Imaging findings in COVID-19 pneumonia

The coronavirus disease (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARSCoV-2), emerged in Wuhan city and was declared a pandemic in March 2020. Although the virus is not restricted to the lung parenchyma, the use of chest imaging in COVID-19 can be especially useful for patients with moderate to severe symptoms or comorbidities. This article aimed to demonstrate the chest imaging findings of COVID-19 on different modalities: chest radiography, computed tomography, and ultrasonography. In addition, it intended to review recommendations on imaging assessment of COVID-19 and to discuss the use of a structured chest computed tomography report. Chest radiography, despite being a low-cost and easily available method, has low sensitivity for screening patients. It can be useful in monitoring hospitalized patients, especially for the evaluation of complications such as pneumothorax and pleural effusion. Chest computed tomography, despite being highly sensitive, has a low specificity, and hence cannot replace the reference diagnostic test (reverse transcription polymerase chain reaction). To facilitate the confection and reduce the variability of radiological reports, some standardizations with structured reports have been proposed. Among the available classifications, it is possible to divide the radiological findings into typical, indeterminate, atypical, and negative findings. The structured report can also contain an estimate of the extent of lung involvement (e.g., more or less than 50% of the lung parenchyma). Pulmonary ultrasonography can also be an auxiliary method, especially for monitoring hospitalized patients in intensive care units, where transfer to a tomography scanner is difficult

Lung Lesion Burden found on Chest CT as a Prognostic Marker in Hospitalized Patients with High Clinical Suspicion of COVID-19 Pneumonia: a Brazilian experience

OBJECTIVE: To investigate the relationship between lung lesion burden (LLB) found on chest computed tomography (CT) and 30-day mortality in hospitalized patients with high clinical suspicion of coronavirus disease 2019 (COVID-19), accounting for tomographic dynamic changes. METHODS: Patients hospitalized with high clinical suspicion of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in a dedicated and reference hospital for COVID-19, having undergone at least one RT-PCR test, regardless of the result, and with one CT compatible with COVID-19, were retrospectively studied. Clinical and laboratory data upon admission were assessed, and LLB found on CT was semi-quantitatively evaluated through visual analysis. The primary outcome was 30-day mortality after admission. Secondary outcomes, including the intensive care unit (ICU) admission, mechanical ventilation used, and length of stay (LOS), were assessed. RESULTS: A total of 457 patients with a mean age of 57±15 years were included. Among these, 58% presented with positive RT-PCR result for COVID-19. The median time from symptom onset to RT-PCR was 8 days [interquartile range 6-11 days]. An initial LLB of ≥50% using CT was found in 201 patients (44%), which was associated with an increased crude at 30-day mortality (31% vs. 15% in patients with LLB of <50%, p<0.001). An LLB of ≥50% was also associated with an increase in the ICU admission, the need for mechanical ventilation, and a prolonged LOS after adjusting for baseline covariates and accounting for the CT findings as a time-varying covariate; hence, patients with an LLB of ≥50% remained at a higher risk at 30-day mortality (adjusted hazard ratio 2.17, 95% confidence interval 1.47-3.18, p<0.001). CONCLUSION: Even after accounting for dynamic CT changes in patients with both clinical and imaging findings consistent with COVID-19, an LLB of ≥50% might be associated with a higher risk of mortality

Tomographic evaluation of coronary calcium burden in critically ill patients with acute respiratory failure due to SARS-COV-2 in the intensive care unit

Introdução: Dos mecanismos fisiopatológicos à estratificação de risco, persistem muitos debates e discussões sobre a doença arterial coronariana (DAC) como fator de risco para desfechos adversos em pacientes com COVID-19. Objetivo: Investigar o papel da carga de calcificação arterial coronariana (CAC) por meio da tomografia computadorizada (TC) de tórax não sincronizada ao eletrocardiograma (ECG) para a predição de mortalidade em 28 dias em pacientes críticos com COVID-19 internados em unidade de terapia intensiva (UTI). Métodos: Foram identificados pacientes adultos críticos consecutivos com insuficiência respiratória aguda pela COVID-19 internados na UTI entre março e junho de 2020 (n = 1.503), sendo incluídos na coorte final aqueles submetidos a TC de tórax sem contraste não sincronizada ao ECG (n = 768). Os pacientes foram estratificados em quatro grupos: (a) CAC = 0, (b) CAC 1-100, (c) CAC 101-300 e (d) CAC > 300. Resultados: CAC foi detectada em 376 pacientes (49%), dos quais 218 (58%) apresentaram CAC > 300. CAC > 300 foi independentemente associado à mortalidade na UTI em 28 dias após a admissão (risco relativo ajustado [RR] 1,79, intervalo de confiança de 95% [IC] 1,36-2,36, p 300. Results: CAC was detected in 376 patients (49%), of whom 218 (58%) showed CAC > 300. CAC > 300 was independently associated with ICU mortality at 28 days after admission (adjusted hazard ratio [aHR] 1.79, 95% confidence interval [CI] 1.36-2.36, p < 0.001), and incrementally improved prediction of death over a model with clinical features and biomarkers assessed within the first 24h in ICU (likelihood ratio test = 140 vs. 123, respectively, p < 0.001). In the final cohort, 286 (37%) patients died within 28 days of ICU admission. Conclusions: In critically ill patients with COVID-19, a high CAC burden quantified with a non-gated chest CT performed for COVID-19 pneumonia assessment is an independent predictor of 28-day mortality, with an incremental prognostic value over a comprehensive clinical assessment during the first 24h in IC