Thoracic tomographic manifestations in symptomatic respiratory patients with COVID-19

China was the epicenter for the novel coronavirus disease (COVID-19), which quickly spread to other Asian countries and later to Western countries; subsequently, COVID-19 was categorized as a pandemic by the World Health Organization. Diagnosis primarily depends on viral detection in respiratory samples; however, available kits are limited, lack high sensitivity, and have a long turnaround time for providing results. In this scenario, computed tomography has emerged as an efficient and available high-sensitivity method, allowing radiologists to readily recognize findings related to COVID-19. The objective of this article is to demonstrate the main tomographic findings in symptomatic respiratory patients with COVID-19 to assist medical professionals during this critical moment.

Keywords:
Coronavirus; COVID-19; Multislice computed tomography

Authorship

Lucas de Pádua Gomes de Farias Correspondence: Dr. Lucas de Pádua Gomes de Farias. Instituto de Radiologia - HC-FMUSP. Rua Doutor Ovídio Pires de Campos, 75, Cerqueira César. São Paulo, SP, Brazil, 05403-010. Email: lucas.padua@hc.fm.usp.br.

Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/HC-FMUSP), São Paulo, SP, Brazil.Universidade de São PauloBrazilSão Paulo, SP, BrazilInstituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/HC-FMUSP), São Paulo, SP, Brazil.

http://orcid.org/0000-0001-5195-9818

Daniel Giunchetti Strabelli

http://orcid.org/0000-0002-0526-5775

Eduardo Kaiser Ururahy Nunes Fonseca

http://orcid.org/0000-0002-0233-0041

Bruna Melo Coelho Loureiro

http://orcid.org/0000-0002-7270-2664

Cesar Higa Nomura

http://orcid.org/0000-0002-7131-6614

Márcio Valente Yamada Sawamura

http://orcid.org/0000-0002-9424-9776

Correspondence: Dr. Lucas de Pádua Gomes de Farias. Instituto de Radiologia - HC-FMUSP. Rua Doutor Ovídio Pires de Campos, 75, Cerqueira César. São Paulo, SP, Brazil, 05403-010. Email: lucas.padua@hc.fm.usp.br.

SCIMAGO INSTITUTIONS RANKINGS

Figures

Figures (11)

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Figure 1
Male patient, 35 years old. Posteroanterior chest radiography (A) showing no pulmonary changes. MDCT (B) on the same day shows opacities with ground-glass attenuation in the lower lobes. Positive RT-PCR for SARS-CoV-2.

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Figure 2
Male patient, 48 years old. MDCT shows ground-glass opacities and diffuse consolidation foci in the upper (A), middle (B), and lower (C) lung fields with predominantly peripheral distribution in the posterior regions. Positive RTPCR for SARS-CoV-2.

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Figure 3
Female patients, 51 (A) and 68 years old (B). MDCT shows reticular opacities (arrows) in the anterior segment of the right upper lobe and bilateral subpleural curvilinear lines (arrowheads) in the lower lobes. Additionally, other multifocal opacities with ground-glass attenuation are present. Positive RT-PCR for SARS-CoV-2 in both patients.

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Figure 4
Male patient, 59 years old. MDCT shows ground-glass opacity in the right lung associated with interlobular and intralobular septal thickening, characterized by the crazy-paving pattern (arrowheads) and some consolidation foci (arrows). Positive RT-PCR for SARS-CoV-2.

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Figure 5
Male patient, 56 years old. MDCT shows ground-glass attenuation opacities, partially or surrounded by a consolidation ring, characterized by the reversed halo sign (arrowheads) in both lungs. Positive RT-PCR for SARS-CoV-2.

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Figure 6
Male patient, 70 years old. MDCT shows parenchymal bands/fibroatelectatic band opacities on the pulmonary periphery. Additionally, other opacities with ground-glass attenuation are observed. Positive RT-PCR for SARS-CoV-2.

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Figure 7
Male patient, 41 years old. MDCT shows pseudo-cavity associated with consolidation and ground-glass opacity on the right lower lobe (arrowhead). Positive RT-PCR for SARS-CoV-2.

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Figure 8
Male patient, 44 years old. Axial MDCT image with maximum intensity projection reconstruction shows extensive peripheral opacity with groundglass attenuation and some ectatic vessels inside (arrowhead). Positive RTPCR for SARS-CoV-2.

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Figure 9
Male patient, 69 years old. MDCT shows diffuse ground-glass opacity in both lungs and consolidation foci associated with a minor bilateral pleural effusion, indicating restrictive atelectasis of the adjacent lung parenchyma. Positive RT-PCR for SARS-CoV-2.

