A review of CT findings in three patients with COVID-19

7th Jan 2021

Remember that there are three predominant computer tomography (CT) findings in patients with COVID-19:

  1. Ground-glass opacity
  2. Consolidations
  3. Crazy-paving pattern

Let's look at some cases that demonstrate these findings.

 

Case study one—65-year-old female

The first patient is a 65-year-old female who had a history of travel to Wuhan, China, and presented with fever and cough.1

Woman with cough. Illustration.

Figure 1. Case study-65-year-old female who had traveled to Wuhan, China presents with fever and cough.

The chest radiograph shows no identifiable lung abnormality. 

The patient tests positive for SARS-CoV-2 and undergoes a subsequent CT scan. 

On CT scan there is patchy ground-glass opacity seen in the peripheral basal region of the right lung.

Normal chest radiograph. Chest CT with ground-glass opacity in COVID-19.

Figure 2. Imaging findings for a 65-year-old woman with COVID-19 show, a) no lung abnormality on the chest radiograph and, b) patchy ground-glass opacity in the peripheral basal region of the right lung on chest CT (Images courtesy of Ng, MY, Lee, EYP, Yang, J, et al., 2020).

 

Case study two—42-year-old male

This patient is a 42-year-old male with high-grade fever, cough, and fatigue for one week.2

Man with fever. Illustration.

Figure 3. Case study—42-year-old male presents with fever, cough, and fatigue for the last seven days.

The chest radiograph shows hazy opacity in the left lower lung zone. 

Chest radiograph with opacity in left lower lobe in a patient with COVID-19.

Figure 4. Opacity is seen in the left lower lung zone on this chest radiograph of a 42-year-old male who presents with a seven-day history of fever, cough, and fatigue (Image courtesy of Shi, H, Han, X, and Zheng, C. 2020).

A subsequent CT better characterized the imaging findings in this case, which included multiple areas of ground-glass opacities in the left lower lobe and both upper lobes, with some reticular opacities in the subpleural area of the left lung. 

Chest CT showing ground-glass opacities and reticular opacities in COVID-19.

Figure 5. Imaging for a 42-year-old male with a seven-day history of cough, fever, and fatigue. Chest computer tomography (CT) shows multiple areas of ground-glass opacities in the left lower lobe and both upper lobes, with some reticular opacities in the subpleural area of the left lung (Images courtesy of Shi, H, Han, X, and Zheng, C. 2020).

 

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Case study three—60-year-old male

Let's consider a worsening clinical picture with the case of a 60-year-old male with a history of pulmonary tuberculosis.2

Man with blue face. Illustration.

Figure 6. Case study-60-year-old male with a history of pulmonary tuberculosis.

The corresponding CT scan confirms the extensive picture of ground-glass opacities and consolidations giving rise to respiratory distress syndrome. This is an example of a more advanced disease state, and the patient died four days after this scan.

Chest x-ray with opacities. Chest CT with ground-glass consolidation in COVID-19.

Figure 7. Imaging for a 60-year-old male with respiratory distress and a history of pulmonary tuberculosis, a) chest radiograph shows extensive opacities throughout bilateral lung fields, b) chest CT shows extensive ground-glass opacities and consolidation (Images courtesy of Shi, H, Han, X, Jiang, N, et al., 2020).

 

Could a chest CT be negative in patients with COVID-19?

The answer is simply YES, although this is rare according to our experience and most of the reports. But some studies found negative chest CT in the first two days after symptoms onset.

In rare cases, individuals with COVID-19 symptoms may have a negative chest CT in the first two days after symptom onset.

Could a chest CT be positive in asymptomatic patients?

And again the answer is, surprisingly, YES.

In a study of 81 patients published in The Lancet Infectious Diseases, a group of 15 subjects was classified as subclinical.2 These were healthcare workers who had close contact with confirmed COVID-19 cases, but they had no symptoms at the time they had a CT scan.

Surprisingly, though asymptomatic, this group of participants had positive chest CT scans.2 But this does not mean that all healthcare workers who are in contact with COVID-19 positive patients will test positive, it only demonstrates that it is possible for a patient to show no symptoms but still have a positive CT scan. This is consistent with other reports. 

Asymptomatic or presymptomatic individuals can still test positive for COVID-19 and show positive CT scans. So, they may transmit the virus to others, even in the absence of symptoms.

That’s it for now. If you want to improve your understanding of key concepts in medicine and improve your clinical skills, make sure to register for a free trial account, which will give you access to free videos and downloads. We’ll help you make the right decisions for yourself and your patients.

References

  1. Ng, MY, Lee, EYP, Yang, J, et al. 2020. Imaging profile of the COVID-19 infection: radiological findings and literature review. Radiol Cardiothorac Imaging2: e200034. PMCID: PMC7233595
  2. Shi, H, Han, X, and Zheng, C. 2020. Evolution of CT manifestations in a patient recovered from 2019 novel coronavirus (2019-nCoV) pneumonia in Wuhan, China. Radiology295: 20. PMID: 32032497