Coronavirus Disease 2019 (COVID-19) Pneumonia Presentations in Chest Computed Tomography: A Pictorial Review

Abstract

Despite imaging not being a tool for novel coronavirus disease 2019 (COVID-19) diagnosis, there has been an increased number of chest computed tomography (CT) scans done worldwide. There are no pathognomonic CT features for COVID-19 pneumonia, as findings are also common in other infectious diseases and noninfectious aetiologies. Nonetheless, point-of-care physicians should be familiarized with the most common imaging presentations of the COVID-19. In this pictorial review, we have summarized the most reported imaging features of COVID-19 pneumonia, including possible differential diagnosis according to the CT finding.

FIG 1

A 38-year-old woman with the diagnosis of COVID-19 by RT-PCR presenting fever for 2 weeks and intense dyspnea for 2 days. (A) axial and (B) coronal CT scans show minimal peripheral GGO in lower lobes. A computed tomography pulmonary angiography (CTPA) was made and showed thrombus in the right and left main pulmonary arteries (C) and in bilateral lower lobe pulmonary arteries (D).

FIG 2

A 49-year-old man with the diagnosis of COVID-19 by RT-PCR presenting fever and diarrhoea for 3 days. (A and B) axial CT scans show a GGO with peripheral and bilateral distribution in lower lobes. (C) Sagittal CT images demonstrated the same findings in the lower lobes.

FIG 3

A 63-year-old man with the diagnosis of COVID-19 by RT-PCR presenting fever and cough for 7 days. (A and B) axial and (C) coronal CT scans show a patchy GGO with random distribution in both lungs. (D and E) demonstrate a frontal and lateral view of 3DCT reconstructions with automatic detection of GGO (red). (Color version of figure is available online.)

FIG 4

A 42-year-old woman with the diagnosis of COVID-19 by RT-PCR with dry cough for 8 days. (A) axial and (B) coronal CT scans present rounded GGO in both lungs.

FIG 5

A 34-year-old man with the diagnosis of COVID-19 by RT-PCR presenting fever and diarrhoea for 2 days. The axial CT scan shows a unilateral GGO with peripheral distribution in the right lower lobe.

FIG 6

A 71-year-old woman with the diagnosis of COVID-19 by RT-PCR presenting fever and dyspnea for 9 days. The axial CT scan shows a diffuse GGO with septal thickening, compatible with “crazy paving.”

FIG 7

A 66-year-old man with the diagnosis of COVID-19 by RT-PCR presenting fever and cough for 11 days. (A and B) axial CT scans show areas of consolidation associated with GGO with diffuse distribution in both lungs. (C and D) coronal and sagittal CT reconstructions demonstrated the same findings in lower lobes.

FIG 8.

An 82-year-old man with the diagnosis of COVID-19 by RT-PCR presenting fever and diarrhoea for 13 days. He was intubated in day 6 of disease. (A and C) axial CT scans show diffuse consolidation with anteroposterior gradient, compatible with diffuse alveolar damage. (B) CT reconstruction demonstrated the same findings.

FIG 9

A 42-year-old man with the diagnosis of COVID-19 by RT-PCR presenting fever and diarrhoea for 9 days. Axial CT scan show 2 solid nodules surrounded by a ground-glass halo in the right and other in left lower lobes.

FIG 10

A 55-year-old man with the diagnosis of COVID-19 by RT-PCR presenting fever and diarrhoea for 6 days. (A and B) axial CT scans show 2 reversed halo signs in the posterior basal segment of the right and left lower lobe.

FIG 11

A 50-year-old woman with the diagnosis of COVID-19 by RT-PCR with fever and mild dyspnea for 9 days. (A) axial and (B) coronal chest CT image shows multiple rounded GGO with a peripheral ring of consolidation (reversed halo sign).