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CT features of SARS-CoV-2 pneumonia according to clinical presentation: a retrospective analysis of 120 consecutive patients from Wuhan city.

ABSTRACT: OBJECTIVES:To characterize the chest computed tomography (CT) findings of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) according to clinical severity. We compared the CT features of common cases and severe cases, symptomatic patients and asymptomatic patients, and febrile and afebrile patients. METHODS:This was a retrospective analysis of the clinical and thoracic CT features of 120 consecutive patients with confirmed SARS-CoV-2 pneumonia admitted to a tertiary university hospital between January 10 and February 10, 2020, in Wuhan city, China. RESULTS:On admission, the patients generally complained of fever, cough, shortness of breath, and myalgia or fatigue, with diarrhea often present in severe cases. Severe patients were 20 years older on average and had comorbidities and an elevated lactate dehydrogenase (LDH) level. There were no differences in the CT findings between asymptomatic and symptomatic common type patients or between afebrile and febrile patients, defined according to Chinese National Health Commission guidelines. CONCLUSIONS:The clinical and CT features at admission may enable clinicians to promptly evaluate the prognosis of patients with SARS-CoV-2 pneumonia. Clinicians should be aware that clinically silent cases may present with CT features similar to those of symptomatic common patients. KEY POINTS:• The clinical features and predominant patterns of abnormalities on CT for asymptomatic, typic common, and severe cases were summarized. These findings may help clinicians to identify severe patients quickly at admission. • Clinicians should be cautious that CT findings of afebrile/asymptomatic patients are not better than the findings of other types of patients. These patients should also be quarantined. • The use of chest CT as the main screening method in epidemic areas is recommended.

SUBMITTER: Zhang R

PROVIDER: S-EPMC7150608 | biostudies-literature | 2020 Aug

REPOSITORIES: biostudies-literature

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CT features of SARS-CoV-2 pneumonia according to clinical presentation: a retrospective analysis of 120 consecutive patients from Wuhan city.

Zhang Rui R Ouyang Huangqing H Fu Lingli L Wang Shijie S Han Jianglong J Huang Kejie K Jia Mingfang M Song Qibin Q Fu Zhenming Z

European radiology 20200411 8

<h4>Objectives</h4>To characterize the chest computed tomography (CT) findings of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) according to clinical severity. We compared the CT features of common cases and severe cases, symptomatic patients and asymptomatic patients, and febrile and afebrile patients.<h4>Methods</h4>This was a retrospective analysis of the clinical and thoracic CT features of 120 consecutive patients with confirmed SARS-CoV-2 pneumonia admitted to a tertiary uni ...[more]

PMID: 32279115

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Project description:INTRODUCTION:The evolution of computed tomography (CT) findings in patients with mild coronavirus disease 2019 (COVID-19) pneumonia has not been described in detail. A large-scale longitudinal study is urgently required. METHODS:We analyzed 606 CT scans of 182 patients. The dynamic evolution of CT scores was evaluated using two staging methods: one was divided into 10 periods based on decile intervals, and the other was one stage per week. Moreover, the latter was used to evaluate the dynamic evolution of imaging performance. A published severity scoring system was used to compare findings of the two methods. RESULTS:In the dynamic evolution of 10 stages, the total lesion CT score peaked during stage 3 (9-11 days) and stage 6 (17-18 days), with scores?=?7.19?±?3.66 and 8.00?±?4.57, respectively. The consolidation score peaked during stage 6 (17-18 days; score?=?2.72?±?3.07). In contrast, when a 1-week interval was used and time was divided into five stages, the total lesion score peaked during week 3 (score?=?7.3?±?4.15). The consolidation score peaked during week 2 (score?=?2.54?±?3.25). The predominant CT patterns differed significantly during each stage (P?<?0.01). Ground-glass opacities (GGO), with an increased trend during week 3 and beyond, was the most common pattern in each stage (33-46%). The second most common patterns during week 1 were GGO and consolidation (24%). The linear opacity pattern with an increased trend was the second most common pattern during week 2 and beyond (21-32%). CONCLUSIONS:The total lesion score of mild COVID-19 pneumonia peaked 17-18 days after disease onset. The consolidation scores objectively reflected the severity of the lung involvement compared with total lesion scores. Each temporal stage of mild COVID-19 pneumonia mainly manifested as GGO pattern. Moreover, good prognosis may be associated with increases in the proportions of the GGO and linear opacity patterns during the later stage of disease.

