Coronavirus Disease-2019 Pneumonia: Clinical Manifestations

Abstract

Coronavirus disease-2019 (COVID-19) pneumonia has diverse clinical manifestations, which have shifted throughout the pandemic. Formal classifications include presymptomatic infection and mild, moderate, severe, and critical illness. Social risk factors are numerous, with Black, Hispanic, and Native American populations in the United States having suffered disproportionately. Biological risk factors such as age, sex, underlying comorbid burden, and certain laboratory metrics can assist the clinician in triage and management. Guidelines for classifying radiographic findings have been proposed and may assist in prognosis. In this article, we review the risk factors, clinical course, complications, and imaging findings of COVID-19 pneumonia.

Keywords: COVID-19; CT chest; Clinical manifestations; Pneumonia; SARS-CoV-2.

Fig. 1

Serial chest radiographs of a 62-year-old gentleman with a history of essential hypertension with COVID-19 pneumonia and requiring hospital admission and oxygen support by non-rebreather mask. He received remdesivir, dexamethasone, ceftriaxone, and azithromycin in hospital and was discharged on home oxygen. (A) Day of first positive SARS-CoV-2 polymerase chain reaction test, taken 9 days after onset of symptoms. Bilateral opacities on the left greater than the right. Air bronchograms and bronchial wall thickening is noted in the right lower lobe. (B) Two days after positive test. Slight worsening of bilateral opacities is seen; (C) Eleven months after infection. Bilateral opacities and prominent interstitial markings are consistent with fibrotic lung disease, likely a sequelae of lung injury from acute infection.

Fig. 2

Axial cuts of a CT angiogram of the chest of a 50-year old gentleman with a history of hyperparathyroidism with typical COVID-19 pneumonia per Radiological Society of North America criteria, taken 1 day after first positive polymerase chain reaction for SARS-CoV-2. The patient required ICU admission and oxygen support by high flow nasal cannula. He was discharged on home oxygen. (A) Bilateral, peripheral GGOs in the left upper lobe; (B) bilateral GGOs with mild consolidations and mild traction bronchiectasis at the level of the carina; (C) Increasing consolidative opacities intermixed with GGOs and more severe bronchiectasis; and (D) Bibasilar, posterior, peripheral consolidative opacities with peripheral GGOs.

Fig. 3

CT chest scan 5 months after COVID-19 pneumonia in the same patient presented in Fig. 1. (A) Subpleural peripheral reticulations seen in the bilateral upper lobes. Traction bronchiectasis in left upper lobe takeoff; (B) Peripheral GGOs with reticulation in bilateral lower lobes. These findings seem to represent fibrotic lung disease.