Frequency and characterization of ancillary chest CT findings in COVID-19 pneumonia

Objectives: Ground-glass opacity and consolidation are recognized typical features of Coronavirus disease-19 (COVID-19) pneumonia on Chest CT, yet ancillary findings have not been fully described. We aimed to describe ancillary findings of COVID-19 pneumonia on CT, to define their prevalence, and investigate their association with clinical data. Methods: We retrospectively reviewed our CT chest cases with coupled reverse transcriptase polymerase chain reaction (rt-PCR). Patients with negative rt-PCR or without admission chest CT were excluded. Ancillary findings included: vessel enlargement, subpleural curvilinear lines, dependent subpleural atelectasis, centrilobular solid nodules, pleural and/or pericardial effusions, enlarged mediastinal lymph nodes. Continuous data were expressed as median and 95% confidence interval (95% CI) and tested by Mann–Whitney U test. Results: Ancillary findings were represented by 106/252 (42.1%, 36.1 to 48.2) vessel enlargement, 50/252 (19.8%, 15.4 to 25.2) subpleural curvilinear lines, 26/252 (10.1%, 7.1 to 14.7) dependent subpleural atelectasis, 15/252 (5.9%, 3.6 to 9.6) pleural effusion, 15/252 (5.9%, 3.6 to 9.6) mediastinal lymph nodes enlargement, 13/252 (5.2%, 3 to 8.6) centrilobular solid nodules, and 6/252 (2.4%, 1.1 to 5.1) pericardial effusion. Air space disease was more extensive in patients with vessel enlargement or centrilobular solid nodules (p < 0.001). Vessel enlargement was associated with longer history of fever (p = 0.035) and lower admission oxygen saturation (p = 0.014); dependent subpleural atelectasis with lower oxygen saturation (p < 0.001) and higher respiratory rate (p < 0.001); mediastinal lymph nodes with shorter history of cough (p = 0.046); centrilobular solid nodules with lower prevalence of cough (p = 0.023), lower oxygen saturation (p < 0.001), and higher respiratory rate (p = 0.032), and pericardial effusion with shorter history of cough (p = 0.015). Ancillary findings associated with longer hospital stay were subpleural curvilinear lines (p = 0.02), whereas centrilobular solid nodules were associated with higher rate of intensive care unit admission (p = 0.01). Conclusion: Typical high-resolution CT findings of COVID-19 pneumonia are frequently associated with ancillary findings that variably associate with disease extent, clinical parameters, and disease severity. Advances in knowledge: Ancillary findings might reflect the broad range of heterogeneous mechanisms in severe acute respiratory syndrome from viral pneumonia, and potentially help disease phenotyping.

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Chest CT Findings in EBUS-TBNA-Proven Anthracosis in Enlarged Mediastinal Lymph Nodes

RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren ◽

10.1055/s-0034-1366595 ◽

2014 ◽

Vol 186 (12) ◽

pp. 1122-1126 ◽

Cited By ~ 2

Author(s):

J. Kirchner ◽

P. Mueller ◽

M. Broll ◽

E. Kirchner ◽

N. Pomjanski ◽

...

Keyword(s):

Lymph Nodes ◽

Chest Ct ◽

Mediastinal Lymph Nodes ◽

Ct Findings

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Comparison of clinical, chest CT and laboratory findings of suspected COVID-19 inpatients with positive and negative RT-PCR

Journal of Pulmonology and Respiratory Research ◽

10.29328/journal.jprr.1001019 ◽

2021 ◽

Vol 5 (1) ◽

pp. 019-026

Author(s):

Perincek Gokhan ◽

Onal Canver ◽

Avci Sema

Keyword(s):

