Chest CT for Typical Coronavirus Disease 2019 (COVID-19) Pneumonia: Relationship to Negative RT-PCR Testing

Abstract

Some patients with positive chest CT findings may present with negative results of real-time reverse-transcription polymerase chain reaction (RT-PCR) tests for coronavirus disease 2019 (COVID-19). In this study, the authors present chest CT findings from five patients with COVID-19 infection who had initial negative RT-PCR results. All five patients had typical imaging findings, including ground-glass opacity (five patients) and/or mixed ground-glass opacity and mixed consolidation (two patients). After isolation for presumed COVID-19 pneumonia, all patients were eventually confirmed to have COVID-19 infection by means of repeated swab tests. A combination of repeated swab tests and CT scanning may be helpful for individuals with a high clinical suspicion of COVID-19 infection but negative findings at RT-PCR screening.

Figure 1:

Patient flowchart. Of 167 patients screened, 5 (3%) had negative RT-PCR results and chest CT findings compatible with 2019-nCoV pneumonia.

Figure 2:

Chest CT imaging of patient1.A-D, CT images show bilateral multifocal GGOs and mixed GGO and consolidation lesions. Traction bronchiectasis(fat arrow) and vascular enlargement are also presented (thin arrow).

Figure 3:

Chest CT imaging of patient 2. A-D, CT images showed multi-focal GGO and mixed consolidation that most appeared at peripheral area of both lungs. The CT involvement score was 11.

Figure 4:

Chest CT imaging of patient 3. A-D, CT images showed bilateral subpleural bandlike areas of GGO compatible with viral pneumonia.