Differential diagnoses of COVID-19 pneumonia: the current challenge for the radiologist—a pictorial essay

Guarnera, Alessia; Podda, Pierfrancesco; Santini, E.; Paolantonio, Pasquale; Laghi, Andréa

doi:10.1186/s13244-021-00967-x

Cited by 19 publications

(17 citation statements)

References 72 publications

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“…Since the COVID-19 outbreak, the scientific researchers have focused more on clinical and radiological findings of COVID-19 infection, whereas a few studies have investigated the differential diagnoses. Three studies from Europe presented a vast spectrum of differential diagnoses with abundant figures and elaborate illustrations to help the radiologist with differentiation [ 43 – 45 ]. Another study evaluated the performances of radiologists from US and China in differentiating COVID-19 from other viral pneumonia [ 46 ].…”

Section: Discussionmentioning

confidence: 99%

Performances of clinical characteristics and radiological findings in identifying COVID-19 from suspected cases

Zhao

et al. 2022

BMC Med Imaging

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Background To identify effective factors and establish a model to distinguish COVID-19 patients from suspected cases. Methods The clinical characteristics, laboratory results and initial chest CT findings of suspected COVID-19 patients in 3 institutions were retrospectively reviewed. Univariate and multivariate logistic regression were performed to identify significant features. A nomogram was constructed, with calibration validated internally and externally. Results 239 patients from 2 institutions were enrolled in the primary cohort including 157 COVID-19 and 82 non-COVID-19 patients. 11 features were selected by LASSO selection, and 8 features were found significant using multivariate logistic regression analysis. We found that the COVID-19 group are more likely to have fever (OR 4.22), contact history (OR 284.73), lower WBC count (OR 0.63), left lower lobe involvement (OR 9.42), multifocal lesions (OR 8.98), pleural thickening (OR 5.59), peripheral distribution (OR 0.09), and less mediastinal lymphadenopathy (OR 0.037). The nomogram developed accordingly for clinical practice showed satisfactory internal and external validation. Conclusions In conclusion, fever, contact history, decreased WBC count, left lower lobe involvement, pleural thickening, multifocal lesions, peripheral distribution, and absence of mediastinal lymphadenopathy are able to distinguish COVID-19 patients from other suspected patients. The corresponding nomogram is a useful tool in clinical practice.

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Section: Discussionmentioning

confidence: 99%

Performances of clinical characteristics and radiological findings in identifying COVID-19 from suspected cases

Zhao

et al. 2022

BMC Med Imaging

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“…Among them are the following types of pneumonia: viral (type A influenza, adenovirus, hantavirus, respiratory syncytial virus, SARS, MERS), atypical bacterial pneumonia (mycoplasma, chlamydia), rare opportunistic fungal Pneumocystis jiroveci pneumonia, hypersensitive, eosinophilic and lipoid pneumonia, damage to the lungs caused by the use of some drugs and narcotics, etc. [21,22]. Knowing the differences in Kod asimptomatskih pacijenata i pacijenata sa blažom kliničkom slikom, tokom CT praćenja mogu da se vide samo promene denziteta "mlečnog stakla", a izostaje konsolidacija [16].…”

Section: Assessment Of the Probability Of Covid-19 Pneumonia As Compared To Other Causes Of Interstitial Pneumoniamentioning

confidence: 99%

“…U diferencijalnoj dijagnozi KOVID-19 pneumonije dolaze u obzir druge intersticijumske pneumonije različite etiologije, koje se karakteristično manifestuju promenama denziteta "mlečnog stakla", kao što su: virusne (influenca tip A, adenovirus, hantavirus, respiratorni sincicijalni virus, SARS, MERS), atipične bakterijske pneumonije (mikoplazma, hlamidija), retka oportunistička gljivična Pneumocystis jiroveci pneumonija, hipersenzitivne, eozinofilne i lipoidne pneumonije, oštećenja pluća prouzrokovana upotrebom nekih lekova i narkotika, i dr. [21,22]. Poznavanje razlika u kliničkoj slici, laboratorijskim nalazima i tipičnoj radiološkoj prezentaciji, koju karakteriše predilekciono subpleuralna i perifrena distribucija inflamatornih promena u plućima, ključno je za postavljanje ispravne dijagnoze.…”

