A retrospective study of the initial 25 COVID-19 patients in Luoyang, China

Abstract

Purpose: To summarize the chest CT imaging and clinical features of the initial COVID-19 patients and provide a clinical diagnostic method that is more effective and can be performed earlier.

Methods: This retrospective study investigated the clinical, laboratory and imaging information of 25 patients in the Luoyang area. There were 15 (60%) male and 10 (40%) female patients ranging from 24 to 88 years old (52 ± 19.30). Data were analyzed by Microsoft Excel and are expressed as the mean ± standard deviation or percentage.

Results: Thirteen (52%) patients had been in Wuhan or were in contact with people who had been in Wuhan, and ten (40%) patients were infected by their families or colleagues. The median time from initial symptoms to diagnosis was 7 days. Ninety-two percent of patients had respiratory symptoms, and 8% of them had digestive symptoms. Fever (92%), cough (60%) and fatigue (56%) were the most common symptoms. Most patients had a normal or reduced WBC (96%), reduced lymphocyte count (60%), increased CRP (48%) and increased ESR (44%). Ground glass opacity (GGO) was the typical radiological finding on chest CT.

Conclusion: Characteristic chest CT imaging features could appear earlier than the viral nucleic acid assay results.

Keywords: COVID-19 pneumonia; CT; SARS-CoV-2.

Fig. 1

Demographic and time course for diagnosing COVID-19 patients

Fig. 2

Patient 1. Images in a 28-year-old male with fever and fatigue. a On the admission day, the unenhanced CT scan shows diffuse bilateral multiple patchy GGO (white arrow), and the partial boundary is clear while some have unclear boundaries, which are especially significant in the lower lobes of both lungs; strip consolidative opacities (black arrow) are in the focal area. b On day 5, the follow-up unenhanced CT scan shows a significant reduction in GGO in both lungs, and solid shadows have no new lesions. c On day 11, the follow-up unenhanced CT scan shows that the lesion was basically absorbed, and few GGOs remain (white arrows). On day 15, the patient was discharged from the hospital

Fig. 3

Patient 4. Images in a 57-year-old woman with fever. The DR is normal in the lung on the admission day. a The unenhanced CT shows multiple patchy GGO-like lesions in the both lungs at subpleural position, unclear boundaries of GGO shadows with halo signs (white arrows) or clear boundaries of partial glass density shadows with reversed halo signs (black arrows). The mesh shadow is visible inside (black arrow). b Follow-up unenhanced CT on day 12 shows multiple new lesions. The lesions spread and fused in the subpleural area, showing a crescentic shape, while some lesions changed in consolidation and partial fibrosis

Fig. 4

Patient 10. Images in a 53-year-old man with fever. a On the admission day, the unenhanced CT scan shows multiple patchy GGO in the subpleural area of both lungs, localized consolidation, air bronchogram sign (white arrow), and slightly thickened localized vascular bundle (black arrow). b Follow-up unenhanced CT on day 6 shows a decrease in GGO density, an occurrence of new lesions on the subpleural and interlobular clefts, which partially combined to produce a patchy shape

Fig. 5

Patient 22. Images in a 56-year-old man with fatigue. a The unenhanced CT scan shows a small patchy GGO shadow and small patchy consolidation in the subpleural area of both lungs. The boundary is unclear, and the capillaries increase (white arrow), whereas viral nucleic acid assay results were negative on this day and the next day. b Follow-up unenhanced CT on day 6 shows a decrease in the lesion density, with only small patchy thin GGOs and no new lesions. However, the third viral nucleic acid assay results were negative on the next day

Fig. 6

Patient 22. Images in a 56-year-old man with fever. a The unenhanced CT scan shows a small patchy thin GGO shadow on the left inferior pulmonary lobe (white arrow) and localized bronchiole wall thickening. However, the viral nucleic acid assay results were reported to be negative on the next 2 consecutive days. b Follow-up unenhanced CT on day 10 shows multiple GGO lesions on the subpleural area in both lungs with partial consolidation, air bronchogram signs, and increased shadows in the capillaries. Then, viral nucleic acid assay results were reported to be positive on day 11