COVID-19 integrated imaging: our experience and literature review

Abstract

Purpose: To investigate the imaging features of emerging COVID-19 pneumonia on chest ultrasound, radiographs and computed tomography examinations performed at admission. In addition, we provide a review of the literature and compare our results with recent evidence regarding the imaging characteristics of this novel disease.

Material and methods: From March 17, 2020 to April 25, 2020, 23 patients with real-time polymerase chain reaction (RT-PCR) assay confirmed COVID-19 were identified. All 23 patients were evaluated and admitted at San Giuseppe Moscati Hospital in Aversa, Italy. Multi-modality imaging findings were evaluated and compared. Literature research was conducted through a methodical search on PubMed.

Results: Twenty-three patients were included in the study. Chest transthoracic ultrasound (US), chest X-ray (CXR), and computed tomography (CT) were performed respectively in 11, 16 and 21 patients. Chest US findings were consistent with diffuse B lines (91%), subpleural consolidations (45%), and thickened pleural line (18%). CXR showed prevalent manifestations of consolidations (50%) and hazy increased opacities (37%). Typical CT features are bilateral and multilobar ground-glass opacities (GGO). Indeed GGO were present in 100% of our patients. Consolidations were visible in 76% of our study population. Notably both GGO and consolidations had a peripheral distribution in all our patients. Other CT imaging features included crazy-paving pattern, fibrous stripes, subpleural lines, architectural distortion, air bronchogram sign, vascular thickening and nodules. Our literature review identified thirty original studies supporting our imaging chest findings.

Conclusions: At admission, COVID-19 pneumonia can manifest in chest imaging as B-lines and consolidations on US, hazy opacities and consolidations on CXR, multiple GGO and consolidations on CT scan.

Keywords: COVID-19; SARS-CoV-2; computed tomography (CT); coronavirus disease; pneumonia; radiographic chest examination (CXR).

Figure 1

A) Lung ultrasound with convex probe shows irregular pleural surface and multiple B lines. B) Chest X-ray shows bilateral, central and peripheral, lung opacities. C, D) Axial chest computed tomography images show patchy bilateral ground-glass opacities with interlobular septal and intralobular interstitial thickening (“crazy-paving” pattern) in the upper lobes, mainly peripheral and more consolidated areas

Figure 2

A) Lung ultrasound shows pleural line irregularities and confluent vertical artifacts (B-lines). B, C) Chest computed tomography axial images show bilateral and peripheral ground-glass opacities with “crazy-paving” pattern and air bronchogram sign in the lower lobes

Figure 3

A) Lung ultrasound with linear probe shows subpleural consolidation. B) Chest computed tomography axial image shows bilateral and prevalent peripheral ground-glass opacities, “crazy-paving” pattern and consolidated areas in the left lower lobe

Figure 4

Chest computed tomography axial image shows patchy bilateral and peripheral ground-glass opacities

Figure 5

Chest computed tomography axial image shows bilateral and diffuse ground-glass opacities and more consolidated areas with air bronchogram sign

Figure 6

Chest computed tomography axial image shows bilateral and diffuse ground-glass opacities with superimposed interlobular septal thickening and intralobular septal thickening (“crazy paving” pattern) and more consolidated areas with air bronchogram sign