COVID-19: high-resolution computed tomography findings in the first
64 patients admitted to the Hospital of Cremona, the epicentre
of the pandemic in Europe
Abstract:In December 2019, a new coronavirus (SARS-CoV-2) was identified as being responsible for the pulmonary infection called COVID-19. On 21 February 2020, the first autochthonous case of COVID-19 was detected in Italy. Our goal is to report the most common chest computed tomography (CT) findings identified in 64 patients, in the initial phase of COVID-19.Methods: Sixty-four chest high-resolution computed tomography (HRCT) examinations performed at the Radiology Unit of the Hospital of Cremona, from 22 to 29 Februa… Show more
“…Even in our case series, it is confirmed that as the disease progresses the number of lesions can rapidly increase extending to central parenchymal areas and evolving from one type of alteration to another, that is, from GGO alone to GGO with or without crazy-paving up to true areas of parenchymal consolidation, with consequent progression of the TSS. In fact, consistently with the literature data, even in our case series, it has been observed that the highest grades [ 3 , 4 ] are mainly featured by crazy-paving alterations and diffuse areas of parenchymal consolidation.…”
Objectives:
Severe acute respiratory syndrome - coronavirus 2 (SARS-CoV-2) is a single-stranded positive ribonucleic acid virus of the coronaviridae family. The disease caused by this virus has been named by the World Health Organization coronavirus disease 19 (COVID-19), whose main manifestation is interstitial pneumonia. Aim of this study is to describe the radiological features of SARS-CoV-2 infection in its original form, to correlate the high-resolution computed tomography (HRCT) patterns with clinical findings, prognosis and mortality, and to establish the need for treatment and admission to the intensive care unit.
Material and Methods:
From March 2020 to May 2020, 193 patients (72 F and 121 M) who were swab positive for SARS-CoV-2 were retrospectively selected for our study. These patients underwent HRCT in the clinical suspicion of SARS-CoV-2 interstitial pneumonia.
Results:
Our results confirm the role of radiology and, in particular, of chest HRCT as a technique with high sensitivity in the recognition of the most peculiar features of COVID-19 pneumonia, in the evaluation of severity of the disease, in the correct interpretation of temporal changes of the radiological picture during the follow-up until the resolution, and in obtaining prognostic information, also to direct the treatment.
Conclusion:
Chest computed tomography cannot be considered as a substitute for real-time - polymerase chain reaction in the diagnosis of COVID-19, but rather supplementary to it in the diagnostic process as it can detect parenchymal changes at an early stage and even before the positive swab, at least for patients who have been symptomatic for more than 3 days.
“…Even in our case series, it is confirmed that as the disease progresses the number of lesions can rapidly increase extending to central parenchymal areas and evolving from one type of alteration to another, that is, from GGO alone to GGO with or without crazy-paving up to true areas of parenchymal consolidation, with consequent progression of the TSS. In fact, consistently with the literature data, even in our case series, it has been observed that the highest grades [ 3 , 4 ] are mainly featured by crazy-paving alterations and diffuse areas of parenchymal consolidation.…”
Objectives:
Severe acute respiratory syndrome - coronavirus 2 (SARS-CoV-2) is a single-stranded positive ribonucleic acid virus of the coronaviridae family. The disease caused by this virus has been named by the World Health Organization coronavirus disease 19 (COVID-19), whose main manifestation is interstitial pneumonia. Aim of this study is to describe the radiological features of SARS-CoV-2 infection in its original form, to correlate the high-resolution computed tomography (HRCT) patterns with clinical findings, prognosis and mortality, and to establish the need for treatment and admission to the intensive care unit.
Material and Methods:
From March 2020 to May 2020, 193 patients (72 F and 121 M) who were swab positive for SARS-CoV-2 were retrospectively selected for our study. These patients underwent HRCT in the clinical suspicion of SARS-CoV-2 interstitial pneumonia.
