Interstitial Lung Disease at High Resolution CT after SARS-CoV-2-Related Acute Respiratory Distress Syndrome According to Pulmonary Segmental Anatomy

Abstract

Background: The purpose of this study was to evaluate High-Resolution CT (HRCT) findings in SARS-CoV-2-related ARDS survivors treated with prolonged low-dose methylprednisolone after hospital discharge.

Methods: A total of 44 consecutive patients (M: 32, F: 12, average age: 64), hospitalised in our department from April to September 2020 for SARS-CoV-2-related ARDS, who had a postdischarge CT scan, were enrolled into this retrospective study. We reviewed the electronic medical charts to collect laboratory, clinical, and demographic data. The CT findings were evaluated and classified according to lung segmental distribution. The imaging findings were correlated with spirometry results and included ground glass opacities (GGOs), consolidations, reticulations, bronchiectasis/bronchiolectasis, linear bands, and loss of pulmonary volume.

Results: Alterations in the pulmonary parenchyma were observed in 97.7% of patients at HRCT (median time lapse between ARDS diagnosis and HRCT: 2.8 months, range 0.9 to 6.7). The most common findings were linear bands (84%), followed by GGOs (75%), reticulations (34%), bronchiolectasis (32%), consolidations (30%), bronchiectasis (30%) and volume loss (25%). They had a symmetric distribution, and both lower lobes were the most affected areas.

Conclusions: A reticular pattern with a posterior distribution was observed 3 months after discharge from severe COVID-19 pneumonia, and this differs from previously described postCOVID-19 fibrotic-like changes. We hypothesized that the systematic use of prolonged low-dose of corticosteroid could be the main reason of this different CT scan appearance.

Keywords: COVID-19 pneumonia; acute respiratory distress syndrome; high resolution computed tomography; pulmonary fibrosis.

Figure 1

HRCT findings in the included population. Of 44 patients with COVID-related ARDS who underwent HRCT, only one had complete resolution, while the remaining patients had abnormal findings, most commonly linear bands, ground glass opacities, and reticulations.

Figure 2

Incidence of HRCT findings divided by lung.

Figure 3

Axial HRCT images. (A) Ill-defined subpleural ground glass opacities in the lower lobes bilaterally; (B) Diffuse ground glass opacities.

Figure 4

Axial HRCT image showing bilateral ground glass opacities associated to subpleural consolidations in the left lung.

Figure 5

(A) HRCT multiplanar reconstruction on the sagittal plane of a 64-year-old woman in which ill-defined ground glass opacities and linear bands are observed. Spirometry values were normal; (B) Axial HRCT image of another patient showing only linear bands.

Figure 6

Axial HRCT image of a patient with extensive lung involvement, including diffuse reticulations, consolidations that predominate in the subpleural regions, and occurrence of pneumomediastinum.

Figure 7

HRCT of a 72-year-old male who developed severe respiratory failure. The multiplanar reconstruction on the sagittal plane (A) shows loss of volume of the left lower lobe and diffuse ground glass opacities and consolidations; the axial plane (B) better demonstrates the presence of reticulations and bronchiectasis.