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. 2021 Feb;37(2):219-224.
doi: 10.1080/03007995.2020.1846173. Epub 2020 Nov 26.

Dandelion and focal crazy paving signs: the lung CT based predictors for evaluation of the severity of coronavirus disease

Xi Zhan  1 , Zhihai Chen  2 , Huijuan Hu  3 , Yibin Yang  4 , Kaisong Wu  4 , Zhenshun Cheng  4   5 , Bing Liu  4   5
Affiliations

Dandelion and focal crazy paving signs: the lung CT based predictors for evaluation of the severity of coronavirus disease

Xi Zhan et al. Curr Med Res Opin. 2021 Feb.

Abstract

Purpose: To describe the radiological features of coronavirus disease 19 (COVID-19) and to explore the significant signs that indicate severity of disease.

Materials and methods: We collected data retrospectively of 180 cases of COVID-19, from 15 January 2020 to 31 March 2020, from both the Wuhan Zhongnan and Beijing Ditan Hospitals, including 103 cases of mild and 77 cases of severe pneumonia. All patients had their first chest computed tomography scan within five days of symptom onset. The dandelion sign was defined by a focal ground glass opacity (GGO) with a central thickening of the airway wall, and the focal crazy paving sign was defined by a focal GGO with thickening of the interlobular septa.

Results: Consolidation presented in only 4.9% (5/103) of the mild pneumonia cases, which was significantly lower than that in severe pneumonia cases (70.1% 54/77), p < .001). Multifocal distribution and pure GGOs were observed more frequently in severe cases of pneumonia (p < .05). The dandelion sign was present in 86.4% (89/103) of the mild pneumonia cases, significantly more frequent than those with severe pneumonia (13.0% [10/77], p < .001). The focal crazy paving sign presented in 65.0% (67/103) of the mild pneumonia cases and was significantly more frequent than in severe cases (23.4% [18/77], p < .001). The hospital stay duration of the mild pneumonia group (13.6 ± 7.2 days) was significantly shorter than the severe pneumonia group (26.6 ± 11.7 days, p < .001).

Conclusions: Consolidation, pure GGO and multifocal distribution on a CT scan were associated with severe COVID-19. The dandelion and focal crazy paving signs indicate mild COVID-19.

Keywords: COVID-19; Dandelion sign; SARS-CoV2; focal crazy paving sign.

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Figures

Figure 1.
Figure 1.
A 39 year old male patient diagnosed with mild COVID-19, with a chief complaint of “febrile for two days”. The CT showed a focal GGO with a central thickening of airway wall (white arrow), which we named as dandelion sign.
Figure 2.
Figure 2.
A 62 year old male patient diagnosed with mild COVID-19, with a chief complaint of “febrile for three days, cough for one day”. The CT showed a focal GGO with a central thickening of airway wall (white arrow), which we named as dandelion sign.
Figure 3.
Figure 3.
A 32 year old female patient diagnosed with mild COVID-19, with a chief complaint of “headache for two days”. The CT showed focal GGOs with a central thickening of airway wall (white arrow) on the right middle lobe, which we named as dandelion sign, and focal GGO with thickening interlobular septa (black arrows) on the left lower lobe, which we named as focal crazy paving sign.
Figure 4.
Figure 4.
A 32 year old female patient diagnosed with mild COVID-19, with a chief complaint of “fever for four days and coughing for two days”. The CT showed a focal GGO with interlobular septa thickening (white arrows) on the right lower lobe, which we named as focal crazy paving sign.
Figure 5.
Figure 5.
A 58 year old male patient diagnosed with mild COVID-19, with a chief complaint of “febrile and coughing for three days”. The CT showed focal GGOs with interlobular septa thickening (white arrows) bilaterally, which we named as focal crazy paving sign.
Figure 6.
Figure 6.
A 58 year old male patient diagnosed with mild COVID-19, with a chief complaint of “febrile and coughing for four days, shortness of breath for two days”. The CT showed reversed halo sign (black arrows) bilaterally.
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