Chest radiological finding of COVID-19 in patients with and without diabetes mellitus: Differences in imaging finding

Abstract

The pandemic of novel coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Diabetes mellitus is a risk factor for developing severe illness and a leading cause of death in patients with COVID-19. Diabetes can precipitate hyperglycaemic emergencies and cause prolonged hospital admissions. Insulin resistance is thought to cause endothelial dysfunction, alveolar capillary micro-angiopathy and interstitial lung fibrosis through pro-inflammatory pathways. Autopsy studies have also demonstrated the presence of microvascular thrombi in affected sections of lung, which may be associated with diabetes. Chest imaging using x-ray (CXR) and computed tomography (CT) of chest is used to diagnose, assess disease progression and severity in COVID-19. This article reviews current literature regarding chest imaging findings in patients with diabetes affected by COVID-19. A literature search was performed on PubMed. Patients with diabetes infected with SARS-CoV-2 are likely to have more severe infective changes on CXR and CT chest imaging. Severity of airspace consolidation on CXR is associated with higher mortality, particularly in the presence of co-morbidities such as ischaemic heart disease. Poorly controlled diabetes is associated with more severe acute lung injury on CT. However, no association has been identified between poorly-controlled diabetes and the incidence of pulmonary thromboembolism in patients with COVID-19.

Keywords: COVID-19; Chest X-Ray; Chest imaging using x-ray; Computed tomography of chest; Diabetes mellitus.

Figure 1

The Chest X-Ray demonstrates multiple bilateral peripheral predominant airspace opacities. There is no pleural effusion.

Figure 2

Chest X-Ray. A: Typical appearances of COVID-19 infection: Bilateral peripheral consolidation (1. block arrow), multifocal groundglass opacities (2. straight arrow); B: Some areas of smooth intralobular septal thickening (3. curved arrow).