不发热COVID-19患者临床特征及胸部薄层CT筛查价值评估

 目的 分析20例不发热新型冠状病毒肺炎（COVID-19）患者临床及胸部薄层CT影像特征。方法 回顾性分析某院20例临床确诊为COVID-19不发热患者首次入院临床特征,主要包括呼吸道、消化道等症状及白细胞计数、淋巴细胞计数、C反应蛋白等试验室指标,同时对胸部薄层CT扫描资料进行分析。结果 临床症状分为完全无症状、不发热有呼吸道或消化道症状,后者症状均轻微,主要症状为干咳,实验室以白细胞计数及淋巴结细胞计数减少多见。不发热COVID-19患者胸部薄层CT以早期、恢复期影像表现为主,少数表现为进展期：（1）早期呈单肺段或多肺段斑片状、结节状、不规则形磨玻璃密度影（GGO）,以肺外周或胸膜下分布为主,常见血管增粗穿行,部分出现长短不一细线状高密度影;（2）进展期病灶融合成不规则片状,可累及多个肺段、肺叶,可见小叶间隔增厚或呈"铺路石"征,部分可见局灶性实变影;（3）恢复期病灶范围缩小、变淡,通常吸收较完全,少见纤维残留灶。结论 不发热COVID-19患者临床特征隐匿,但胸部影像表现具有特征性,胸部薄层CT对COVID-19的早期诊断和评估有重要价值。

Clinical characteristics and chest thin-layer CT screening of COVID-19 patients without fever

Objective To analyze clinical and chest thin-layer CT imaging characteristics of 20 coronavirus disease 2019(COVID-19) patients without fever. Methods Clinical characteristics of 20 COVID-19 patients without fever at the first admission in a hospital were retrospectively analyzed, including symptoms of respiratory tract and digestive tract, as well as laboratory test results of white blood cell count, lymphocyte count and C-reactive protein, meanwhile, the thin-layer CT scanning data of chest were analyzed. Results Clinical symptoms were classified into completely asymptomatic, respiratory or/and digestive symptoms without fever, symptoms of the latter were mild, mainly dry cough, leukopenia and lymphopenia was common in laboratory test results. Chest thin-layer CT in COVID-19 patients without fever mainly showed early and convalescent images, and a few showed progressive images:(1) In the early stage, segmental or multi-segmental ground-glass opacity (GGO) with patchy, nodular, or irregular form distributed along the peripheral of lung or subpleural area, among which vascular thickened and uneven length of linear high density opacity may be found in some patients; (2) In progressive stage, lesions enlarged as irregular form, and multiple pulmonary segments and lobes were involved, showing the "paving stone" sign or even evolved into pulmonary consolidation; (3) In convalescent stage, lesions diminished, completely absorbed, and residual fiber was uncommon. Conclusion Clinical characteristics of COVID-19 patients without fever are occult, while thin-layer CT findings of chest are typical, chest thin-layer CT plays an important role in the early diagnosis and evaluation of COVID-19.