Chest CT manifestations of new coronavirus disease 2019 (COVID-19): a pictorial review

Abstract

Coronavirus disease 2019 (COVID-19) outbreak, first reported in Wuhan, China, has rapidly swept around the world just within a month, causing global public health emergency. In diagnosis, chest computed tomography (CT) manifestations can supplement parts of limitations of real-time reverse transcription polymerase chain reaction (RT-PCR) assay. Based on a comprehensive literature review and the experience in the frontline, we aim to review the typical and relatively atypical CT manifestations with representative COVID-19 cases at our hospital, and hope to strengthen the recognition of these features with radiologists and help them make a quick and accurate diagnosis.Key Points• Ground glass opacities, consolidation, reticular pattern, and crazy paving pattern are typical CT manifestations of COVID-19.• Emerging atypical CT manifestations, including airway changes, pleural changes, fibrosis, nodules, etc., were demonstrated in COVID-19 patients.• CT manifestations may associate with the progression and prognosis of COVID-19.

Keywords: Coronavirus infections; Pneumonia; Tomography, X-ray computed.

Fig. 1

a A 35-year-old male COVID-19 patient presenting fever and headache for 1 day. CT scan shows a pure ground glass opacity in the right lower lobe (red frame). b A 47-year-old male COVID-19 patient presenting fever for 7 days. CT scan shows consolidation in the right lobe subpleural area (red frame)

Fig. 2

a A 34-year-old female COVID-19 patient presenting fever with dry cough for 2 days. CT scan shows slight reticular pattern in the left lower lobe and subpleural area (red frame). b An 81-year-old female COVID-19 patient presenting fever with cough for 7 days. CT scan shows reticular pattern superimposed on the background of GGO, resembling the sign of crazy paving stones in the right middle lobe (red frame)

Fig. 3

a A 48-year-old male COVID-19 patient presenting fever for 5 days. CT scan shows bilateral GGO in the lower lobe (red frames) and air bronchogram (white arrow) in the left subpleural area. b A 66-year-old male COVID-19 patient presenting fever with cough for 7 days. CT scan shows reticular pattern in the subpleural areas of the bilateral lower lobe, GGO, and bronchial wall thickening (white arrow) in the right middle lobe

Fig. 4

a An 80-year-old female COVID-19 patient presenting fever for 7 days. CT scan shows left pleural thickening (white arrows). b A 43-year-old female COVID-19 patient presenting fever and chills for 5 days. CT scan shows subpleural lines (white arrows) in bilateral lower lobes. c A 66-year-old female COVID-19 patient presenting cough and myalgia for 7 days. CT scan shows bilateral GGO and fibrous stripes (white arrows) in the left lower lobe. d A 35-year-old male COVID-19 patient presenting fever and headache for 1 day. CT scan shows a large area of GGO (red frame) in the right upper lobe with multiple small vascular enlargement (white arrows)

Fig. 5

a A 49-year-old male COVID-19 patient presenting fever with diarrhea for 3 days. CT scan shows a patchy GGO (red frame) with an air bubble sign (white arrow) in the apicoposterior segment of the upper left lobe. b A 76-year-old female COVID-19 patient presenting fever with cough for 4 days. CT scan shows an irregular nodule (white arrow) in the posterior segment of the right upper lobe. c A 46-year-old male COVID-19 patient presenting fever with dry cough for 5 days. CT scan shows a solid nodule surrounded by a ground glass halo in the lateral segment of the right middle lobe (red frame). d A 66-year-old woman confirmed with COVID-19 presenting fever and myalgia for 7 days. CT scan shows a reversed halo sign (red frame) in the posterior basal segment of the right lower lobe

Fig. 6

A 49-year-old female COVID-19 patient presenting chest pain for 14 days. CT scan shows enlargement of mediastinal lymph nodes (asterisks)