Troponin T ◽

Clinical Findings ◽

Chest Ct ◽

Pcr Analysis ◽

Rt Pcr ◽

Laboratory Findings ◽

Ct Findings ◽

History Of ◽

Laboratory Examinations ◽

Pcr Test

Introduction: COVID-19 is an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 and it was first reported in China. The aim of this study was to compare clinical features, chest CT findings and laboratory examinations of suspected COVID-19 inpatients according to RT-PCR analysis. Methods: Demographics, comorbidites, symptoms and signs, laboratory results and chest CT findings were compared between positive and negative groups. The study included 292 patients (134 females, 158 males) suspected of COVID-19. All statistical calculations were performed with SPSS 23.0. Results: 158 (54.1%) of the cases were male and 134 (45.9%) were female. Their ages ranged from 17 to 95 years, with an average of 50.46 ± 20.87. A symptom or sign was detected in 86.3% of all patients. The chest CT images of 278 patients were analyzed. Chest CT was negative in 59.2% of patients with positive RT-PCR and 43.9% of patients with negative RT-PCR results. Chest CT findings were atypical or indeterminate in 22.4% of patients with positive RT-PCR results and 20% of patients with negative RT-PCR analysis. ALP, bilirubine, CRP, eosinophil count, glucose, CK-MB mass and lactate were significantly lower in patients with positive RT-PCR test. LDH, lipase, MCV, monocyte, neutrophil count, NLR, platelet, pO2, pro-BNP, procalcitonin, INR, prothrombin time, sodium, troponin T, urea, WBC were significantly lower in patients with positive RT-PCR test results. Conclusion: The diagnosis of COVID-19 is based on history of patient, typical symptoms or clinical findings. Chest CT, RT-PCR and laboratory abnormalities make the diagnosis of disease stronger.

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Sepsis-like illness with mediastinal involvement after EUS-FNP of mediastinal lymph nodes in a patient with sarcoidosis and a history of esophageal carcinoma

Ultraschall in der Medizin - European Journal of Ultrasound ◽

10.1055/s-0033-1354968 ◽

2013 ◽

Vol 34 (S 01) ◽

Author(s):

W Bohle ◽

WG Zoller

Keyword(s):

Lymph Nodes ◽

Esophageal Carcinoma ◽

Mediastinal Lymph Nodes ◽

History Of ◽

Mediastinal Involvement

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CT findings of 795 COVID-19 positive cases: a multicenter study in Egypt

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-020-00351-7 ◽

2020 ◽

Vol 51 (1) ◽

Author(s):

Youssriah Yahia Sabri ◽

Mohamed Mohsen Tolba Fawzi ◽

Eman Zaki Nossair ◽

Safaa Mohamed El-Mandooh ◽

Amira Aly Hegazy ◽

...

Keyword(s):

Virus Disease ◽

Chest Ct ◽

Imaging Features ◽

Rt Pcr ◽

Relevant Research ◽

Non Invasive ◽

Ct Findings ◽

Global Pandemic ◽

Polymerase Chain ◽

Ct Studies

Abstract Background Corona Virus Disease 2019 (COVID-19) outbreak was officially announced as a global pandemic by the WHO on March 11th 2020. Thorough understanding of CT imaging features of COVID-19 is essential for effective patient management; rationalizing the need for relevant research. The aim of this study was to analyze the chest CT findings of patients with real-time polymerase chain reaction (RT-PCR) proved COVID-19 admitted to four Egyptian hospitals. The recently published RSNA expert consensus statement on reporting COVID-19 chest CT findings was taken into consideration. Results Normal CT “negative for COVID-19” was reported in 26.1% of our RT-PCR proved COVID-19 cases. In descending order of prevalence, imaging findings of the positive CT studies (73.9%) included GGO (69%), consolidation (49.7%), crazy paving (15.4%), and peri-lobular fibrosis (40.6%). These showed a dominantly bilateral (68.2%), peripheral (72.4%), and patchy (64.7%) distribution. Remarkably, thymic hyperplasia was identified in 14.3% of studies. According to the RSNA consensus, CT findings were classified as typical in 68.9%, indeterminate in 3.6%, and atypical in 1.4% of the evaluated CT studies. Conclusion Although COVID-19 cannot be entirely excluded by chest CT, it can be distinguished in more than two-thirds of cases; making CT a widely available, non-invasive, and rapid diagnostic tool.

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The role of CT imaging for management of COVID-19 in epidemic area: early experience from a University Hospital

Insights into Imaging ◽

10.1186/s13244-020-00957-5 ◽

2021 ◽

Vol 12 (1) ◽

Author(s):

Vikram rao Bollineni ◽

Koenraad Hans Nieboer ◽

Seema Döring ◽

Nico Buls ◽

Johan de Mey

Keyword(s):