Project description:BackgroundHospital-acquired pneumonia (HAP) is defined as radiologically confirmed pneumonia occurring ?48h after hospitalization, in non-intubated patients. Empirical treatment regimens use broad-spectrum antimicrobials.AimTo evaluate the accuracy of the diagnosis of HAP and to describe the demographic and microbiological features of patients with HAP.MethodsMedical and surgical inpatients receiving intravenous antimicrobials for a clinical diagnosis of HAP at a UK tertiary care hospital between April 2013 and 2014 were identified. Demographic and clinical details were recorded.FindingsA total of 166 adult patients with a clinical diagnosis of HAP were identified. Broad-spectrum antimicrobials were prescribed, primarily piperacillin-tazobactam (57.2%) and co-amoxiclav (12.5%). Sputum from 24.7% of patients was obtained for culture. Sixty-five percent of patients had radiological evidence of new/progressive infiltrate at the time of HAP treatment, therefore meeting HAP diagnostic criteria (2005 American Thoracic Society/Infectious Diseases Society of America guidelines). Radiologically confirmed HAP was associated with higher levels of inflammatory markers and sputum culture positivity. Previous surgery and/or endotracheal intubation were associated with radiologically confirmed HAP. A bacterial pathogen was identified from 17/35 sputum samples from radiologically confirmed HAP patients. These were Gram-negative bacilli (N = 11) or Staphylococcus aureus (N = 6). Gram-negative bacteria tended to be resistant to co-amoxiclav, but susceptible to ciprofloxacin, piperacillin-tazobactam and meropenem. Five of the six S. aureus isolates were meticillin susceptible and all were susceptible to doxycycline.ConclusionIn ward-level hospital practice 'HAP' is an over-used diagnosis that may be inaccurate in 35% of cases when objective radiological criteria are applied. Radiologically confirmed HAP represents a distinct clinical and microbiological phenotype. Potential risk factors were identified that could represent targets for preventive interventions.

Project description:ObjectiveThe aim of this study was to investigate the clinical and computed tomography (CT) features associated with severe and critical coronavirus disease 2019 (COVID-19) pneumonia.Materials and methodsEighty-three patients with COVID-19 pneumonia including 25 severe/critical cases and 58 ordinary cases were enrolled. The chest CT images and clinical data of them were reviewed and compared. The risk factors associated with disease severity were analyzed.ResultsCompared with the ordinary patients, the severe/critical patients had older ages, higher incidence of comorbidities, cough, expectoration, chest pain, and dyspnea. The incidences of consolidation, linear opacities, crazy-paving pattern, and bronchial wall thickening in severe/critical patients were significantly higher than those of the ordinary patients. Besides, severe/critical patients showed higher incidences of lymph node enlargement, pericardial effusion, and pleural effusion than the ordinary patients. The CT scores of severe/critical patients were significantly higher than those of the ordinary patients (P < 0.001). Receiver operating characteristic curve showed that the sensitivity and specificity of CT score were 80.0% and 82.8%, respectively, for the discrimination of the 2 types. The clinical factors of age older than 50 years, comorbidities, dyspnea, chest pain, cough, expectoration, decreased lymphocytes, and increased inflammation indicators were risk factors for severe/critical COVID-19 pneumonia. Computed tomography findings of consolidation, linear opacities, crazy-paving pattern, bronchial wall thickening, high CT scores, and extrapulmonary lesions were features of severe/critical COVID-19 pneumonia.ConclusionsThere are significant differences in clinical symptoms, laboratory examinations, and CT manifestations between the ordinary patients and the severe/critical patients. Many factors are related to the severity of the disease, which can help clinicians to judge the severity of the patient and evaluate the prognosis.

Dataset Information

CT features of SARS-CoV-2 pneumonia according to clinical presentation: a retrospective analysis of 120 consecutive patients from Wuhan city.

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CT features of SARS-CoV-2 pneumonia according to clinical presentation: a retrospective analysis of 120 consecutive patients from Wuhan city.

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