新型冠状病毒肺炎胸部CT初诊特征分析

目的:探讨新型冠状病毒肺炎(COVID-19)的胸部CT初诊特点,提高对该病的认识。方法:回顾性分析29例确诊为新型冠状病毒肺炎患者的影像学资料,男12例,女17例,平均年龄44±8岁。所有病例均行高分辨率CT扫描,由放射科高年资医生对CT图像进行分析、总结。结果:COVID-19胸部CT初诊典型表现:双肺野外带胸膜下区为主的单发或多发磨玻璃影,可伴小叶间隔增厚;部分多发病灶中同时可见磨玻璃影及实变影,实变影中可见支气管充气征。不典型者表现为单发的斑片状实变影或小结节影。以上少部分病例伴胸膜反应或叶间胸膜增厚,但未见胸水。结论:新型冠状病毒肺炎胸部CT初诊有一定的特征性,结合流行病学及实验室检查可早期诊断。     

Clinical characteristics of the coronavirus disease 2019 (COVID-19) outbreak on a cruise ship

BackgroundA large COVID-19 outbreak occurred on the cruise ship Diamond Princess in February 2020. Little information has been reported about the clinical characteristics of the patients.MethodsThis single-center, retrospective, observational study was conducted in Yokohama, Japan. We included symptomatic patients who were infected on the ship and admitted to our hospital between 5 and 19 February 2020. All the cases were confirmed with SARS-CoV-2 infection by polymerase chain reaction (PCR).ResultsWe confirmed 17 cases. The average age was 69 years; 10 patients were Asian and 7 were Caucasian. Eleven patients had one or more chronic diseases. The major symptoms were cough and fever. Chest computed tomography (CT) scans found bilateral ground-glass opacities predominantly in the peripheral area, which were similar to reports from cases in China. C-reactive protein (CRP) levels were higher in severe and critical cases than in mild to moderate cases. The moderate to severe cases reached symptomatic resolution; one of the three critical cases resulted in death due to multiple organ failure. SARS-CoV-2 was detected by PCR at an average of 7 days after symptomatic resolution.ConclusionsCough and fever, increased blood CRP levels, and CT findings of bilateral ground-glass opacities predominantly in the peripheral lung were characteristic of the COVID-19 cases in this study. These findings were compatible with those of previous reports.     

Temporal changes of lung computed tomography findings pulmonary COVID-19 infection

ObjectivesCOVID-19 infection demonstrates characteristic findings in chest CT. The optimal timing of repeated CT scans still needs to be clarified, and the optimal time to assess imaging clearance in COVID-19 is still unknown. It is crucial to have a roadmap of the imaging course of COVID-19 pneumonia to develop guidelines for prompt diagnosis of pulmonary complications, especially fibrosis, at the earliest stage.PurposeTo assess the temporal changes of chest CT findings in patients with COVID-19 pneumonia and evaluate the rate of a complete resolution and determine the patients are at excessive risk for residual parenchymal abnormalities.Materials and MethodsThis retrospective observational study included 48 patients with real-time polymerase chain reaction–confirmed COVID-19 who were admitted to three academic hospitals. These patients underwent at least one initial chest CT before or after admission and at least one follow-up CT scan four weeks or more after the onset of the symptoms. All chest CTs were categorized according to time of performance into four groups, including the first week, second week, third-fourth week, and more than 28 days. Lung involvement was categorized as predominantly alveolar (ground-glass opacity and consolidation), organizing pneumonia, and reticular patterns. The severity of involvement was also evaluated by the reader.ResultsForty-eight patients and a total of 130 chest CT scans were evaluated. The alveolar pattern showed a gradual decrease in frequency from 91% in the first week to 9% after the fourth week of the disease but the organizing pneumonia pattern gradually increased with disease progression and the frequency of reticular pattern increased significantly after third week. Complete resolution of CT findings was seen in 17 patients (13.1%) and was significantly more prevalent in patients of younger age (p value<0.001) and with lower initial CT severity scores (p value=0.048). CT severity scores in the second week were significantly higher in ICU admitted patients (p value=0.003).ConclusionThere are temporal patterns of lung abnormalities in patients with COVID-19 pneumonia. The predominant CT pattern was alveolar infiltrate in the first and second weeks of the disease, replaced with an organizing pneumonia pattern in the third and fourth weeks. Progression of lung involvement was correlated with ICU admission due to the highest CT severity score in the second and third weeks of presentation but not in the first week in patients who were admitted at ICU. Complete CT resolution was significantly more common in patients of younger age and lower initial CT severity scores.     

