Incidentally discovered COVID-19 in low-suspicion patients—a threat to front line health care workers

Abstract

Purpose The COVID-19 pandemic has been responsible for thousands of deaths worldwide. Testing remains at a premium, and criteria for testing remains reserved for those with lower respiratory infection symptoms and/or a known high-risk exposure. The role of imaging in COVID-19 is rapidly evolving; however, few algorithms include imaging criteria, and it is unclear what should be done in low-suspicion patients with positive imaging findings. Methods From 03/01/2020-03/20/2020, a retrospective review of all patients with suspected COVID-19 on imaging was performed. Imaging was interpreted by a board-certified, fellowship-trained radiologist. Patients were excluded if COVID-19 infection was suspected at the time of presentation, was the reason for imaging, or if any lower respiratory symptoms were present.Results Eight patients with suspected COVID-19 infection on imaging were encountered. Seven patients received testing due to suspicious imaging findings with subsequent lab-confirmed COVID-19. No patients endorsed prior exposure to COVID-19 or recent international travel. COVID-19 was suggested in six patients incidentally on abdominal CT and two on chest radiography. At the time of presentation, no patients were febrile, and seven endorsed gastrointestinal symptoms. Five COVID-19 patients eventually developed respiratory symptoms and required intubation. Two patients expired during the admission. Conclusions Patients with imaging findings suspicious for COVID-19 warrant prompt reverse transcription polymerase chain reaction (RT-PCR) testing even in low clinical suspicion cases. The prevalence of disease in the population may be underestimated by the current paradigm of RT-PCR testing with the current clinical criteria of lower respiratory symptoms and exposure risk.

Abdominal imaging findings in patients with SARS-CoV-2 infection: a scoping review

“…The largest study, a single-center study by Luo et al found that of 1141 confirmed cases of COVID-19, 16% presented with only GI symptoms [ 25 ]. Additionally, many cases of COVID-19 have been found incidentally through abdominal imaging scans indicated by patients presenting mainly or only with GI symptoms [ 20 , 21 , 26 – 29 ]. Hossain et al found that more than 50% of their 119 patients first demonstrated evidence of COVID-19 incidentally through either an abdominal or cervical spine/neck CT [ 30 ].…”

“…Three case reports included hematochezia as a symptom [17][18][19]. There are also several case reports that describe patients that present with only GI symptoms initially or throughout the course of their entire infection [20][21][22][23][24]. The largest study, a single-center study by Luo et al found that of 1141 confirmed cases of COVID-19, 16% presented with only GI symptoms [25].…”

Chest CT findings in asymptomatic cases with COVID-19: a systematic review and meta-analysis

“…This should raise concern among clinicians towards close monitoring of patients that test positive for SARS-CoV-2 and have chest imaging findings, as some will eventually become symptomatic. Xiao et al, have reported COVID-19 cases without respiratory symptoms at presentation with incidentally positive chest CT findings, who eventually developed respiratory symptoms warranting critical care and even leading to death 27 ; however, the median age of the patients studied by Xiao et al was 64 years, whereas in the three studies included in the analysis the median ages of patient populations were 31, 32, and 52 years. In the study, all cases that developed symptoms eventually recovered, indicating a good prognosis of this population.…”

“…Xiao et al. , have reported COVID-19 cases without respiratory symptoms at presentation with incidentally positive chest CT findings, who eventually developed respiratory symptoms warranting critical care and even leading to death 27 ; however, the median age of the patients studied by Xiao et al. was 64 years, whereas in the three studies included in the analysis the median ages of patient populations were 31, 32, and 52 years.…”

Risk of COVID-19 in Healthcare Workers of the Nephrology Department in a Tertiary Hospital

“…These results have two important consequences. First, since being asymptomatic was initially considered as a criterion of non-transmission, the high proportion of asymptomatic workers could have played a key role in the evolution of the pandemic acting as disease vectors [8]. Second, the late diagnosis could have aggravated late stages of the disease due to the lack of prompt treatment.…”