Title:Clinical and Temporal Radiological Findings from Critical Patients with
COVID-19 Pneumonia: A Descriptive Study
Volume: 20
Author(s): Ye Tian, Yuqiong Wang, Min Liu, Xu Huang, Yi Zhang, Xiaojing Wu, Linna Huang, Xiaoyang Cui, Sichao Gu and Qingyuan Zhan*
Affiliation:
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, National Center for
Respiratory Medicine, National Center for Respiratory Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- Peking University, China-Japan Friendship School of Clinical Medicine, Beijing, China
Keywords:
COVID-19, SARS-CoV-2, Critical, Severe viral pneumonia, Clinical features, Computed tomography.
Abstract:
Background:
In late December 2019, Wuhan, the capital of Hubei Province, China, became the center of an outbreak of pneumonia caused by severe acute
respiratory syndrome Coronavirus 2 (SARS-CoV-2).
Introduction:
The radiological changes in the lungs of critical people with coronavirus disease 2019 (COVID-19) pneumonia at different times have not been
fully characterized. We aim to describe the computed tomography findings of patients with critical COVID-19 pneumonia at different disease
stages.
Methods:
Clinical and laboratory features of critical patients were assessed. CT scans were assigned to groups 1, 2, 3, or 4 based on the interval from
symptom onset (within 2 weeks; ≥ 2-4 weeks; ≥ 4-6 weeks; or ≥ 6 weeks, respectively). Imaging features were analyzed and compared across the
four groups. Total CT scores, corresponding periods of laboratory findings, and glucocorticoid dosages during the imaging intervals were
longitudinally observed in five patients with complete data.
Results:
All 11 critical patients (median age: 60 years [42-69]) underwent a total of 40 CT examinations, and the acquisition times ranged from 1-59 days
after symptom onset. Median total CT scores were 18 (9-25.25); 445 (42.88-47.62); 4375 (38.62-49.38); and 42 (32.25-53.25) in groups 1, 2, 3,
and 4, respectively. The observed lesions were mainly bilateral (37 [92.5%]). The median values of involved lung segments were 10.5 (4.5-13.5);
17 (16-18.5); 18 (18-19.5); and 18 (18-19) in groups 1-4, respectively. The predominant patterns of observed abnormalities were ground-glass
opacities (GGO) (9 [90%]); GGO with reticulation and mixed patterns (3 [37.5%] for both); GGO with consolidation (3 [30%]); and GGO with
reticulation (8 [66.7%]) in groups 1-4, respectively. Patients developed fibrotic manifestations at later stages.
Conclusion:
Critical patients with COVID-19 infection generally presented with temporally changing abnormal CT features from focal unilateral to diffuse
bilateral GGO and consolidation that progressed to or coexisted with reticulation in the long term after symptom onset. Low-dose glucocorticoids
may be effective in patients with interstitial changes on CT findings.
