Presentation of pulmonary infection on CT in COVID-19: initial experience in Brazil

Abstract

The disease caused by the new coronavirus (SARS-CoV-2), designated COVID-19, emerged in late 2019 in China, in the city of Wuhan (Hubei province), and showed exponential growth in that country. It subsequently spread to all continents, and infection with SARS-CoV-2 is now classified as a pandemic. Given the magnitude achieved, scientific interest in COVID-19 has also grown in the international literature, including its manifestations on imaging studies, particularly on CT. To date, no case series have been published in Brazil. Therefore, our objective was to describe the CT findings in an initial series of 12 patients.

Figure 1. Axial images (in A to C) and coronal reconstructions (in D) of chest CT scans of a 44-year-old man with clinical findings suggestive of COVID-19 (fever, sore throat, and frequent dry cough), demonstrating the most commonly described pattern: numerous bilateral multifocal ground-glass opacities, associated with fine reticulation and interlobular septal thickening (crazy-paving pattern), involving various lung lobes and being predominantly peripheral in distribution in the parenchyma and a little more extensive in the posterior regions of the lower lobes. The patient had a positive RT-PCR result for COVID-19 on the day he underwent the first CT scan (images on the left in each pair) and was hospitalized. A second CT scan, which was performed three days later (images on the right in each pair) because he continued to have fever spikes and dry cough, demonstrated an increase in the number and extent of pulmonary opacities.

Figure 2. Chest CT scans of different patients illustrating the spectrum of findings of COVID-19 in our sample. In A, a 61-year-old male patient with peripheral and posterior ground-glass opacities in the lower lobes (blue arrows in the right lower lobe), as well as a focus of parenchymal opacification in the lingula. In B and C, a 41-year-old male patient with extensive ground-glass opacities associated with septal thickening and fine reticulation (crazy-paving) in the right upper lobe, in addition to other small scattered foci in the upper and lower left lobes. In D, an 85-year-old male patient with ground-glass opacities, associated with fine reticulation and thickening of some interlobular septa, extending mostly into the periphery of the left lower lobe, but also present in the lingula and in the right lower lobe. In E and F, a 42-year-old male patient with ground-glass opacities and bilateral foci of consolidation, predominantly in the most posterior regions of the lower lobes. The patient also had bilateral minimal pleural effusion (arrows), a relatively uncommon finding in patients with COVID-19. In addition, signs suggestive of hepatic steatosis were identified.