To report the spectrum of chest computed tomographic (CT) imaging findings in coronavirus disease-19 (COVID-19) infected Indian patients. Methods: This was a prospective descriptive study comprising 147 consecutive reverse transcriptase polymerase chain reaction (RT-PCR) positive patients who underwent CT chest. Prevalence, distribution, extent and type of abnormal lung findings were recorded. Results: Among the total study cohort of 147 patients, 104 (70.7 %) were males and 43 (29.3 %) were females with mean age of 40.9 ± 17.2 years (range 24-71 years). We observed lung parenchymal abnormalities in 51 (34.7 %) cases whereas 96 (65.3 %) RT-PCR positive cases had a normal chest CT. Only 12.2 % of the patients were dyspneic, 6.1 % had desaturation, 7.4 % had increased respiratory rate and 10.9 % had comorbidities. Among the patients with abnormal CT findings bilateral 39/51 (76.5 %), multilobar (88.2 %) lung involvement with a predominant peripheral and posterior distribution was commonly observed. With regards to the type of opacity, ground glass opacity (GGO) was the dominant abnormality found in all 51 (100 %) cases. Pure GGO was observed in 15 (29.4 %), GGO with crazy paving pattern was seen in 15 (29.4 %) and GGO mixed with consolidation was noted in 21(41.2 %). Peri-lesional or intralesional segmental or subsegmental pulmonary vessel enlargement was observed in 36 (70.6 %) cases. Conclusion:In this study population predominantly with mild symptoms and few comorbidities, two-thirds of RT-PCR positive patients had a normal chest CT; whereas the remaining patients showed typical findings of predominant GGOs with a bilateral distribution and peripheral predominance.

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Objective: The study aimed to describe the clinical and imaging course of reverse transcriptase polymerase chain reaction) confirmed coronavirus disease (COVID-19) patients who are asymptomatic at admission. Methods: This was a retrospective observational study. Severe acute respiratory syndrome coronavisrus-2 (SARS-CoV-2) positive cases that were asymptomatic at admission were retrospectively enrolled. Specific clinical information, laboratory test results, chest CT imaging features and outcome data during hospital stay were collected and analyzed. Results: 137 non-consecutive asymptomatic patients with reverse transcriptase polymerase chain reaction confirmed COVID-19 were enrolled in the present study. On admission, patients had no symptoms but chest CT findings were present in 61/137 (44.5%). Ground glass opacity (48, 78.7%) followed by ground glass opacity with crazy-paving pattern (9, 14.7%) were the commonest type of opacities with posterior, peripheral predominance and lower zone predilection. Among the initial CT positive group of 61 patients, follow-up imaging revealed progression of pulmonary opacities in 13/61 (21.4%), complete resorption in 21/61 (34.4%), partial resolution in 22/61 (36%) and no change in 5/61 (8.2%). The patients in progression group (54 ± 19.7 years) were older and had higher frequency of co-morbidities (46.2%) compared to the other three groups (10.4%). The patients in progression group had a significantly higher C-reactive protein, higher lactate dehydrogenase and lower lymphocyte count than the other groups (all p-values < 0.05). The duration of hospital stay was longer in the progression group (27.1 ± 11.4 days) compared to the other three groups (16.12 ± 5.8) (p =< 0.05). Conclusion: Nearly half of the asymptomatic cases with confirmed COVID-19 had abnormal chest CT imaging. Asymptomatic infections can have a variable clinicoradiological course. Clinically, some recover without developing symptoms, some present few mild symptoms whereas some deteriorate. Similarly, imaging follow-up may reveal resolution (partial or complete), progression or no change. Advances in knowledge: Clinicoradiological course of asymptomatic COVID-19 cases is diverse.

A 35-year-old man presented to the emergency department (ED) with a 3-month history of increasing shortness of breath associated with reduced exercise tolerance. The patient was a smoker with more than 20 pack-years of tobacco use. He had no history of fever, night sweats, cough, hemoptysis or chest pain, and his medical history was unremarkable. Physical examination revealed a well-looking man who was alert, stable and in no respiratory distress. Vital signs were blood pressure 122/74 mm Hg, pulse 92 beats/min, respiratory rate 22 breaths/min, temperature 35.8°C and oxygen saturation 97% on room air. The patient had no pallor, cyanosis, diaphoresis, clubbing or peripheral edema. His jugular veins were not distended; however, his trachea was shifted to the right and breath sounds were diminished over the left hemithorax without dullness to percussion. The patient's heart sounds were maximally audible over the right hemithorax. An electrocardiogram revealed normal sinus rhythm and right axis deviation without evidence of ischemia. Pulmonary function tests were consistent with an obstructive pattern (forced expiratory volume in 1 second [FEV 1 ] = 1.71 L; 45% predicted). A posterior-anterior chest x-ray is shown in Figure 1. Question The most likely diagnosis is: a) bullous emphysema; b) tension pneumothorax; c) spontaneous pneumothorax; or d) right-sided pneumonia? For the Answer to this Challenge, see page 233. This article has not been peer reviewed.