Radiological approach to COVID-19 pneumonia with an emphasis on chest CT

Güneyli, Serkan; Atceken, Zeynep; Doğan, Hakan; Altınmakas, Emre; Atasoy, Kayhan Çetın

doi:10.5152/dir.2020.20260

Cited by 59 publications

(98 citation statements)

References 64 publications

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“…Typical COVID-19 findings include hazy opacities that are often bilateral and peripheral. 74 With the exception of one outlier, the reported sensitivity of single-view chest X-ray for COVID-19 ranges from 33% to 60%. [75][76][77][78][79] Chen et al 80 represent the outlier reporting 100% accuracy of chest X-ray early in the COVID-19 pandemic.…”

Section: Antigen Testsmentioning

confidence: 94%

“…99,110 Nonetheless, CT likely plays a role when rRT-PCR tests are either too inaccurate or unavailable or suffer unacceptably slow turnaround times in patients with higher levels of COVID-19 concern based on exposure history or other clinical findings. 74 The public health benefits of a more liberal CT screening approach from the ED merit additional research.…”

Section: Ct As Diagnostic Adjunct To Reduce False Negativesmentioning

confidence: 99%

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Diagnosing COVID‐19 in the Emergency Department: A Scoping Review of Clinical Examinations, Laboratory Tests, Imaging Accuracy, and Biases

Carpenter

Mudd

West

et al. 2020

Academic Emergency Medicine

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Objective Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) emerged as a global pandemic in early 2020 with rapidly evolving approaches to diagnosing the clinical illness called coronavirus disease (COVID‐19). The primary objective of this scoping review is to synthesize current research of the diagnostic accuracy of history, physical examination, routine laboratory tests, real‐time reverse transcription–polymerase chain reaction (rRT‐PCR), immunology tests, and computed tomography (CT) for the emergency department (ED) diagnosis of COVID‐19. Secondary objectives included a synopsis of diagnostic biases likely with current COVID‐19 research as well as corresponding implications of false‐negative and false‐positive results for clinicians and investigators. Methods A Preferred Reporting Items for Systematic Reviews and Meta‐Analyses–Scoping Review (PRISMA‐ScR)–adherent synthesis of COVID‐19 diagnostic accuracy through May 5, 2020, was conducted. The search strategy was designed by a medical librarian and included studies indexed by PubMed and Embase since January 2020. Results A total of 1,907 citations were screened for relevance. Patients without COVID‐19 are rarely reported, so specificity and likelihood ratios were generally unavailable. Fever is the most common finding, while hyposmia and hypogeusia appear useful to rule in COVID‐19. Cough is not consistently present. Lymphopenia is the mostly commonly reported laboratory abnormality and occurs in over 50% of COVID‐19 patients. rRT‐PCR is currently considered the COVID‐19 criterion standard for most diagnostic studies, but a single test sensitivity ranges from 60% to 78%. Multiple reasons for false‐negatives rRT‐PCR exist, including sample site tested and disease stage during which sample was obtained. CT may increase COVID‐19 sensitivity in conjunction with rRT‐PCR, but guidelines for imaging patients most likely to benefit are emerging. IgM and IgG serology levels are undetectable in the first week of COVID‐19, but sensitivity (range = 82% to 100%) and specificity (range = 87% to 100%) are promising. Whether detectable COVID‐19 antibodies correspond to immunity remains unanswered. Current studies do not adhere to accepted diagnostic accuracy reporting standards and likely report significantly biased results if the same tests were to be applied to general ED populations with suspected COVID‐19. Conclusions With the exception of fever and disorders of smell/taste, history and physical examination findings are unhelpful to distinguish COVID‐19 from other infectious conditions that mimic SARS‐CoV‐2 like influenza. Routine laboratory tests are also nondiagnostic, although lymphopenia is a common finding and other abnormalities may predict severe disease. Although rRT‐PCR is the current criterion standard, more inclusive consensus‐based criteria will likely emerge because of the high false‐negative rate of PCR tests. The role of serology and CT in ED assessments remains undefined.