Pulmonary fibrosis in critical ill patients recovered from COVID-19 pneumonia: Preliminary experience

ObjectiveTo investigate chest computed tomography (CT) findings associated with severe COVID-19 pneumonia in the early recovery period.MethodsWe retrospectively analyzed the cases of patients diagnosed with severe COVID-19 pneumonia at a single center between January 12, 2020, and March 16, 2020. The twelve ICU patients studied had been diagnosed SARS-CoV-2 (COVID-19) nucleic acid positive. Patient clinical symptoms were relieved or disappeared, and basic clinical information and laboratory test results were collected. The study focused on the most recent CT imaging characteristics.ResultsThe average age of the 12 patients was 58.8 ± 16.2 years. The most prevalent symptoms were fever (100%), dyspnea (100%), and cough (83.3%). All patients experienced acute respiratory distress syndrome (ARDS), of which 9 were moderate to severe. Six patients used noninvasive ventilators, and 4 patients used mechanical ventilation. One patient was treated with extracorporeal membrane oxygenation (ECMO). The lymphocyte count decreased to 0.67 ± 0.3 (× 10 ⁹/L). The average day from illness onset to the last follow-up CT was 56.1 ± 7.7 d. The CT results showed a decrease in ground glass opacities (GGO), whereas fibrosis gradually increased. The common CT features included GGO (10/12, 83.3%), subpleural line (10/12, 83.3%), fibrous stripes (12/12, 100%), and traction bronchiectasis (10/12, 83.3%). Eight patients (66.7%) showed predominant reticulation and interlobular thickening. Four patients (33.3%) showed predominant GGO. Lung segments involved were 174/216 (80.6%).ConclusionsFibrous stripes and GGO are common CT signs in critically ill patients with COVID-19 pneumonia in the early recovery period. Signs of pulmonary fibrosis in survivors should be carefully monitored.     

Comparison of chest CT findings in outpatient and hospitalized COVID-19 RT-PCR positive patients of Shiraz

IntroductionChest CT provides valuable information regarding coronavirus disease 2019 (COVID-19) during the treatment process. The present study aimed to assess the distribution of chest CT findings in outpatient (OPD) and hospitalized corona patients.Material and methodThis was a retrospective study. Archived corona patient's data on the picture archiving and communication system (PACS) was assessed in terms of demographic data and patients' lungs' radiologic features. The OPD and hospitalized patients referred to University hospitals from February 20 to the study's date were evaluated. Data were analyzed using independent chi-square and t-test.ResultsFive hundred and fifty nine patients, including 187 OPD and 372 hospitalized patients, were analyzed. The frequency of normal chest CT, typical, and possible corona features was 37.4%, 40.8%, and 14.3%. The normal chest CT rate was significantly higher in outpatient versus hospitalized patients (P<0.001). Consolidation and/or ground-glass opacity were seen in 61% of patients, considerably higher in hospitalized patients (P<0.001). 2% and 15% OPD and hospitalized patients had more than 25% lung involvement, respectively. The frequency of other signs such as Crazy Paving, atoll sign, subpleural band/distortion also was significantly higher in hospitalized patients (P<0.001).ConclusionMost OPD patients had less than 5% lung involvement or normal chest CT. The typical features of lung involvement in COVID-19 were significantly higher in hospitalized patients.     

新型冠状病毒肺炎CT表现及动态变化

目的 [JP2]观察新型冠状病毒肺炎（COVID-19）CT表现及其动态变化。方法 回顾性分析45例经病毒核酸检测确诊、且具有完整动态胸部HRCT资料的COVID-19患者，复查间隔时间48~72 h。结果 29例于发病3天内接受CT检查，21例（21/29，72.41%）胸部见磨玻璃密度影，8例（8/29，27.59%）见磨玻璃密度影伴局部实变，其中2例（25.00%，2/8）为单发结节；26例（26/29，89.66%）病灶呈不规则形或扇形，3例呈类圆形（3/29，10.34%）。16例于发病3天以上接受CT检查，病灶进展。首次复查CT病变均有变化，其中14例（14/45，31.11%）呈单纯磨玻璃密度影，27例（27/45，60.00%）以磨玻璃样密度影为主且有肺实变，4例（4/45，8.89%）以肺实变为主。38例于发病7~10天接受第2次复查，25例（25/38，65.79%）病变范围缩小，4例病灶范围增大（4/38，10.53%），1例（1/38，2.63%）病灶范围同前；8例（8/38，21.05%）原有病灶密度减低但出现新发病灶。其余7例因病变进展而未能接受复查。结论 胸部HRCT能清晰显示COVID-19疾病过程中的影像学变化，有助于指导临床早诊断、早隔离、早治疗，并可作为评价COVID-19临床综合治疗效果的依据。     

