Chest CT Findings and Their Temporal Evolution in COVID-19 Pneumonia

Abstract

Introduction: The coronavirus disease 2019 (COVID-19) pandemic originated in China in November 2019 and is caused by the SARS-CoV-2 virus. The virus binds to nasal and pharyngeal epithelial cells and migrates to the lower respiratory tract. The confirmatory test for COVID-19 infection is the reverse transcription-polymerase chain reaction (RT-PCR). Chest CT plays an important role in the diagnosis, triage, and treatment of affected individuals. We describe the findings on chest CT and their temporal evolution in COVID-19 pneumonia.

Methods: We conducted a retrospective, cross-sectional study on COVID-19-positive patients who underwent chest CT. CT images of the patients were reviewed for ground-glass opacities, consolidation, crazy-paving appearance, vascular dilatation, traction bronchiectasis, architectural distortion, and subpleural and parenchymal bands. Distribution of opacities on axial sections, ancillary findings, and co-existent lung diseases were recorded. To assess the temporal evolution of CT findings, the time in days between the onset of the first symptom and the date of the CT scan of each patient was recorded. Statistical analysis was performed.

Results: Ground-glass opacities, consolidation, and a combination of both were the most important features in COVID-19 pneumonia. Patients in the early stage showed simple ground-glass opacities; in the progressive stage showed consolidation and ground-glass opacities with crazy-paving appearance, subpleural and parenchymal bands, and architectural distortion; in the peak stage showed progression of these findings; and in the late stage showed interval resolution of these findings. Axial distribution of these opacities was asymmetric, with peripheral subpleural predominance involving posterior, lateral, and both these locations, associated with apicobasal gradient.

Conclusion: Chest CT permits rapid diagnosis of COVID-19 pneumonia, enabling appropriate treatment to be instituted at the earliest. Thus, it is life-saving in resource-constrained environments.

Keywords: consolidation; covid-19; covid-19 pandemic; ct chest; ground glass opacities; temporal evolution.

Figure 1. Axial CT section of the chest showing ground-glass opacities in a patient with COVID-19 pneumonia

Figure 2. Axial CT section of the chest showing consolidation in a patient with COVID-19 pneumonia

Figure 3. Axial CT section of the chest showing the “crazy-paving” appearance of ground-glass opacities with intralobular septal thickening in a patient with COVID-19 pneumonia

Figure 4. Axial CT section of the chest showing parenchymal bands and peripheral subpleural predominant distribution of opacities in a patient with COVID-19 pneumonia