COVID-19 mimics on chest CT: a pictorial review and radiologic guide

Hochhegger, Bruno; Zanon, Matheus; Altmayer, Stephan; Mandelli, Nicole S.; Stüker, Guilherme; Mohammed, Tan-Lucien; Verma, Nupur; Meirelles, Gustavo de Souza Portes; Marchiori, Edson

doi:10.1259/bjr.20200703

Cited by 21 publications

(21 citation statements)

References 39 publications

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“…It has previously been described that COVID-19 CT imaging features will vary drastically according to the stage of disease. Early on, patients will have predominantly small areas of GGOs, compared to the late phase of disease (12–17 days after onset of symptoms), during which patients will have bilateral consolidations mixed with GGOs, and even crazy-paving pattern [ 22 , 23 ]. The presence of fibroproliferative attenuations in chest CT scans obtained in later stages of the disease, could potentially explain the discrepancies between their study and ours.…”

Section: Discussionmentioning

confidence: 99%

The Ichikado CT score as a prognostic tool for coronavirus disease 2019 pneumonia: a retrospective cohort study

et al. 2021

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Background The relationship between computed tomography (CT) and prognosis of patients with COVID-19 pneumonia remains unclear. We hypothesized that the Ichikado CT score, obtained in the first 24 h of hospital admission, is an independent predictor for all-cause mortality during hospitalization in patients with COVID-19 pneumonia. Methods Single-center retrospective cohort study of patients with confirmed COVID-19 pneumonia admitted at our institution between March 20th, 2020 and October 31st, 2020. Patients were enrolled if, within 24 h of admission, a chest CT scan, an arterial blood gas, a complete blood count, and a basic metabolic panel were performed. Two independent radiologists, who were blinded to clinical data, retrospectively evaluated the chest CT scans following a previously described qualitative and quantitative CT scoring system. The primary outcome was all-cause in-hospital mortality or survival to hospital discharge. Secondary outcomes were new requirements for invasive mechanical ventilation and hospital length of stay. Cox regression models were used to test the association between potential independent predictors and all-cause mortality. Results Two hundred thirty-five patients, 197 survivors and 38 nonsurvivors, were studied. The median Ichikado CT score for nonsurvivors was significantly higher than survivors (P < 0.001). An Ichikado CT score of more than 172 enabled prediction of mortality, with a sensitivity of 84.2% and a specificity of 79.7%. Multivariate analysis identified Ichikado CT score (HR, 7.772; 95% CI, 3.164–19.095; P < 0.001), together with age (HR, 1.030; 95% CI, 1.030–1.060; P = 0.043), as independent predictors of all-cause in-hospital mortality. Conclusions Ichikado CT score is an independent predictor of both requiring invasive mechanical ventilation and all-cause mortality in patients hospitalized with COVID-19 pneumonia. Further prospective evaluation is necessary to confirm these findings. Trial registration: The WCG institutional review board approved this retrospective study and patient consent was waived due to its non-interventional nature (Identifier: 20210799).

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Section: Discussionmentioning

confidence: 99%

The Ichikado CT score as a prognostic tool for coronavirus disease 2019 pneumonia: a retrospective cohort study

et al. 2021

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“…Or is it a real SSc? The radiological finding of ground glass opacity may occur both in COVID-19 infection and in the early stage of non-specific interstitial pneumonia (NSIP) related to SSc ( 23 ). The patient had COVID-19 infection on the 12 th of November, and the HRCT was done on the 11 th of March.…”

Section: Discussionmentioning

confidence: 99%

Case Report: Systemic Sclerosis After Covid-19 Infection

Fineschi

2021

Front. Immunol.