Lung Ultrasound May Support Diagnosis and Monitoring of COVID-19 Pneumonia

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (COVID-19) is characterized by severe pneumonia and/or acute respiratory distress syndrome in about 20% of infected patients. Computed tomography (CT) is the routine imaging technique for diagnosis and monitoring of COVID-19 pneumonia. Chest CT has high sensitivity for diagnosis of COVID-19, but is not universally available, requires an infected or unstable patient to be moved to the radiology unit with potential exposure of several people, necessitates proper sanification of the CT room after use and is underutilized in children and pregnant women because of concerns over radiation exposure. The increasing frequency of confirmed COVID-19 cases is striking, and new sensitive diagnostic tools are needed to guide clinical practice. Lung ultrasound (LUS) is an emerging non-invasive bedside technique that is used to diagnose interstitial lung syndrome through evaluation and quantitation of the number of B-lines, pleural irregularities and nodules or consolidations. In patients with COVID-19 pneumonia, LUS reveals a typical pattern of diffuse interstitial lung syndrome, characterized by multiple or confluent bilateral B-lines with spared areas, thickening of the pleural line with pleural line irregularity and peripheral consolidations. LUS has been found to be a promising tool for the diagnosis of COVID-19 pneumonia, and LUS findings correlate fairly with those of chest CT scan. Compared with CT, LUS has several other advantages, such as lack of exposure to radiation, bedside repeatability during follow-up, low cost and easier application in low-resource settings. Consequently, LUS may decrease utilization of conventional diagnostic imaging resources (CT scan and chest X-ray). LUS may help in early diagnosis, therapeutic decisions and follow-up monitoring of COVID-19 pneumonia, particularly in the critical care setting and in pregnant women, children and patients in areas with high rates of community transmission.     

Bilateral spontaneous pneumothorax in SARS-CoV-2 infection: A very rare,life-threatening complication

In the coronavirus disease 2019 (COVID-19) era, the presence of acute respiratory failure is generally associated with acute respiratory distress syndrome; however, it is essential to consider other differential diagnoses that require different, and urgent, therapeutic approaches. Herein we describe a COVID-19 case complicated with bilateral spontaneous pneumothorax. A previously healthy 45-year-old man was admitted to our emergency department with sudden-onset chest pain and progressive shortness of breath 17 days after diagnosis with uncomplicated COVID-19 infection. He was tachypneic and presented severe hypoxemia (75% percutaneous oxygen saturation). Breath sounds were diminished bilaterally on auscultation. A chest X-ray revealed the presence of a large bilateral pneumothorax. A thoracic computed tomography (CT) scan confirmed the large bilateral pneumothorax, with findings consistent with severe COVID-19 infection. Chest tubes were inserted, with immediate clinical improvement. Follow-up chest CT scan revealed resolution of bilateral pneumothorax, reduction of parenchymal consolidation, and formation of large bilateral pneumatoceles. The patient remained under observation and was then discharged home. Bilateral spontaneous pneumothorax is a very rare, potentially life-threatening complication in patients with COVID-19. This case highlights the importance of recognizing this complication early to prevent potentially fatal consequences.     

新型冠状病毒肺炎临床表现与影像学特征分析

目的:分析新型冠状病毒肺炎(COVID-19)的临床表现与影像学征象,提高对该病的认识。方法:回顾分析解放军总医院第五医学中心确诊的58例COVID-19患者的临床资料和胸部影像学表现。根据新型冠状病毒肺炎诊疗方案(试行第6版),将所有患者分为轻型(7例)、普通型(34例)、重型(7例)和危重型(10例)并分析影像学表现。结果:COVID-19患者常见临床表现为发热(47例,81.0%)、咳嗽(31例,53.4%)、乏力(10例,17.2%)。实验室检查:白细胞计数正常或减低52例(89.7%),淋巴细胞计数减低14例(24.1%),C-反应蛋白升高18例(31.0%)。CT表现为双下肺分布阴影(46例,90.2%),COVID-19普通型患者CT主要表现为磨玻璃影(23/34,67.6%)或混合型(17/34,50.0%),周边分布为主(28/34,82.4%),重型及危重型患者CT主要表现为实变(13/17,76.5%)及混合型(14/17,82.4%),周边及中心同时受累(14/17,82.4%)。其他常见征象包括胸膜平行征、晕征、血管增粗征、铺路石征、空气支气管征等。5例重型及危重型患者有胸腔积液。结论:COVID-19患者的胸部影像学表现具有一定特征,不仅能做为早期诊断参考,还能对临床病程及严重程度进行评估。     

