Radiological Society of North America Expert Consensus Document on                     Reporting Chest CT Findings Related to COVID-19: Endorsed by the Society of                     Thoracic Radiology, the American College of Radiology, and RSNA

Simpson, Scott A.; Kay, Fernando Uliana; Abbara, Suhny; Bhalla, Sanjeev; Chung, Jonathan H.; Chung, Michael; Henry, Travis S.; Kanne, Jeffrey P.; Kligerman, Seth; Ko, Jane P.; Litt, Harold

doi:10.1148/ryct.2020200152

Cited by 695 publications

(878 citation statements)

References 27 publications

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“…Although RT-PCR testing for SARS-CoV-2 is the current standard for diagnosis of COVID-19, the sensitivity of nasopharyngeal swabs has been reported to vary, ranging from 42% to 71%. 1,2 In a recent case series of patients with high probability of COVID-19 based on clinical presentation and imaging, only 9 of 19 patients (47%) had a positive result for oropharyngeal testing using RT-PCR. 3 Sensitivity of SARS-CoV-2 swabs is thought to be affected by sampling technique and timing within the clinical course of COVID-19.…”

Section: Discussionmentioning

confidence: 99%

“…Given his history of progressive symptoms, persistent lymphopenia and potential exposure to a student with COVID-19, we were advised to restart droplet and contact precautions. 1 We stopped the previous antibiotic regimen and started broader antibiotic treatment (piperacillin/tazobactam and vancomycin). We also started empiric treatment with methylprednisolone (125 mg administered intravenously once daily) for possible organizing pneumonia.…”

mentioning

confidence: 99%

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SARS-CoV-2 infection in a 76-year-old man with initially negative nasopharyngeal swabs

Kumar

O’Neill

Johnston

et al. 2020

CMAJ

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A 76-year-old man presented to a quaternary care hospital with a 6-day history of respiratory symptoms, fatigue and a fainting episode. The patient had a resolving postinfectious dry cough from an upper respiratory infection that occurred 3 months before presentation. He had hypertension, gastritis, diabetes, sciatica, a remote 30 pack-year smoking history and no history of recreational drug use. His medications included metformin and rosuvastatin. He worked as a professor and attended language classes.In early March, our patient was informed of a potential classroom exposure to coronavirus disease 2019 (COVID-19). One week after this exposure, he had an outpatient nasopharyngeal swab for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) after 2 days of worsening cough. The results were negative for both the envelope and RNA-dependent RNA polymerase genes, which are common targets for polymerase chain reaction (PCR) amplification of SARS-CoV-2. A worsening dry cough, fatigue, exertional dyspnea, fevers, low appetite and diarrhea developed over the next 4 days. He presented to the emergency department 4 days after his first swab for SARS-CoV-2 (11 d after his potential exposure).The patient was admitted to hospital and placed under droplet and contact precautions. His initial vital signs included a body temperature of 38.6°C, blood pressure of 98/55 mm Hg with an orthostatic drop, pulse 94 beats/min, and a respiratory rate of 18 breaths/ min with an oxygen saturation of 96% on room air. A physical examination showed flat neck veins, and he had mild inspiratory bibasilar crackles. Bloodwork showed lymphopenia, but electrolytes and hepatic and renal function tests were normal. Chest radiography showed ill-defined right basal airspace opacification.We started treatment with crystalloids administered intravenously and ceftriaxone and azithromycin for pneumonia. Blood and stool culture tests performed on admission were negative; influenza A, influenza B and respiratory syncytial virus were not present; and a repeat nasopharyngeal swab for SARS-CoV-2 on admission also returned a negative result.On day 3 after admission, our patient became hypoxemic and he required 2 L/min of oxygen. Repeat radiography of the chest showed new bilateral, ill-defined patchy opacities. Results for an extended viral panel, legionella urinary antigen and a third nasopharyngeal swab for SARS-CoV-2 were negative. Consequently, we stopped droplet and contact precautions on day 3 of admission. A computed tomography (CT) scan of the chest showed bilateral ground glass opacification and septal lines (Figure 1). This was consistent with atypical bacterial or viral infection, and our differential diagnosis included edema, hemorrhage, drug reaction and connective tissue disease.On day 4 of admission, our patient's hypoxemia worsened and he required 5 L/min of oxygen. We consulted our respirology department. Given his history of progressive symptoms, persistent lymphopenia and potential exposure to a student with COVID-19, we were advised to...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

SARS-CoV-2 infection in a 76-year-old man with initially negative nasopharyngeal swabs

Kumar

O’Neill

Johnston

et al. 2020

CMAJ

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show abstract

“…(2,3) However, this procedure is not recommended for screening by the majority of medical societies. (1) The halo sign is not characteristic or a frequent presentation among patients with COVID-19 lung injury. There are few reports on this subject in published literature, although the halo sign has been observed in other viral pneumonias.…”

Section: B C Amentioning

confidence: 98%

“…The most common aspect includes multifocal ground-glass opacities associated or not with areas of consolidation or septal thickness (the "crazy-paving" pattern), and bilateral distribution involving mainly the peripheral lung regions. (1) The CT can be used for symptomatic patients, including higher sensibility reports, but with limited specificity concerning the standard molecular test. (2,3) However, this procedure is not recommended for screening by the majority of medical societies.…”

Section: B C Amentioning

confidence: 99%

The halo sign as a chest computed tomography finding of COVID-19

Farias¹,

Pereira²,

Anastacio³

et al. 2020

Einstein (São Paulo)

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“…(12) Implementing a structured report should be beneficial, particularly in the current scenario of COVID-19 pandemic, for increasing productivity of radiologists and enabling better understanding of the requesting physicians, with a potential positive impact in management of patients. (13)…”

mentioning

confidence: 99%