Clinical characteristics and imaging manifestations of the 2019 novel coronavirus disease (COVID-19):A multi-center study in Wenzhou city, Zhejiang, China

Abstract

Background: Little is known about COVID-19 outside Hubei. The aim of this paper was to describe the clinical characteristics and imaging manifestations of hospitalized patients with confirmed COVID-19 infection in Wenzhou, Zhejiang, China.

Methods: In this retrospective cohort study, 149 RT-PCR confirmed positive patients were consecutively enrolled from January 17th to February 10th, 2020 in three tertiary hospitals of Wenzhou. Outcomes were followed up until Feb 15th, 2020.

Findings: A total of 85 patients had Hubei travel/residence history, while another 49 had contact with people from Hubei and 15 had no traceable exposure history to Hubei. Fever, cough and expectoration were the most common symptoms, 14 patients had decreased oxygen saturation, 33 had leukopenia, 53 had lymphopenia, and 82 had elevated C-reactive protein. On chest computed tomography (CT), lung segments 6 and 10 were mostly involved. A total of 287 segments presented ground glass opacity, 637 presented mixed opacity and 170 presented consolidation. Lesions were more localized in the peripheral lung with a patchy form. No significant difference was found between patients with or without Hubei exposure history. Seventeen patients had normal CT on admission of these, 12 had negative findings even10 days later.

Interpretation: Most patients presented with a mild infection in our study. The imaging pattern of multifocal peripheral ground glass or mixed opacity with predominance in the lower lung is highly suspicious of COVID-19 in the first week of disease onset. Nevetheless, some patients can present with a normal chest finding despite testing positive for COVID-19.

Funding: We did not receive any fundings.

Keywords: COVID-19; CT; Infection; Lung; Outside Hubei.

Fig. 1

Chest CT of a male patient, 37 years old. This individual came back from Wuhan to Wenzhou on January 19th. He presented with cough and expectoration. He underwent a chest CT examination on January 24th, which showed subtle peripheral ground glass opacity in the middle lobe, and right inferior lobe. He was hospitalized on the same day. The RT-PCR test was done and was found to be positive. The CT images of January 27th and February 2nd showed a significant increase of lesion number and density, especially in the both lower lobes. Two RT-PCR tests were performed on February 4th and 7th and both results were negative. The CT images of February 7th showed a decrease in density of the pulmonary lesions. On the CT examination of February 15th, the lesions were absorbed and the patient was discharged. During the hospitalization, the patient had arbidol as antiviral treatment and nasal spray of interferon, no oxygen therapy was performed since the oxygen saturation of the patient remained normal. The patient had no fever during the entire disease course.