Covid – 19 and Radiology

Radiology

COVID-19 (Corona virus disease 2019) is a viral infectious disease caused by SARS-CoV-2 and is currently declared as pandemic by World Health Organization (WHO).

It is most often asymptomatic infection. Symptoms and signs of COVID-19, when present are non-specific, and are of respiratory viral illness/flu. So they most commonly include fever, cough, fatigue, sputum production, shortness of breath.

More severe illness resulting in hospitalization is closely associated with advanced age (more than 60yrs), other medical co-morbidities like diabetes and hypertension, and underlying lung conditions. 

Radiographic features-

The primary findings of COVID-19 are those of a typical or organizing pneumonia. Up to 18% of cases demonstrate normal chest x-rays or CT Scan when mild/early in the disease course. Bilateral and/or multi-lobar involvement is common, more often with a lower zone and peripheral distribution.

Plain radio graph :

Predominantly peripheral patchy ground-glass opacities in early stages and diffuse airspace opacities (consolidation) in later stages.

Pleural effusions are quite rare.

Image sourced from radiopedia. “no copyright infringement is intended”

CT Imaging:

The primary findings on CT in adults have been reported as:

  • Peripheral ground-glass opacities (GGO)
  • Consolidations
  • Crazy paving appearance (GGOs with inter-/intra-lobular septal thickening)
  • Broncho-vascular thickening within the GGO/ consolidation.
Image sourced from lancet ; Volume 20, ISSUE 4, P425-434, April 01, 2020; “no copyright infringement is intended”

However, imaging findings in covid-19 infection are neither specific nor confirmatory to be diagnosed on imaging alone.

 Many other disease pathologies present similar picture on imaging like:

  • influenza or parainfluenza virus and other causes of atypical pneumonia.
  • interstitial lung disease (ILD)
  • pulmonary edema

Treatment and prognosis:

Treatment is currently, basically supportive including ventilator support for some patients.

No specific treatment or vaccine is currently available but extensive active research is happening in this field now.

The mortality rate is estimated to be 3.6%

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