Severe Acute Respiratory Syndrome: Spectrum of High-Resolution CT Findings and Temporal Progression of the Disease

Hui, Joyce Y. H.; Cho, Danny H. Y.; Yang, Michael K. W.; Wang, K.; Lo, Kitty K. L.; Fan, Wenhui; Chan, C. K.; Chu, Chung Ming; Loke, Tkl; Chan, John

doi:10.2214/ajr.181.6.1811525

Cited by 17 publications

(16 citation statements)

References 26 publications

(34 reference statements)

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“…Over time, GGO remains a common finding and consolidation occurs with higher frequencies than in the early phase of disease, which means the disease is progressing rapidly. It is different from what happened with SARS [12]. Frequency of consolidation decreases 2 weeks after symptom onset.…”

Section: Discussioncontrasting

confidence: 61%

Evolution of CT findings in patients with mild COVID-19 pneumonia

Liang

Liu

et al. 2020

Eur Radiol

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Objectives To delineate the evolution of CT findings in patients with mild COVID-19 pneumonia. Methods CT images and medical records of 88 patients with confirmed mild COVID-19 pneumonia, a baseline CT, and at least one follow-up CT were retrospectively reviewed. CT features including lobar distribution and presence of ground glass opacities (GGO), consolidation, and linear opacities were analyzed on per-patient basis during each of five time intervals spanning the 3 weeks after disease onset. Total severity scores were calculated. Results Of patients, 85.2% had travel history to Wuhan or known contact with infected individuals. The most common symptoms were fever (84.1%) and cough (56.8%). The baseline CT was obtained on average 5 days from symptom onset. Four patients (4.5%) had negative initial CT. Significant differences were found among the time intervals in the proportion of pulmonary lesions that are (1) pure GGO, (2) mixed attenuation, (3) mixed attenuation with linear opacities, (4) consolidation with linear opacities, and (5) pure consolidation. The majority of patients had involvement of ≥ 3 lobes. Bilateral involvement was more prevalent than unilateral involvement. The proportions of patients observed to have pure GGO or GGO and consolidation decreased over time while the proportion of patients with GGO and linear opacities increased. Total severity score showed an increasing trend in the first 2 weeks. Conclusions While bilateral GGO are predominant features, CT findings changed during different time intervals in the 3 weeks after symptom onset in patients with COVID-19. Key Points • Four of 88 (4.5%) patients with COVID-19 had negative initial CT.• Majority of COVID-19 patients had abnormal CT findings in ≥ 3 lobes.• A proportion of patients with pure ground glass opacities decreased over the 3 weeks after symptom onset.

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Section: Discussioncontrasting

confidence: 61%

Evolution of CT findings in patients with mild COVID-19 pneumonia

Liang

Liu

et al. 2020

Eur Radiol

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“…At the time of writing, the numbers of probable SARS cases has reached 8,422 globally [6]. Two previous studies have noted the occurrence of spontaneous pneumomediastinum (SP) occasionally in patients with SARS, unrelated to assisted ventilation [7,8]. However, SP in SARS has not been systematically studied.…”

mentioning

confidence: 99%

Spontaneous pneumomediastinum in patients with severe acute respiratory syndrome

Chu¹,

Leung²,

Hui³

et al. 2004

Eur Respir J

126

170

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Spontaneous pneumomediastinum (SP) unrelated to assisted ventilation is a newly recognised complication of severe acute respiratory syndrome (SARS). The objective of the present study was to examine the incidence, risk factors and the outcomes of SP in a cohort of SARS victims from a community outbreak.Data were retrieved from a prospectively collected database of virologically confirmed SARS patients. One hundred and twelve cases were analysable, with 13 patients developing SP (11.6%) at a mean ¡ SD of 19.6 ¡ 4.6 days from symptom onset.Peak lactate dehydrogenase level was associated with the development of SP. SP was associated with increased intubation and a trend towards death. Drainage was required in five cases. For patients who survived, the SP and/or the associated pneumothoraces took a median of 28 days (interquartile range: 15-45 days) to resolve completely.In conclusion, spontaneous pneumomediastinum appeared to be a frequent complication of severe acute respiratory syndrome. Further research is needed to investigate its pathogenesis. Severe acute respiratory syndrome (SARS) has been documented to be caused by a novel coronavirus (SARS-CoV) [1][2][3], which satisfied the Koch's postulations for causation [4,5]. At the time of writing, the numbers of probable SARS cases has reached 8,422 globally [6]. Two previous studies have noted the occurrence of spontaneous pneumomediastinum (SP) occasionally in patients with SARS, unrelated to assisted ventilation [7,8]. However, SP in SARS has not been systematically studied. In the present study the incidence, risk factors and the implications of the development of SP in SARS sufferers were examined. MethodsThe present study examined SP in SARS patients by retrospective analysis of a prospectively collected SARS database. Patients included in the study were consecutive SARS patients admitted to the United Christian Hospital (Hong Kong, SAR, China) during a community outbreak from March 24 to April 28, 2003. Patients met a modified WHO definition of SARS, which included fever (o38uC), cough or shortness of breath, new pulmonary infiltrates on radiological examination, in the absence of an alternative diagnosis, together with virological documentation of SARS-CoV infection (paired serology and/or positive RT-PCR for SARS-CoV from clinical specimens). All patients were treated with a standard protocol of broad spectrum antibiotics, ribavirin and a tailing regimen of corticosteroids [9]. The clinical, haematological, biochemical, radiological and virological findings were prospectively entered into a preset database, according to previous publications [1,7].Chest radiographs were taken at intervals of 1 to 3 days, depending on clinical need. SP was defined as the presence of gas in the mediastinum, occurring before assisted ventilation. For equivocal cases, high resolution computed tomography (HRCT) of the thorax would be utilised to detect this complication. All chest radiographs and HRCT were interpreted by thoracic radiologists. Results were expressed ...

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“…Serial HRCT show a shifting pattern of air-space opacification, with resolution of the original lesion and appearance of a new lesion in the adjacent lung [17]. Progressive decrease in the extent of ground glass opacity and consolidation occurs with resolution of symptoms.…”

Section: Hrctmentioning

confidence: 98%

“…Findings consistent with fibrosis have been described in a small percentage of patients [17,18]. Muller et al reviewed the HRCT findings in 29 [18].…”

Section: Hrctmentioning

confidence: 99%