Chest CT Findings in Coronavirus Disease-19 (COVID-19): Relationship to Duration of Infection

Abstract

In this retrospective study, chest CTs of 121 symptomatic patients infected with coronavirus disease-19 (COVID-19) from four centers in China from January 18, 2020 to February 2, 2020 were reviewed for common CT findings in relationship to the time between symptom onset and the initial CT scan (i.e. early, 0-2 days (36 patients), intermediate 3-5 days (33 patients), late 6-12 days (25 patients)). The hallmarks of COVID-19 infection on imaging were bilateral and peripheral ground-glass and consolidative pulmonary opacities. Notably, 20/36 (56%) of early patients had a normal CT. With a longer time after the onset of symptoms, CT findings were more frequent, including consolidation, bilateral and peripheral disease, greater total lung involvement, linear opacities, "crazy-paving" pattern and the "reverse halo" sign. Bilateral lung involvement was observed in 10/36 early patients (28%), 25/33 intermediate patients (76%), and 22/25 late patients (88%).

Figure 1a:

An axial CT image obtained without intravenous contrast in a 36‐year‐old male (Panel A) shows bilateral ground‐glass opacities in the upper lobes with a rounded morphology (arrows). An axial CT image obtained in a 44‐year‐old male (Panel B) shows larger groundglass opacities in the bilateral lower lobes with a rounded morphology (arrows). An axial CT image obtained in a 65‐year‐old female (Panel C) shows bilateral ground‐glass and consolidative opacities with a striking peripheral distribution.

Figure 1b:

An axial CT image obtained without intravenous contrast in a 36‐year‐old male (Panel A) shows bilateral ground‐glass opacities in the upper lobes with a rounded morphology (arrows). An axial CT image obtained in a 44‐year‐old male (Panel B) shows larger groundglass opacities in the bilateral lower lobes with a rounded morphology (arrows). An axial CT image obtained in a 65‐year‐old female (Panel C) shows bilateral ground‐glass and consolidative opacities with a striking peripheral distribution.

Figure 1c:

An axial CT image obtained without intravenous contrast in a 36‐year‐old male (Panel A) shows bilateral ground‐glass opacities in the upper lobes with a rounded morphology (arrows). An axial CT image obtained in a 44‐year‐old male (Panel B) shows larger groundglass opacities in the bilateral lower lobes with a rounded morphology (arrows). An axial CT image obtained in a 65‐year‐old female (Panel C) shows bilateral ground‐glass and consolidative opacities with a striking peripheral distribution.

Figure 2:

An axial CT image obtained without intravenous contrast in a 56‐year‐old female shows ground‐glass opacities with a rounded morphology (arrows) in the right middle and lower lobes. The left lung was normal.

Figure 3:

An axial CT image obtained without intravenous contrast in a 42‐year‐old male in the “late” time group (10 days from symptom onset to this CT) shows bilateral consolidative opacities, with a striking peripheral distribution in the right lower lobe (solid arrows), and with a rounded morphology in the left lower lobe (dashed arrow).

Figure 4:

Frequency of selected chest CT findings as a function of time course from symptom onset.

Figure 5a:

An axial CT image obtained without intravenous contrast in a 43 year old female (Panel A) shows a “crazy‐paving” pattern as manifested by right lower lobe ground‐glass opacification with interlobular septal thickening (arrows) with intralobular lines. An axial CT image obtained in a 22‐year old‐female (Panel B) shows an area of faint ground‐glass opacification in the left upper lobe with a ring of denser consolidation (arrow, “reverse halo” sign).

Figure 5b:

An axial CT image obtained without intravenous contrast in a 43 year old female (Panel A) shows a “crazy‐paving” pattern as manifested by right lower lobe ground‐glass opacification with interlobular septal thickening (arrows) with intralobular lines. An axial CT image obtained in a 22‐year old‐female (Panel B) shows an area of faint ground‐glass opacification in the left upper lobe with a ring of denser consolidation (arrow, “reverse halo” sign).