E1067. A Radiologist’s Guide to the Short- and Long-term Chest Findings in the Patient With COVID-19
University of British Columbia
University of British Columbia
The COVID-19 pandemic has been an ongoing cause of major morbidity and mortality. CT has played an important role in the management of patients with COVID-19 including long-term follow-up. However, it is particularly important for assessing patients who deteriorate in-hospital due to the rapid image acquisition and ability to provide alternative or complicating diagnoses.
Educational Goals / Teaching Points
This exhibit aims to discuss the expected imaging pattern of different stages of COVID-19; review the intrathoracic complications that may arise throughout the disease course, including complications more commonly observed with variant strains; and highlight pertinent chest CT findings relevant to COVID-19 follow-up clinics.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
CT imaging features of COVID-19 pneumonia has been well-documented and stratified into acute, subacute, and late findings. In the acute phase, ground-glass opacities typically in a peripheral distribution predominate. These opacities become more extensive during the subacute phase with associated consolidation. In the later phase, the disease peaks with extensive consolidation, usually co-occurring with evolving acute lung injury and organizing pneumonia. The lung parenchymal findings may improve during the late/recovery phase of disease but may also persist for months. In hospitalized patients with COVID-19, multiple complications may cause patients to clinically deteriorate. Acute respiratory distress syndrome and/or secondary bacterial or viral infection may cause acute deterioration. Lung cavitary lesions may arise from pulmonary infarction or secondary infection. Regardless of intubation status, the presence of pneumatoceles may result in spontaneous pneumomediastinum and/or pneumothorax. Pleural effusions were initially a rare finding and were observed primarily in severe COVID-19 disease. However, with increased prevalence of variant strain infections, there has also been a rise in the incidence of these complications. Furthermore, COVID-19 is also associated with increased risk of venous thromboembolism including pulmonary embolism, which can worsen patient hypoxia. With resolution of COVID-19 pneumonia, most patients also have resolution of symptoms and pulmonary findings;.however, some patients with prior moderate/severe disease have persistent pulmonary dysfunction and radiologic changes. These include ground glass opacities and fibrotic-like changes on follow-up, which may persist and evolve over 12 months after infection. Dedicated post-COVID-19 clinics have been established at our center to longitudinally follow patients; accurate reporting of chest findings are necessary for correlation with the patient’s clinical findings.
Although COVID-19 pneumonia has an expected course, complications may result in clinical worsening of hospitalized patients, which seem to be more prevalent with variant strain infection. Moreover, as the long-term outcomes of COVID-19 infection remain unclear, accurate reporting of the radiologic findings are necessary to correlate with the degree of symptoms/dysfunction and better understand its long-term sequelae.