胸部HRCT评分在新型冠状病毒肺炎诊断中的应用价值

目的探讨新型冠状病毒肺炎（COVID-19）高分辨率CT（HRCT）表现及胸部HRCT评分在COVID-19临床诊疗中的应用价值。 方法收集连云港地区同时行RT-PCR及胸部CT的COVID-19确诊患者28例及非COVID-19患者67例,观察分析病变的分布、范围、形态及密度,纵隔、肺门有无淋巴结,胸腔及胸膜有无异常。根据COVID-19的CT表现,利用胸部HRCT对COVID-19及非COVID-19患者进行评分并分为0~5级,分别评价各等级对COVID-19的诊断价值。 结果28例COVID-19中,胸部HRCT示病变呈双肺胸膜下或多中心分布20例,单发或多发斑片状或节段性磨玻璃密度影11例,磨玻璃伴小叶间隔增厚14例,磨玻璃伴实变8例,实变5例,支气管壁增厚或扩张18例,弥漫性小叶中心磨玻璃样结节分布5例,网格状及蜂窝样纤维索条5例,胸膜增厚1例。COVID-19与非COVID-19患者相比,病变呈双肺胸膜下或多中心分布（71% vs 12%）比例升高,磨玻璃伴小叶间隔增厚（50% vs 13%）比例升高,差异具有统计学意义（P＜0.001）。COVID-19与非COVID-19患者的其他HRCT表现,差异无统计学意义（P＞0.05）。以5级、4级及以上、3级及以上、2级及以上、1级及以上评分标准诊断COVID-19,敏感度、特异度、准确度、阳性预测值、阴性预测值、Kappa值分别为64.3%、97.0%、87.4%、90.0%、86.7%、0.669;92.9%、82.1%、85.3%、68.4%、96.5%、0.679;100.0%、59.7%、71.6%、50.9%、100.0%、0.466;100.0%、29.9%、50.5%、37.3%、100.0%、0.201;100.0%、7.5%、29.5%、31.1%、100.0%、0.045。 结论COVID-19胸部HRCT表现具有一定的特征。胸部HRCT评分可以对COVID-19高度疑似患者的控制及早期治疗提供有效的检查手段,有利于医疗机构控制疫情及提高治愈率。     

Late histopathologic characteristics of critically ill COVID-19 patients: Different phenotypes without evidence of invasive aspergillosis,a case series

PurposePathological data of critical ill COVID-19 patients is essential in the search for optimal treatment options.Material and methodsWe performed postmortem needle core lung biopsies in seven patients with COVID-19 related ARDS. Clinical, radiological and microbiological characteristics are reported together with histopathological findings.Measurement and main resultsPatients age ranged from 58 to 83 years, five males and two females were included. Time from hospital admission to death ranged from 12 to 36 days, with a mean of 20 ventilated days. ICU stay was complicated by pulmonary embolism in five patients and positive galactomannan on bronchoalveolar lavage fluid in six patients, suggesting COVID-19 associated pulmonary aspergillosis. Chest CT in all patients showed ground glass opacities, commonly progressing to nondependent consolidations. We observed four distinct histopathological patterns: acute fibrinous and organizing pneumonia, diffuse alveolar damage, fibrosis and, in four out of seven patients an organizing pneumonia. None of the biopsy specimens showed any signs of invasive aspergillosis.ConclusionsIn this case series common late histopathology in critically ill COVID patients is not classic DAD but heterogeneous with predominant pattern of organizing pneumonia. Postmortem biopsy investigations in critically COVID-19 patients with probable COVID-19 associated pulmonary aspergillosis obtained no evidence for invasive aspergillosis.     