Results:
Our results confirm the role of radiology and, in particular, of chest HRCT as a technique with high sensitivity in the recognition of the most peculiar features of COVID-19 pneumonia, in the evaluation of severity of the disease, in the correct interpretation of temporal changes of the radiological picture during the follow-up until the resolution, and in obtaining prognostic information, also to direct the treatment.
Conclusion:
Chest computed tomography cannot be considered as a substitute for real-time - polymerase chain reaction in the diagnosis of COVID-19, but rather supplementary to it in the diagnostic process as it can detect parenchymal changes at an early stage and even before the positive swab, at least for patients who have been symptomatic for more than 3 days.
“…Facilities such as harmonic imaging, compound imaging, color‐ and power‐Doppler imaging (now with new microvasculature techniques), elastography, trapezoid fields of view, and real‐time extended field of view are available on all medium‐to‐high level US scanners and are employed by the operator basing on his/her preferences and on the specific clinical setting 3,4 . At the same time, in the last year, chest US has become quite popular, also owing to the recent Covid‐19 pandemic 5–12 . The normal pleural line is hyperechoic, thin (≤3 mm), and regular.…”
PurposeWhile scanning women for breast US, is possible to observe changes in the appearance of the pleural line or in the most superficial portion of the lung. The objective of this single‐center, prospective study was to determine the prevalence of a variety of pleural and pulmonary US findings during routine breast US.MethodsIn this study, there were 200 women undergoing standard breast US examination. The presence of pleural and pulmonary abnormalities in these cases was recorded. Two off‐site reviewers confirmed the presence of pleura and lung changes.ResultsThere was no abnormal finding in 168 out of 200 cases (84%) while there were one or more abnormal findings in 32 cases (16%). Pleural effusion was observed in 0.5% of cases, thickening of the pleural line 5% of cases, irregularity of the pleural line in 6% of cases, increased number of vertical artifacts in 9% of cases, subpleural nodulations in 2% of cases, and lung consolidation in 0.5%.ConclusionPleural and lung changes are not uncommon during breast US. Operators performing breast US examinations should be aware of the possibility to identify unsuspected pleuro‐pulmonary abnormalities.
“…Since the beginning of the COVID-19 outbreak, radiologists were among the first-in-line to diagnose and assess the severity of this disease [ 2 , 3 ]. To properly address the needs of radiology departments, while allowing them to continue to provide standard health care to non-COVID patients, it has been postulated that the organization and workflow of radiology departments during a pandemic needs to change [ 4 , 5 ].…”
Purpose
The aim of this multicentric study is to illustrate how the COVID-19 pandemic lockdown affected the workload and outcomes of radiological examinations in emergency radiology.
Material and methods
The exams performed in the radiology departments of 4 Italian hospitals during 3 weeks of the Italian lockdown were retrospectively reviewed and compared to the exams conducted during the same period in 2019. Only exams from the emergency department (ED) were included. Two radiologists from each hospital defined the cases as positive or negative findings, based on independent blind readings of the imaging studies. In the case of differences in the evaluation, consensus was reached amongst them via discussion. Continuous measurements are presented as median and interquartile range, while categorical measurements are presented as frequency and percentage;
p
-values were calculated using the
t
-test, Mann-Whitney test, and the c
2
test.
Results
There were 745 patients (53% male; 62 years [44-78]) who underwent radiological examinations in 2020 vs. 2623 (52% male; 56 years [35-76]) in 2019 (
p
< 0.001). Furthermore, the total number of ED exams dropped from 3206 (2019) to 939 (2020), with a relative increase of CT examinations from 23% to 33% (
p
< 0.001). The percentage of patients with a positive finding was significantly higher in 2020 (355, 48%) compared to 2019 (684, 26%) (
p
< 0.001).
Conclusions
Our findings show that despite the reduction of emergency radiological examinations, there was a rela-tive increase in the number of positive cases. These significant findings are crucial to ensure better organization of radiology departments and improve patient management during similar health emergencies in the future.
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