Comparing Lung CT in COVID-19 Pneumonia and Acute Heart Failure: An Imaging Conundrum

Abstract

BackgroundChest computed tomography (CT) provides an effective modality to evaluate patients with suspected coronavirus disease 2019 . However, overlapping imaging findings with cardiogenic pulmonary edema is not uncommon. Reports comparing the chest CT features of these diseases have not been elaborated. Thus, we aimed to show the difference between the low-dose lung CT findings of COVID-19 pneumonia and comparing them to those with acute heart failure (HF). MethodsThis retrospective analysis enrolled hospitalized patients with COVID-19 (n=10) and acute heart failure (n=9) that exclusively underwent low-dose chest CT scans within 24 hours of admission. Clinical and lung CT characteristics were collected and analyzed. ResultsThe appearance of ground-glass-opacities (GGOs) has been recorded in all individuals in the HF and COVID-19 groups. There was no significant statistical difference between the two groups for rounded morphology, consolidation, crazy paving pattern, lesion distribution, and parenchymal band (P> 0.05). However, diffuse lesions were more frequent in HF cases (55.6% vs. 0%) than in COVID-19 pneumonia, which had a predominantly multifocal pattern. Notably, CT images in HF patients were more likely to have signs of interstitial tissue thickening, such as the interlobular septums, fissures, and peribronchovascular interstitium (55.6% vs 0%, 88.9% vs 20% and 44.4% vs 0%, respectively), as well as cardiomegaly (77.8% vs 0%), increased artery to bronchus ratio (55.6% vs 0%), and pleural effusions (77.8% vs 0%). ConclusionsMajor overlaps of lung CT imaging features existed between COVID-19 pneumonia and acute HF cases. However, signs of fluid redistribution are clues that favor HF over COVID-19 pneumonia.

COVID-19 Pneumonia: The Great Ultrasonography Mimicker

“…Bilateral and symmetrical GGOs in the dependent regions of the lower lobes and interlobular septal thickening represent overlapping features on chest CT although a peri-hilar distribution of GGOs is more typical for CPE ( 26 , 27 ). The presence of bilateral pleural effusion and cardiomegaly may help orienting toward a diagnosis of CPE ( 28 ). Anyhow, it should be pointed out that COVID-19 pneumonia and CPE may also coexist ( 29 ) ( Figures 2A,A' ).…”

Correlation of plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) with radiographic features of congestion in chest CT scan of patients with COVID-19

“…They include (1) cardiac enlargement, (2) peribronchovascular thickening, (3) thickening of the interlobular fissure, (4) upper pulmonary vein enlargement and (5) subpleural effusion [12]. The study population was divided into two groups: the case group (with radiographic features of congestion) included the patients who had these findings in chest CT, and another group was the patients without these imaging characteristics [18]. The plasma levels of NT-proBNP were measured by ELISA in a special laboratory with the RAMP device.…”