Spectrum of atypical pulmonary manifestations of COVID-19 on computed tomography

Abstract

Background The typical CT manifestations of COVID-19 pneumonia include ground-glass opacity (GGO) with or without consolidation and superimposed interlobular septal thickening. These are often rounded in morphology and frequently bilateral, multilobar, posterior, peripheral, and basilar in distribution. The various atypical CT features of COVID-19 are seldom described in the literature. The study aims to enumerate the atypical pulmonary CT features in patients with COVID-19 pneumonia in correlation with the disease severity. Results A total of 298 confirmed cases of COVID-19 pneumonia with positive reverse transcription polymerase chain reaction (RT-PCR) who underwent chest CT scans were retrospectively evaluated. The cohort included 234 (78.5%) men and 64 (21.5%) women and the mean age was 53.48 ± 15.74 years. The most common presenting symptoms were fever [n = 197 (66.1%)] and cough [n = 139 (46.6%)]. Out of 298 cases of COVID-19 pneumonia, 218 cases (73.1%) showed typical CT features while 63 cases (21.1%) showed atypical CT features with concurrent classical findings and the remaining 17 cases (5.8%) were normal. Among the atypical CT features, the most common was pulmonary cysts [n = 27 (9%)]. The other features in the order of frequency included pleural effusion [n = 17 (5.7%)], nodules [n = 13 (4.3%)], bull’s eye/target sign[n = 4 (1.3%)], cavitation [n = 3 (1.0%)], spontaneous pneumothorax [n = 2 (0.6%)], hilar lymphadenopathy [n = 2 (0.6%)], spontaneous pneumo-mediastinum with subcutaneous emphysema [n = 1 (0.3%)], Halo sign [n = 1 (0.3%)], empyema [n = 1 (0.3%)] and necrotizing pneumonia with abscess [n = 1 (0.3%)]. Conclusion CT imaging features of COVID-19 pneumonia while in a vast majority of cases is classical, atypical diverse patterns are also encountered. A comprehensive knowledge of various atypical presentations on imaging plays an important role in the early diagnosis and management of COVID-19.

Post-COVID-19 Necrotizing Pneumonia in Patients on Invasive Mechanical Ventilation

“…It is also an infrequent complication in COVID-19 patients, with only a few reports to date [5][6][7]. Except for one case of NP reported in a cohort of 298 patients with COVID-19 pneumonia (less than 0.3%), the incidence of this complication in COVID-19 patients is unknown [8]. Here, we report 42 NP cases over a 14-month period in 913 COVID-19 patients on IMV, for an Drainage and/or surgical procedures were performed on 19 patients (45.2%).…”

“…However, lung cavitation was described to be notably absent [ 10 ]. More recently, pulmonary abscess [ 2 , 8 , 11 , 12 , 13 ], infected pneumatoceles [ 14 ], and lung cavitation [ 11 , 15 , 16 , 17 , 18 , 19 , 20 ] have been described in COVID-19 patients. Aside from areas of consolidation with necrosis, characteristic of NP, radiologic and/or operative findings in our cohort included predominantly pulmonary abscess(es), mediastinal and/or hilar adenopathies, cavities, pneumatoceles, and pneumothorax.…”

Pulmonary Cystic Disease Associated With COVID 19 Pneumonia: An Emerging Atypical Manifestation

“…Cyst occurs in greater profusion in the subpleural areas, typically representing emphysema, bullae, or honeycombing [ 8 , 9 ]. The descriptions of cystic disease related to COVID 19 are unusual, with a prevalence ranging between 9% and 25% [ 10 ]. They are usually well-defined, thin-walled (2-4 mm), and variable in size, but usually less than 2.5 cm; larger cysts have been described [ 10 , 11 ].…”

“…The descriptions of cystic disease related to COVID 19 are unusual, with a prevalence ranging between 9% and 25% [ 10 ]. They are usually well-defined, thin-walled (2-4 mm), and variable in size, but usually less than 2.5 cm; larger cysts have been described [ 10 , 11 ]. They are usually distributed peripherally and sometimes have a random or perihilar distribution; it has been found in different series a predominance in the anterior part of the lung and the lower lobe, followed by the upper and middle lobe [ 10 , 11 ].…”

The Multifaceted COVID-19: CT Aspects of Its Atypical Pulmonary and Abdominal Manifestations and Complications in Adults and Children. A Pictorial Review

“…Lymphadenopathy, pleural effusion, pericardial effusion, bronchiectasis, halo sign and reverse halo sign, cavitation and some complications, such as spontaneous pneumothorax and pneumomediastinum, are reported as either pulmonary unusual manifestations or atypical complications of COVID-19 [4][5][6][7]. As we will clarify below, if lymphadenopathies are more often found in acute phase of the disease, the pleural effusion is frequently identified in the advanced stages.…”