Ct Scan ◽

Predictive Value ◽

Ct Imaging ◽

Chest Ct ◽

University Hospital ◽

Rt Pcr ◽

Ct Findings ◽

Epidemic Area ◽

Chest Ct Scan ◽

Pcr Test

Abstract Background To evaluate the clinical value of the chest CT scan compared to the reference standard real-time polymerase chain reaction (RT-PCR) in COVID-19 patients. Methods From March 29th to April 15th of 2020, a total of 240 patients with respiratory distress underwent both a low-dose chest CT scan and RT-PCR tests. The performance of chest CT in diagnosing COVID-19 was assessed with reference to the RT-PCR result. Two board-certified radiologists (mean 24 years of experience chest CT), blinded for the RT-PCR result, reviewed all scans and decided positive or negative chest CT findings by consensus. Results Out of 240 patients, 60% (144/240) had positive RT-PCR results and 89% (213/240) had a positive chest CT scans. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of chest CT in suggesting COVID-19 were 100% (95% CI: 97–100%, 144/240), 28% (95% CI: 19–38%, 27/240), 68% (95% CI: 65–70%) and 100%, respectively. The diagnostic accuracy of the chest CT suggesting COVID-19 was 71% (95% CI: 65–77%). Thirty-three patients with positive chest CT scan and negative RT-PCR test at baseline underwent repeat RT-PCR assay. In this subgroup, 21.2% (7/33) cases became RT-PCR positive. Conclusion Chest CT imaging has high sensitivity and high NPV for diagnosing COVID-19 and can be considered as an alternative primary screening tool for COVID-19 in epidemic areas. In addition, a negative RT-PCR test, but positive CT findings can still be suggestive of COVID-19 infection.

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Prevalence and echo features of mediastinal lymph nodes in EUS for non-malignant indications: a prospective study in a Southern European Population

Endoscopy International Open ◽

10.1055/s-0044-101602 ◽

2018 ◽

Vol 06 (04) ◽

pp. E432-E436

Author(s):

Joana Carmo ◽

Miguel Bispo ◽

Susana Marques ◽

Cristina Chagas

Keyword(s):

Lymph Nodes ◽

European Population ◽

Significant Heterogeneity ◽

Mediastinal Lymph Nodes ◽

Single Center Study ◽

History Of ◽

Echo Features ◽

Portuguese Study ◽

A Prospective Study ◽

Ct Studies

Abstract Background and study aims Significant heterogeneity in geographic distribution regarding the prevalence of mediastinal lymph nodes (MLN) has been documented in autopsy and computed tomography (CT) studies. Awareness of the local prevalence and characteristics of lymph nodes will be relevant when performing endoscopic ultrasonography (EUS) for staging of malignant neoplasias. The aims of this study were to document the prevalence and echo features of MLN in patients undergoing EUS for non-malignant extrathoracic disease and to identify predictive factors for the presence of MLN. Patients and methods A prospective single-center study was performed over 6 months. Mediastinal stations 9, 8, 7, 6, 5, 4 L and 2 were systematically evaluated using a linear echoendoscope in all patients undergoing EUS due to benign extrathoracic pathology and without history of oncologic disease. Demographic, clinical and EUS features of the lymph nodes were analysed. Results Seventy-five patients were included: male/female 32/43; mean age, 63 years. The majority of patients (72 %) had lymph nodes in at least one mediastinal station and 88 % of these were found in stations 7 or 4 L. Overall, 133 MLN were identified: 19 % were hypoechogenic, 6 % had a short-axis diameter > 10 mm, and 6 % were round. The prevalence of lymph nodes was higher in smokers (83 % vs 64 %, P = 0.024), with a higher average number of lymph nodes per patient in this group (2.1 vs 1.6; P = 0.017). By logistic regression analysis, none of the variables analyzed were independently associated with the presence of MLN. Conclusion This prospective Portuguese study documented a higher prevalence of MLN than previously reported in Northern Europe, in patients with no evidence of oncologic disease. This higher prevalence may negatively influence the specificity and positive predictive value for malignancy of MLN (N) staging by EUS.

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Prognosis of P-N2 Non-small Cell Lung Cancer with Special Emphasis on the Significance ofa Chest CT Diagnosis of Metastasis to Mediastinal Lymph Nodes.

Haigan ◽

10.2482/haigan.33.1031 ◽

1993 ◽

Vol 33 (7) ◽

pp. 1031-1036

Author(s):

Masao Ichiki ◽

Masanori Sakurai ◽

Izumi Hayashi ◽

Yukitoshi Sato ◽

Sakae Okumura ◽

...

Keyword(s):

Lung Cancer ◽

Lymph Nodes ◽

Small Cell Lung Cancer ◽

Cell Lung Cancer ◽

Chest Ct ◽

Small Cell ◽

Mediastinal Lymph Nodes ◽

Ct Diagnosis ◽

Small Cell Lung

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A Comparative Study on the Clinical Features of Coronavirus 2019 (COVID-19) Pneumonia With Other Pneumonias

Clinical Infectious Diseases ◽

10.1093/cid/ciaa247 ◽

2020 ◽

Vol 71 (15) ◽

pp. 756-761 ◽

Cited By ~ 95

Author(s):

Dahai Zhao ◽

Feifei Yao ◽

Lijie Wang ◽

Ling Zheng ◽

Yongjun Gao ◽

...