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The coronavirus disease (COVID-19) is a respiratory tract infection caused by the new virus SARS-CoV-2. The acute phase of the infection may in certain individuals be followed by another longer phase of disease (long COVID) of unknown etiology probably associated in certain cases with autoimmune activation. It has been shown that COVID-19 can trigger autoantibody production and in genetically predisposed patients may cause the onset or exacerbation of autoimmune diseases. We are reporting a case of mild COVID-19 infection complicated by autoantibody production and cutaneous and gastrointestinal symptoms and subsequently diagnosed with systemic sclerosis (SSc). A 47-year-old man with no history of any autoimmune diseases and in good health became sick together with his family on the 12th of November with mild symptoms: tiredness, fever, cough, and sore throat. Oropharyngeal swab for SARS-CoV-2 tested positive. He was isolated at home and did not require hospitalization. Three weeks later he presented with clinical manifestation compatible with suspicion of SSc. He briefly presented with skin rush, periorbital edema and conjunctivitis, vomiting, dysphagia, burning sensation in the skin, above all in the fingertips and around the mouth, puffy fingers, Raynaud’s phenomenon, pain at the fingertip of the middle finger where a depressed area was noticed without a clear ulceration. ANA showed a strongly positive nucleolar pattern. Anti-PM/Scl 75 and PM/Scl 100 resulted positive. High-resolution computed tomography (HCRT) showed early stage of interstitial lung disease (ILD). The patient was diagnosed with SSc based on the persistence of autoantibodies and the clinical and radiological pictures according to the ACR/EULAR classification (scores: puffy finger, 2; ILD, 2; Raynaud’s phenomenon, 3; SSc related antibodies, 3; total 10). There are several cases described in the medical literature of possible new onset of SLE after COVID-19 infection. This is the first case that describes a possible new onset of SSc. Conclusion: SARS-CoV-2 may trigger systemic sclerosis.

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“…Another interesting finding was that more than half of the respondents who had predominantly used CXR indicated that they would have preferred to use chest CT to assess/exclude COVID-19 pneumonia. The desire to change the diagnostic method from CXR to chest CT is likely due to the relatively higher sensitivity of chest CT in the detection of lung abnormalities (especially in the early stage of the disease) [ 13 – 20 ], as well as its superior ability to differentiate COVID-19 pneumonia from other infectious and noninfectious interstitial diseases [ 38 – 40 ]. However, CXR does have several advantages in the management of patients with suspected or confirmed COVID-19 infection [ 6 – 13 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of the COVID-19 pandemic on the selection of chest imaging modalities and reporting systems: a survey of Italian radiologists

et al. 2021

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Purpose Chest imaging modalities play a key role for the management of patient with coronavirus disease (COVID-19). Unfortunately, there is no consensus on the optimal chest imaging approach in the evaluation of patients with COVID-19 pneumonia, and radiology departments tend to use different approaches. Thus, the main objective of this survey was to assess how chest imaging modalities have been used during the different phases of the first COVID-19 wave in Italy, and which diagnostic technique and reporting system would have been preferred based on the experience gained during the pandemic. Material and Methods The questionnaire of the survey consisted of 26 questions. The link to participate in the survey was sent to all members of the Italian Society of Medical and Interventional Radiology (SIRM). Results The survey gathered responses from 716 SIRM members. The most notable result was that the most used and preferred chest imaging modality to assess/exclude/monitor COVID-19 pneumonia during the different phases of the first COVID-19 wave was computed tomography (51.8% to 77.1% of participants). Additionally, while the narrative report was the most used reporting system (55.6% of respondents), one-third of participants would have preferred to utilize structured reporting systems. Conclusion This survey shows that the participants’ responses did not properly align with the imaging guidelines for managing COVID-19 that have been made by several scientific, including SIRM. Therefore, there is a need for continuing education to keep radiologists up to date and aware of the advantages and limitations of the chest imaging modalities and reporting systems.

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COVID-19 mimics on chest CT: a pictorial review and radiologic guide

Cited by 21 publications

References 39 publications

The Ichikado CT score as a prognostic tool for coronavirus disease 2019 pneumonia: a retrospective cohort study

The Ichikado CT score as a prognostic tool for coronavirus disease 2019 pneumonia: a retrospective cohort study

Case Report: Systemic Sclerosis After Covid-19 Infection

Impact of the COVID-19 pandemic on the selection of chest imaging modalities and reporting systems: a survey of Italian radiologists

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