Section: Procena Verovatnoće Kovid-19 Pneumonije U Odnosu Na Druge Uzroke Intersticijumskih Pneumonijaunclassified

Radiological presentation of COVID-19 pneumonia

Đurić-Stefanović¹

2021

Srpski medicinski časopis Lekarske komore

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Interstitial pneumonia is the main manifestation of the COVID-19 disease. The aim of this paper is to present the spectrum of typical radiological findings (CT - computed tomography, and radiographic) in COVID-19 pneumonia, the different CT examination techniques, the types and evolution of inflammatory lesions in the lungs, the criteria for assessing the probability of COVID-19 pneumonia in comparison to other types of interstitial pneumonia, and the scoring systems for determining the extent of COVID-19 pneumonia, based on CT findings and radiography. The standard CT examination protocol is a native CT examination of the chest, and, due to high sensitivity of low-dose CT protocols for detecting lung lesions, this imaging technique has become widely used in radiological practice during the COVID-19 pandemic. Bilateral, multiple, round or confluent zones of ground-glass density, predominantly localized subpleurally, peripherally and posteriorly, usually most extensive in the lower lobes, represent a typical CT presentation of COVID-19 pneumonia. Consolidations may develop at a later stage. A chest X-ray shows homogeneously reduced transparency in the lateral pulmonary fields, circular and irregular cloudlike shadows, and confluent patchy shadows, usually most extensive basally and laterally. RSNA and CO-RADS criteria are used to assess the probability of COVID-19 pneumonia, based on the criteria of a typical/atypical CT finding. Four stages of COVID-19 pneumonia have been defined, based on the dynamics of inflammatory lung lesion presentation: early, progressive, the phase of consolidation and the phase of organization. To assess the extent and severity of pneumonia, various scoring systems have been proposed, the most widely accepted one being the CT severity scoring system, based on visual semiquantitative assessment of the percentage of lung parenchyma inflammation lesions involvement of each of the five lobes, on a scale of 1 (<5%) to 5 (>75%), whereby the maximum score can be 25.

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“…Literature on COVID-19 pneumonia clinical-radiological diagnosis and therapy is extremely fertile and has mainly focused on the most common differential diagnoses [ 2 , 3 , 4 ], while few papers investigated rarer differential diagnoses and of COVID-19 pneumonia overlapping on long-lasting lung pathologies.…”

Section: Introductionmentioning

confidence: 99%

Idiopathic Interstitial Pneumonias and COVID-19 Pneumonia: Review of the Main Radiological Features and Differential Diagnosis

2021

Self Cite

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COVID-19 pneumonia represents a challenging health emergency, due to the disproportion between the high transmissibility, morbidity, and mortality of the virus and healthcare systems possibilities. Literature has mainly focused on COVID-19 pneumonia clinical-radiological diagnosis and therapy, and on the most common differential diagnoses, while few papers investigated rare COVID-19 pneumonia differential diagnoses or the overlapping of COVID-19 pneumonia on pre-existing lung pathologies. This article presents the main radiological characteristics of COVID-19 pneumonia and Idiopathic Interstitial Pneumonias (IIPs) to identify key radiological features for a differential diagnosis among IIPs, and between IIPs and COVID-19 pneumonia. COVID-19 pneumonia differential diagnosis with IIPs is challenging, since these entities may share common radiological findings as ground glass opacities, crazy paving patterns, and consolidations. Multidisciplinary discussion is crucial to reach a final and correct diagnosis. Radiologists have a pivotal role in identifying COVID-19 pneumonia patterns, reporting possible overlapping with long-lasting lung diseases, and suggesting potential differential diagnoses. An optimal evaluation of HRTC may help in containing the disease, in promoting better treatment for patients, and in providing an efficient allocation of human and economic resources.

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Differential diagnoses of COVID-19 pneumonia: the current challenge for the radiologist—a pictorial essay

Cited by 19 publications

References 72 publications

Performances of clinical characteristics and radiological findings in identifying COVID-19 from suspected cases

Performances of clinical characteristics and radiological findings in identifying COVID-19 from suspected cases

Radiological presentation of COVID-19 pneumonia

Idiopathic Interstitial Pneumonias and COVID-19 Pneumonia: Review of the Main Radiological Features and Differential Diagnosis

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