新型冠状病毒肺炎的早期胸部高分辨率CT表现

目的 观察新型冠状病毒肺炎（COVID-19）早期胸部高分辨率CT（HRCT）表现。方法 分析31例确诊COVID-19患者早期胸部HRCT表现。结果 31例发病1周内胸部HRCT呈不同程度肺炎改变。23例见多发病灶（≥3个病灶）；24例病变累及2个以上肺叶，7例病灶累及单肺叶；22例表现为肺部磨玻璃密度病灶（GGO），9例GGO伴混合性实变灶，病灶边界均模糊；25例病变分布于肺外周带，6例病灶分布于肺外周伴局部中央分布；26例病灶呈不规则斑片状，5例呈不规则斑片状伴局部球形表现；26例伴细支气管充气征，29例病变内血管增粗，24例见小叶内间隔增厚，6例伴小叶间隔增厚；2例伴小叶中心结节，1例伴少量胸腔积液。结论 COVID-19早期胸部HRCT表现具有一定特征性，结合临床病史有利于早期诊断COVID-19。     

胸部低剂量CT辅助诊断新型冠状病毒肺炎

目的 探讨胸部低剂量CT（LDCT）辅助诊断新型冠状病毒肺炎（COVID-19）的临床应用价值。方法 收集50例咽拭子新型冠状病毒（2019-nCoV）核酸检测阳性的COVID-19患者。首次胸部CT采用常规剂量扫描（常规剂量组），随访胸部CT采用LDCT扫描方案（LD组），对2组图像质量进行评价。采用Kappa检验分析2名医师评价2组图像质量结果的一致性，比较2组图像质量及2种CT扫描方案X线有效辐射剂量（ED）。结果 2名医师图像质量评分一致性较高（Kappa=0.65，P<0.05）LD组与常规剂量组之间图像质量差异无统计学意义（Z=-0.93，P=0.35）。LD组ED[（2.43±0.66）mSv]较常规剂量组[（4.02±1.03）mSv]减少约39.55%（t=0.85，P<0.01）。结论 胸部LDCT可用于临床筛查和辅助诊断COVID-19，图像质量可满足临床诊断要求，且能降低辐射剂量，具有重要临床应用价值。     

Persistent hiccups as an atypical presenting complaint of COVID-19

Hiccups (singultus) are reflex inspiratory movements that involve the swallowing reflex arc and can be classified as acute (<48 h) or persistent (>48 h). A 62-year-old man with no history of malignancy or pulmonary disease presented to the Emergency Department with a four-day history of persistent hiccups. Other than episodic hiccupping, his physical examination was otherwise unremarkable. An abnormal chest X-ray led to a CT scan of the chest with IV contrast, which demonstrated regional, peripheral groundglass opacities of the upper lobes with small focal groundglass opacities scattered throughout the lungs. He was tested for COVID-19 per admission protocol, started on hydroxychloroquine, his hiccups improved, and he was discharged to home after 3 days. An emergency medicine physician should keep COVID-19 on the differential and be vigilant of exposure in atypical presentations.     

Early identification of novel coronavirus (COVID-19) pneumonia using clinical and radiographic findings

IntroductionThe Japanese Respiratory Society (JRS) scoring system is a useful tool for identifying Mycoplasma pneumoniae pneumonia. Most COVID-19 pneumonia in non-elderly patients (aged <60 years) are classified as atypical pneumonia using the JRS scoring system. We evaluated whether physicians could distinguish between COVID-19 pneumonia and M. pneumoniae pneumonia using chest computed tomography (CT) findings. In addition, we investigated chest CT findings if there is a difference between the variant and non-variant strain.MethodsThis study was conducted at five institutions and assessed a total of 823 patients with COVID-19 pneumonia (335 had lineage B.1.1.7.) and 100 patients with M. pneumoniae pneumonia.ResultsIn COVID-19 pneumonia, at the first CT examination, peripheral, bilateral ground-glass opacity (GGO) with or without consolidation or crazy-paving pattern was observed frequently. GGO frequently had a round morphology (39.2%). No differences were observed in the radiological findings between the non-B.1.1.7 groups and B.1.1.7 groups. The frequency of pleural effusion, lymphadenopathy, bronchial wall thickening and nodules (tree-in-bud and centrilobular) was low. In contrast to COVID-19 pneumonia, bronchial wall thickening (84%) was observed most frequently, followed by nodules (81%) in M. pneumoniae pneumonia. These findings were significantly higher in M. pneumoniae pneumonia than COVID-19 pneumonia.ConclusionsOur results demonstrated that a combination of the JRS scoring system and chest CT findings is useful for the rapid presumptive diagnosis of COVID-19 pneumonia in patients aged <60 years. However, this clinical and radiographic diagnosis is not adapted to elderly people.