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

Fu, Fangfang; Lou, Jiatao; Deyan, Xi; Bai, Yan; Ma, Gongbao; Zhao, Bin; Liu, Dong; Bao, Guofeng; Zhidan, Lei; Wang, Meiyun

doi:10.1007/s00330-020-06920-8

Cited by 65 publications

(74 citation statements)

References 16 publications

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“…Given this likely high prevalence of OP, AFOP or both in early COVID-19, a concern is that the increasingly adopted RECOVERY trial protocol (6 mg dexamethasone daily for up to 10 days) may be insufficient given that treatment of secondary OP often requires higher doses, prolonged duration of treatment, and a careful and monitored tapering. 9 Thus, additional studies comparing corticosteroid type, dosing and duration should be conducted along with the use of other immunosuppressive agents. Initial and maintenance corticosteroid dosing should be similar to that recommended to treat COP, although patients with secondary OP typically require a shorter duration.…”

Section: Resultsmentioning

confidence: 99%

SARS-CoV-2 organising pneumonia: ‘Has there been a widespread failure to identify and treat this prevalent condition in COVID-19?’

Kory

Kanne

2020

BMJ Open Resp Res

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Reviews of COVID-19 CT imaging along with postmortem lung biopsies and autopsies indicate that the majority of patients with COVID-19 pulmonary involvement have secondary organising pneumonia (OP) or its histological variant, acute fibrinous and organising pneumonia, both well-known complications of viral infections. Further, many publications on COVID-19 have debated the puzzling clinical characteristics of ‘silent hypoxemia’, ‘happy hypoxemics’ and ‘atypical ARDS’, all features consistent with OP. The recent announcement that RECOVERY, a randomised controlled trial comparing dexamethasone to placebo in COVID-19, was terminated early due to excess deaths in the control group further suggests patients present with OP given that corticosteroid therapy is the first-line treatment. Although RECOVERY along with other cohort studies report positive effects with corticosteroids on morbidity and mortality of COVID-19, treatment approaches could be made more effective given that secondary OP often requires prolonged duration and/or careful and monitored tapering of corticosteroid dose, with ‘pulse’ doses needed for the well-described fulminant subtype. Increasing recognition of this diagnosis will thus lead to more appropriate and effective treatment strategies in COVID-19, which may lead to a further reduction of need for ventilatory support and improved survival.

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Section: Resultsmentioning

confidence: 99%

SARS-CoV-2 organising pneumonia: ‘Has there been a widespread failure to identify and treat this prevalent condition in COVID-19?’

Kory

Kanne

2020

BMJ Open Resp Res

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“…These findings are consistent with findings by Fu et al, which studied 56 laboratory-confirmed patients and showed that 32.7% (18) with GGO only, 52.7% (29) had GGO and consolidative opacities, and 14.5% (8) with only consolidation. A total of 54.5% of the opacities involved both peripheral and central parenchymas and 45.5% were purely peripheral distribution [13].…”

Section: Discussionmentioning

confidence: 99%

“…Each of the five lung lobes was assigned a score that was based on the following: score 0, 0% involvement; score 1, 1-25% involvement; score 2, 26-50% involvement; score 3, 51-75% involvement; and score 4, 76-100% involvement. Summation of scores provided overall lung involvement (range of possible scores, 0-20) [7,13].…”

Section: Image Analysismentioning

confidence: 99%

2019 novel coronavirus (COVID-19) pneumonia: CT manifestations and pattern of evolution in 110 patients in Jiangxi, China

Zhan

et al. 2020

Eur Radiol

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Objectives To elucidate the CT manifestations and patterns of evolution in patients with COVID-19 pneumonia. Methods This is a retrospective review of CT scans of 110 patients. All 110 patients had initial and second CT scans, 60 of 110 patients had three serial CT scans, and 17 of 60 patients had four serial CT scans. Numerous characteristics of pulmonary and extrapulmonary abnormalities and recognizable patterns of evolution were evaluated. Results Of the 110 initial CT scans, ground-glass opacities without consolidation (65.4%) were more common than a consolidation or mixed pattern. The most common findings were subpleural involvement (77.2%), multifocal involvement (80.7%), and bilateral involvement (67.3%). Three serial CT scans of 60 patients showed four patterns of CT evolution: type 1 showing relatively high CT scores on initial CT (averaged 4 days after symptom onset), with mild progression and improvement on follow-up CT scans (25%); type 2 with progression of CT findings from initial CT to first follow-up CT (averaged 9 days after symptom onset) with subsequent improvement on second follow-up CT (averaged 13 days after symptom onset, 61.7%); type 3 with no CT changes (5.0%); and type 4 pattern was similar to type 2 but with a more prolonged course and more severe CT findings (8.3%). Conclusions Predominant findings at initial CT scans were bilateral multifocal subpleural GGO. The most commonly shown evolution pattern was type 2: progression of disease with increased extent and density of opacities on first follow-up CT followed by improvement on second follow-up CT. Key Points • Predominant findings at initial CT in patients with COVID-19 infection are bilateral multifocal subpleural ground-glass opacities. • Ill-defined patchy or nodular opacities were most commonly observed on CT scans with the right lower lobe most commonly involved. • The most commonly shown evolution pattern on chest CT was type 2: progression of CT findings from initial CT to first followup CT with subsequent improvement on second follow-up CT.

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“…The common radiological, including computed tomography (CT) features are multiple lung opacities and multiple types of opacities such as ground glass shadows, ground glass shadows with consolidations and bilateral consolidations. Multiple lobes are affected especially the lower lobes 17 . Crazy paving pattern and organising pneumonia are seen at a later stage in the disease 18 .…”

Section: Pneumonia and Ardsmentioning

confidence: 99%

Respiratory manifestations of COVID-19

Undugodage

Wanigasuriya

Madegedara³

2020

J of Cey Coll of Phy

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Corona virus disease 2019 (COVID-19), is the biggest health challenge faced by the world in the recent years. It rapidly spread to the rest of the world, over a short period of time, after its appearance in Wuhan, China. WHO declared it a pandemic on the 11 th of March. At the time of writing, 5,556,574 people are affected worldwide with 348,223 deaths 1. In Sri Lanka, the first local case was detected in early March 2020, and 2 months later, despite the much lower population compared to the severely affected countries such as China, US and Italy, there are over 1000 cases with 9 deaths 2. COVID-19 is primarily a disease affecting the respiratory system. The corona virus that leads to COVID-19 is a beta coronavirus and belongs to the same subgenus as the Severe Acute Respiratory Syndrome [SARS] virus. COVID-19 virus is known as the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS COV2) 3. The virus binds to Angiotensin Converting Enzyme 2 (ACE 2) protein to enter human cells 4. ACE 2 proteins are expressed in the airway epithelium, lung parenchyma and vascular endothelium 5. ACE 2 is expressed more on the apical surface of the airway epithelium as opposed to the baso-lateral surface. Thus, rendering the lung susceptible to infection by SARS COV2. The respiratory involvement in COVID-19 can manifest in several ways-• Upper respiratory tract infection • Pneumonia and Acute respiratory distress syndrome [ARDS] Respiratory manifestations of COVID-19 This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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

Cited by 65 publications

References 16 publications

SARS-CoV-2 organising pneumonia: ‘Has there been a widespread failure to identify and treat this prevalent condition in COVID-19?’

SARS-CoV-2 organising pneumonia: ‘Has there been a widespread failure to identify and treat this prevalent condition in COVID-19?’

2019 novel coronavirus (COVID-19) pneumonia: CT manifestations and pattern of evolution in 110 patients in Jiangxi, China

Respiratory manifestations of COVID-19

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