Clinicoradiological course in coronavirus disease-19 (COVID-19) patients who are asymptomatic at admission

Abstract

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.

Medium-term chest computed tomography (CT) follow-up of COVID-19 pneumonia patients after recovery to assess the rate of resolution and determine the potential predictors of persistent lung changes

“…The preliminary reports suggest that pulmonary parenchymal abnormalities do not completely resolve in all the survivors of COVID-19, and in some, the initial inflammation progresses into lung fibrosis [5]. A few published studies have assessed the temporal course of pulmonary findings in COVID-19 pneumonia, but they have mainly focused on the short-term changes in pulmonary opacities, usually up to 4 weeks [8][9][10][11].…”

Utility of screening chest radiographs in patients with asymptomatic and mildly symptomatic COVID-19 at a field hospital in Samut Sakhon, Thailand

“…Yet the typical chest radiographic findings in asymptomatic patients might not be a definite indication for transfer of patients to the hospital and might not predict the course of disease. Parry, et al [19] reported that asymptomatic infection could have a variable clinicalradiological course, spanning resolution, progression and no change. However, in the progression group, patients also had high levels of C-reactive protein and L-delactohydrogenase, as well as lower lymphocyte counts.…”

Chest Imaging in Coronavirus Disease-19 (COVID-19)

“…Many infected patients do not develop any symptoms. 19-50% patients have been reported to have an asymptomatic infection [12]. Asymptomatic patients act as covert transmitters and constitute a potential contagious source of SARS-CoV-2 as they unknowingly transmit the virus to others [13][14][15][16][17].…”