral alveolar consolidation.

48 hours: Radiological worsening. Bilateral alveolar consolidation with panlobar affectation.

72 hours: Bilateral alveolar consolidation with panlobar affectation, with typical radiological findings of ARDS. 24 hours later the patient passed away.

Possible role of CT

CT can play a role in:

Triage of patients:

- no COVID-19

- possible or most likely COVID-19

- severity of the disease

Prediction of worsening

Prediction of improvement

Problem solver

Triage

Some published clinical guidelines recommend chest CT for patients with suspected COVID-19.

The decision to use of CT for triage depends on many considerations:

a priori chance of COVID-19 infection.

CT availability, for instance can one CT be used as Corona-CT or is there a CT near the emergency room.

clinical suspicion in patients with negative PCR.

Video cases of CT Chest

Source video : https://www.youtube.com/watch?v=3l6UKbZB9EY&feature=emb_logo


This is a 67 year old woman who was coughing for one week and now presented with shortness of breath. source video : https://www.youtube.com/watch?v=kz8Q9eSypnA&feature=emb_logo


This is a CT-scan of a 53 year old woman at admission.
There are 2 areas with a halo sign, some areas of ground-glass and consolidations in the lower lobes.
Based on the CT-findings she was suspected of having COVID-19.
The PCR-test the next day was positive.
source video : https://www.youtube.com/watch?v=sr-UmOyx9uU&feature=emb_logo


60 year old male with complaints of fatigue and coughing for one week.
Source video  https://www.youtube.com/watch?v=k12dPqCeOQg&feature=emb_logo

Source content:

Imaging Profile of the COVID-19 Infection: Radiologic Findings and Literature Review

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Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus–Infected Pneumonia

Qun Li, M.Med., Xuhua Guan, Ph.D., Peng Wu, Ph.D., Xiaoye Wang, M.P.H., et al.

A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster

Jasper Fuk-Woo Chan, MD * Shuofeng Yuan, PhD * Kin-Hang Kok, PhD * Kelvin Kai-Wang To, MD * Hin Chu, PhD * Jin Yang, MD et al.

Coronavirus Disease 2019 (COVID-19): A Systematic Review of Imaging Findings in 919 Patients Read More: https://www.ajronline.org/doi/full/10.2214/AJR.20.23034

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Sana Salehi, Aidin Abedi1, Sudheer Balakrishnan and Ali Gholamrezanezhad

Rapidly progressive ARDS secondary to COVID-19 infection - Eurorad case 16660

Edgar Lorente Martínez - Hospital Universitario Doctor Peset, Valencia, Spain

CT Features of Coronavirus Disease 2019 (COVID-19) Pneumonia in 62 Patients in Wuhan, China

AJR 2020; 214:1–8

Shuchang Zhou et al

https://radiologyassistant.nl/chest/lk-jg-1#chest-ct-subpleural-bands-and-architectural-distortion

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