COVID-19 patients and the radiology department - advice from the European Society of Radiology (ESR) and the European Society of Thoracic Imaging (ESTI)

Abstract

This document from the European Society of Radiology (ESR) and the European Society of Thoracic Imaging (ESTI) aims to present the main imaging features, and the role of CT scan in the early diagnosis of COVID-19, describing, in particular, the typical findings which make it possible to identify the disease and distinguish it from bacterial causes of infection, and to define which category of patients may benefit from CT imaging. The precautions that must be taken when performing scans to protect radiologists and technologists from infection will be described. The organisational measures that can be taken within radiology departments in order to cope with the influx of patients, while continuing to manage other emergency and time-sensitive activity (e.g. oncology, other infectious diseases etc.), will be discussed. KEY POINTS: • Bilateral ground glass opacities are typical CT manifestations of COVID-19. • Crazy paving and organising pneumonia pattern are seen at a later stage. • Extensive consolidation is associated with a poor prognosis.

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

Fig. 1

Axial and sagittal thin-sections showing bilateral pure ground glass in the sub pleural portion of both lower lobes, at presentation, in a 71-year-old woman with cough and fever for 5 days (a, c). Evolution 6 days later with linear consolidation typical for organizing pneumonia pattern (b, d)

Fig. 2

Typical findings of COVID-19 pneumonia in CT Ground glass opacities in large area (a) or nodular (b). Consolidation focal (c) or linear (d). Crazy paving pattern (e)

Fig. 3

Subpleural predominance (a-c)

Fig. 4

Disease extent mild (a), moderate (b), severe (c)

Fig. 5

CT features suggesting other diagnoses. Mucoid impactions (a), tree-in-bud (b), centrilobular nodules (c), septal lines (d), segmental consolidation (e)