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Figure 10
Female patient, 76 years old. MDCT shows air bronchogram between opacity with ground-glass attenuation and some consolidation foci associated with bronchial wall thickening and distortion (arrowhead). Positive RT-PCR for SARS-CoV-2.

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Figure 11
Illustrative scheme to measure the cardiac chambers and estimate the volume of pericardial effusion/thickening in chest tomography not coupled to an electrocardiogram. The left atrium (LA) must be measured in the anteroposterior diameter while the other cardiac chambers must be measured in the transverse diameter⁽²⁷27 Hota P, Simpson S. Going beyond cardiomegaly: evaluation of cardiac chamber enlargement at non-electrocardiographically gated multidetector CT: current techniques, limitations, and clinical implications. Radiology: Cardiothoracic Imaging. 2019 Apr 25;1(1).^,²⁸28 Ivens EL, Munt BI, Moss RR. Pericardial disease: what the general cardiologist needs to know. Heart. 2007;93:993-1000.⁾.

Figure 1 Male patient, 35 years old. Posteroanterior chest radiography (A) showing no pulmonary changes. MDCT (B) on the same day shows opacities with ground-glass attenuation in the lower lobes. Positive RT-PCR for SARS-CoV-2.

Figure 2 Male patient, 48 years old. MDCT shows ground-glass opacities and diffuse consolidation foci in the upper (A), middle (B), and lower (C) lung fields with predominantly peripheral distribution in the posterior regions. Positive RTPCR for SARS-CoV-2.

Figure 3 Female patients, 51 (A) and 68 years old (B). MDCT shows reticular opacities (arrows) in the anterior segment of the right upper lobe and bilateral subpleural curvilinear lines (arrowheads) in the lower lobes. Additionally, other multifocal opacities with ground-glass attenuation are present. Positive RT-PCR for SARS-CoV-2 in both patients.

Figure 4 Male patient, 59 years old. MDCT shows ground-glass opacity in the right lung associated with interlobular and intralobular septal thickening, characterized by the crazy-paving pattern (arrowheads) and some consolidation foci (arrows). Positive RT-PCR for SARS-CoV-2.

Figure 5 Male patient, 56 years old. MDCT shows ground-glass attenuation opacities, partially or surrounded by a consolidation ring, characterized by the reversed halo sign (arrowheads) in both lungs. Positive RT-PCR for SARS-CoV-2.

Figure 6 Male patient, 70 years old. MDCT shows parenchymal bands/fibroatelectatic band opacities on the pulmonary periphery. Additionally, other opacities with ground-glass attenuation are observed. Positive RT-PCR for SARS-CoV-2.

Figure 7 Male patient, 41 years old. MDCT shows pseudo-cavity associated with consolidation and ground-glass opacity on the right lower lobe (arrowhead). Positive RT-PCR for SARS-CoV-2.

Figure 8 Male patient, 44 years old. Axial MDCT image with maximum intensity projection reconstruction shows extensive peripheral opacity with groundglass attenuation and some ectatic vessels inside (arrowhead). Positive RTPCR for SARS-CoV-2.

Figure 9 Male patient, 69 years old. MDCT shows diffuse ground-glass opacity in both lungs and consolidation foci associated with a minor bilateral pleural effusion, indicating restrictive atelectasis of the adjacent lung parenchyma. Positive RT-PCR for SARS-CoV-2.

Figure 10 Female patient, 76 years old. MDCT shows air bronchogram between opacity with ground-glass attenuation and some consolidation foci associated with bronchial wall thickening and distortion (arrowhead). Positive RT-PCR for SARS-CoV-2.

Figure 11 Illustrative scheme to measure the cardiac chambers and estimate the volume of pericardial effusion/thickening in chest tomography not coupled to an electrocardiogram. The left atrium (LA) must be measured in the anteroposterior diameter while the other cardiac chambers must be measured in the transverse diameter⁽²⁷27 Hota P, Simpson S. Going beyond cardiomegaly: evaluation of cardiac chamber enlargement at non-electrocardiographically gated multidetector CT: current techniques, limitations, and clinical implications. Radiology: Cardiothoracic Imaging. 2019 Apr 25;1(1).^,²⁸28 Ivens EL, Munt BI, Moss RR. Pericardial disease: what the general cardiologist needs to know. Heart. 2007;93:993-1000.⁾.

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Thoracic tomographic manifestations in symptomatic respiratory patients with COVID-19

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[1] Correspondence: Dr. Lucas de Pádua Gomes de Farias. Instituto de Radiologia - HC-FMUSP. Rua Doutor Ovídio Pires de Campos, 75, Cerqueira César. São Paulo, SP, Brazil, 05403-010. Email: lucas.padua@hc.fm.usp.br.