Imaging and clinical features of patients with 2019 novel coronavirus SARS-CoV-2

Abstract

Background The pneumonia caused by the 2019 novel coronavirus (SARS-CoV-2, also called 2019-nCoV) recently break out in Wuhan, China, and was named as COVID-19. With the spread of the disease, similar cases have also been confirmed in other regions of China. We aimed to report the imaging and clinical characteristics of these patients infected with SARS-CoV-2 in Guangzhou, China. Methods All patients with laboratory-identified SARS-CoV-2 infection by real-time polymerase chain reaction (PCR) were collected between January 23, 2020, and February 4, 2020, in a designated hospital (Guangzhou Eighth People's Hospital). This analysis included 90 patients (39 men and 51 women; median age, 50 years (age range, 18-86 years). All the included SARS-CoV-2-infected patients underwent non-contrast enhanced chest computed tomography (CT). We analyzed the clinical characteristics of the patients, as well as the distribution characteristics, pattern, morphology, and accompanying manifestations of lung lesions. In addition, after 1-6 days (mean 3.5 days), follow-up chest CT images were evaluated to assess radiological evolution. Findings The majority of infected patients had a history of exposure in Wuhan or to infected patients and mostly presented with fever and cough. More than half of the patients presented bilateral, multifocal lung lesions, with peripheral distribution, and 53 (59%) patients had more than two lobes involved. Of all included patients, COVID-19 pneumonia presented with ground glass opacities in 65 (72%), consolidation in 12 (13%), crazy paving pattern in 11 (12%), interlobular thickening in 33 (37%), adjacent pleura thickening in 50 (56%), and linear opacities combined in 55 (61%). Pleural effusion, pericardial effusion, and lymphadenopathy were uncommon findings. In addition, baseline chest CT did not show any abnormalities in 21 patients (23%), but 3 patients presented bilateral ground glass opacities on the second CT after 3-4 days. Conclusion SARS-CoV-2 infection can be confirmed based on the patient's history, clinical manifestations, imaging characteristics, and laboratory tests. Chest CT examination plays an important role in the initial diagnosis of the novel coronavirus pneumonia. Multiple patchy ground glass opacities in bilateral multiple lobular with periphery distribution are typical chest CT imaging features of the COVID-19 pneumonia.

Epidemiological, clinical characteristics of cases of SARS-CoV-2 infection with abnormal imaging findings

“…Higher radiograph score was related to severity of disease, in accordance with former report which used another CT score (Xu et al, 2020) . These clinical features may be a useful tool for predicting of severe/critical type as it is convenient to tested in hospitals.…”

“…The symptoms of COVID-19 are similar to other respiratory viruses, including fever, cough and fatigue, diarrhea and vomiting, with radiographs showing invasive lesions in the lung. And some of patients may be presented with serious complications such as acute respiratory distress syndrome or shock (Chen et al, 2020, Huang et al, 2020, Zhu et al, 2020 . With the continuous improvement of modern imaging technology, imaging examination is more conducive to the objective assessment and early detection of lung abnormality.…”

The epidemiology, diagnosis and treatment of COVID-19

“…COVID-19 also manifests with chest CT imaging abnormalities in asymptomatic patients, with rapid evolution from focal unilateral to diffuse bilateral ground-glass opacities that progressed to or co-existed with consolidations within 1-3 weeks. Combining assessment of imaging features with clinical and laboratory findings could facilitate early diagnosis of COVID-19 pneumonia [38][39][40] . As the diagnostic criteria expanded from laboratory examination to chest CT imaging, more than 14 0 0 0 patients were diagnosed on February 12, 2020.…”

Recommendations for coronavirus infection in rheumatic diseases treated with biologic therapy

“…The CoViD-19 infection is suspected when patients develop fever, cough, myalgia and fatigue, with bilateral interstitial pneumonia diagnosed in most patients (up to 76% in the earliest series) by ground glass opacity and patchy infiltrates in the chest as visualized by computerized tomography. Around 20% of cases rapidly worsen into respiratory failure or acute respiratory distress syndrome (ARDS), requiring admission to the intensive care unit (ICU) with a mortality rate of approximately 2-3%, being highest in older age patients particularly those with chronic diseases and who are currently hospitalized in ICUs (up to 38%) [2][3][4]. Currently there are no specific drugs and/or vaccines for SARS-CoV2 infection, prompting the use of several broadspectrum antiviral molecules.…”