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Section: Antigen Testsmentioning

confidence: 94%

Section: Ct As Diagnostic Adjunct To Reduce False Negativesmentioning

confidence: 99%

Diagnosing COVID‐19 in the Emergency Department: A Scoping Review of Clinical Examinations, Laboratory Tests, Imaging Accuracy, and Biases

Carpenter

Mudd

West

et al. 2020

Academic Emergency Medicine

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show abstract

“…However, the findings are non-specific and may be present in other types of viral pneumonias. The negative predictive value of CT in a multicenter study in China was only 42%, and since in a substantial portion of COVID-19 patients with minimal symptoms a chest CT may be normal, CT is not recommended as a screening tool for Covid-19 [ 77 , 78 ].…”

Section: Laboratory Findings and Imagingmentioning

confidence: 99%

A Telemedicine Approach to Covid-19 Assessment and Triage

et al. 2020

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Covid-19 is a new highly contagious RNA viral disease that has caused a global pandemic. Human-to-human transmission occurs primarily through oral and nasal droplets and possibly through the airborne route. The disease may be asymptomatic or the course may be mild with upper respiratory symptoms, moderate with non-life-threatening pneumonia, or severe with pneumonia and acute respiratory distress syndrome. The severe form is associated with significant morbidity and mortality. While patients who are unstable and in acute distress need immediate in-person attention, many patients can be evaluated at home by telemedicine or videoconferencing. The more benign manifestations of Covid-19 may be managed from home to maintain quarantine, thus avoiding spread to other patients and health care workers. This document provides an overview of the clinical presentation of Covid-19, emphasizing telemedicine strategies for assessment and triage of patients. Advantages of the virtual visit during this time of social distancing are highlighted.

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“…Rarely, cases with upper lobe involvement can be seen. The disease most often affects both lungs (82.2%), subregions (54.5%), peripheral parts (87.1%) and multifocal areas (54.5%) (10,13). The most frequently involved lung segments are the dorsal segment of the lower right lobe (86%), the posterior basal segment of the lower right lobe (85%), the lower right lower lobe segment (80%), the dorsal segment of the lower left lobe (76%) and the posterior basal segment of the left lower lobe (81%).…”

Section: Anatomical Distribution Of Lesionsmentioning

confidence: 99%

“…The lower lobes are the most commonly involved lobes and the right middle lobe is the least commonly involved lobe (14,15). Irregular multifocal distribution is more common than the diffuse disease; however, unilateral and even unifocal involvement can be seen, especially in early cases (10,16,17). Only peribronchial distribution, which is seen only in 4% of the patients, is defined (18).…”

Section: Anatomical Distribution Of Lesionsmentioning

confidence: 99%

Thorax CT Findings in Novel Coronavirus Disease 2019 (COVID-19)

Atalar¹

2020

Erciyes Med J

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Novel coronavirus disease 2019 (COVID-19) is a disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 has high mortality rates. It has become a severe pandemic worldwide. Real-time PCR testing is still the gold standard test method for the definitive diagnosis of COVID-19 despite the possibility of false negatives. Radiological imaging methods, especially computed tomography (CT), are important assistant methods in the diagnosis and management of the disease. This review presents the role of CT in COVID-19 pneumonia, its diagnostic accuracy, thorax CT findings of the disease and differential diagnosis.

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Radiological approach to COVID-19 pneumonia with an emphasis on chest CT

Cited by 59 publications

References 64 publications

Diagnosing COVID‐19 in the Emergency Department: A Scoping Review of Clinical Examinations, Laboratory Tests, Imaging Accuracy, and Biases

Diagnosing COVID‐19 in the Emergency Department: A Scoping Review of Clinical Examinations, Laboratory Tests, Imaging Accuracy, and Biases

A Telemedicine Approach to Covid-19 Assessment and Triage

Thorax CT Findings in Novel Coronavirus Disease 2019 (COVID-19)

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