Keyword(s):

Clinical Features ◽

Clinical Symptoms ◽

Severe Pneumonia ◽

Ground Glass Opacity ◽

Chest Ct ◽

Rt Pcr ◽

Bilateral Involvement ◽

Radiological Features ◽

History Of ◽

Novel Coronavirus

Abstract Background A novel coronavirus (COVID-19) has raised world concern since it emerged in Wuhan, China in December 2019. The infection may result in severe pneumonia with clusters of illness onsets. Its impacts on public health make it paramount to clarify the clinical features with other pneumonias. Methods Nineteen COVID-19 and 15 other patients with pneumonia (non-COVID-19) in areas outside of Hubei were involved in this study. Both COVID-19 and non-COVID-19 patients were confirmed to be infected using throat swabs and/or sputa with/without COVID-2019 by real-time RT-PCR. We analyzed the demographic, epidemiological, clinical, and radiological features from those patients, and compared the differences between COVID-19 and non-COVID-19. Results All patients had a history of exposure to confirmed cases of COVID-19 or travel to Hubei before illness. The median (IQR) duration was 8 (6–11) and 5 (4–11) days from exposure to onset in COVID-19 and non-COVID-19 cases, respectively. The clinical symptoms were similar between COVID-19 and non-COVID-19. The most common symptoms were fever and cough. Fifteen (78.95%) COVID-19 but 4 (26.67%) non-COVID-19 patients had bilateral involvement while 17 COVID-19 patients (89.47%) but 1 non-COVID-19 patient (6.67%) had multiple mottling and ground-glass opacity on chest CT images. Compared with non-COVID-19, COVID-19 presents remarkably more abnormal laboratory tests, including AST, ALT, γ-GT, LDH, and α-HBDH. Conclusions The COVID-19 infection has onsets similar to other pneumonias. CT scan may be a reliable test for screening COVID-19 cases. Liver function damage is more frequent in COVID-19 than non-COVID-19 patients. LDH and α-HBDH may be considerable markers for evaluation of COVID-19.

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Prevalence of COVID-19 Diagnostic Output with Chest Computed Tomography: A Systematic Review and Meta-Analysis

Diagnostics ◽

10.3390/diagnostics10121023 ◽

2020 ◽

Vol 10 (12) ◽

pp. 1023

Author(s):

Temitope Emmanuel Komolafe ◽

John Agbo ◽

Ebenezer Obaloluwa Olaniyi ◽

Kayode Komolafe ◽

Xiaodong Yang

Keyword(s):

Computed Tomography ◽

Meta Analysis ◽

Age Groups ◽

Disease Prevalence ◽

Chest Ct ◽

Imaging Features ◽

Rt Pcr ◽

Chest Computed Tomography ◽

Pooled Prevalence ◽

History Of

Background: The pooled prevalence of chest computed tomography (CT) abnormalities and other detailed analysis related to patients’ biodata like gender and different age groups have not been previously described for patients with coronavirus disease 2019 (COVID-19), thus necessitating this study. Objectives: To perform a meta-analysis to evaluate the diagnostic performance of chest CT, common CT morphological abnormalities, disease prevalence, biodata information, and gender prevalence of patients. Methods: Studies were identified by searching PubMed and Science Direct libraries from 1 January 2020 to 30 April 2020. Pooled CT positive rate of COVID-19 and RT-PCR, CT-imaging features, history of exposure, and biodata information were estimated using the quality effect (QE) model. Results: Out of 36 studies included, the sensitivity was 89% (95% CI: 80–96%) and 98% (95% CI: 90–100%) for chest CT and reverse transcription-polymerase chain reaction (RT-PCR), respectively. The pooled prevalence across lesion distribution were 72% (95% CI: 62–80%), 92% (95% CI: 84–97%) for lung lobe, 88% (95% CI: 81–93%) for patients with history of exposure, and 91% (95% CI: 85–96%) for patients with all categories of symptoms. Seventy-six percent (95% CI: 67–83%) had age distribution across four age groups, while the pooled prevalence was higher in the male with 54% (95% CI: 50–57%) and 46% (95% CI: 43–50%) in the female. Conclusions: The sensitivity of RT-PCR was higher than chest CT, and disease prevalence appears relatively higher in the elderly and males than children and females, respectively.

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