The Role of Computed Tomography in the Management of Hospitalized Patients With COVID-19

Abstract

The emergence of SARS-CoV-2 at the end of 2019 sparked the beginning of the COVID-19 pandemic. Even though it was a novel virus, the workup of suspected COVID-19 included standard protocols used for the investigation of similar respiratory infections and pneumonia. One of the most important diagnostic tests in this regard is computed tomography (CT). CT scans have a high sensitivity in diagnosing COVID-19, and many of the characteristic imaging findings of COVID-19 are used in its diagnosis. The role of CT in COVID-19 management is expanding as more and more hospital practices adopt regular CT use in both the initial workup and continued care of COVID-19 patients. CT has helped hospitalists diagnose complications such as pulmonary embolism, subcutaneous emphysema, pneumomediastinum, pneumothoraces, and nosocomial pneumonia. Although mainly used as a diagnostic tool, the prognostic role of CT in COVID-19 patients is developing. In this review, we explore the role of CT in the management of hospitalized patients with COVID-19, specifically elucidating its use as a diagnostic and prognostic modality, as well as its ability to guide hospital decision-making regarding complex cases. We will highlight important time points when CT scans are used: the initial encounter, the time at admission, and during hospitalization.

Keywords: computed tomography pulmonary angiography; covid-19; covid-19 pneumonia; ct (computed tomography) imaging; ground-glass opacity; hospitalized covid 19; outcomes in covid-19 hospitalizations; thromboembolism.

Figure 1. Typical peripheral, bilateral lower lung, ground-glass opacities (blue arrows) of COVID-19 pneumonia on CT.

Figure 2. COVID-19 pneumonia with more confluent peripheral ground-glass opacities (blue arrows).

Figure 3. Mixed ground-glass opacities (blue arrows) and consolidation. Note the presence of pneumomediastinum as a complication of mechanical ventilation.

Figure 4. An example of subtle, crazy paving-like changes (blue arrow) in a patient with COVID-19 pneumonia, consisting of ground-glass opacities and superimposed interstitial thickening.

Figure 5. Aortic arch thrombus (blue arrow) in a patient with COVID-19 pneumonia.

Figure 6. The same patient with a right distal main pulmonary artery embolus (blue arrow). Peripheral pulmonary involvement with COVID-19 pneumonia is shown.

Figure 7. The same patient with popliteal arterial thrombosis on the right. Non-enhancement of the right popliteal artery (blue arrow) when compared to the left in this lower extremity (green arrow) CT angiogram is shown.