The lingering manifestations of COVID-19 during and after convalescence: update on long-term pulmonary consequences of coronavirus disease 2019 (COVID-19)

Abstract

The long-term sequelae of coronavirus disease 2019 (COVID-19) are still unknown. Lessons from past viral epidemics reveal that, after recovery, patients with viral pulmonary infections can suffer from irreversible pulmonary dysfunction and demonstrate residual imaging or functional abnormalities. Residual ground glass opacities, consolidations, reticular and linear opacities, residual crazy paving pattern, melted sugar sign, and parenchymal fibrotic bands are several features found in the late or remission stages of COVID-19. These radiologic findings have been observed weeks after symptom onset, even after hospital discharge, and they may or may not correlate with clinical manifestations. High-resolution CT may be indicated to establish new baselines and track changes in residual impairments. In our previous review, we observed significant pulmonary sequelae in some COVID-19 survivors at follow-up. In this update, we review the current literature on the clinical and radiologic manifestations of post-recovery COVID-19 toward the end of hospital admission and after discharge.

Keywords: COVID-19; Co-morbidities; High-resolution CT; Recovery; SARS-CoV-2; Surveillance.

Fig. 1

A 64-year-old woman presented with myalgia and low-grade fever to the emergency department. Baseline CT examination showed multifocal patchy ground glass opacities and interlobular septal thickening (a, b). The diagnosis of COVID-19 was confirmed later by RT-PCR. Follow-up imaging 35 days after initial CT demonstrated residual pure ground glass opacity without focal pleural thickening (c, d)

Fig. 2

A 44-year-old man with shortness of breath, cough and fever was referred to us for non-contrast chest CT. Multifocal bilateral peripheral ground glass opacities were identified (a, b), consistent with COVID-19. He returned for follow-up imaging 34 days after the initial presentation. Follow-up non-contrast chest CT demonstrates residual pulmonary opacities and fibrotic bands involving peripheral bilateral lung bases (c–e)