Lung Radiographic Patterns in Patients Diagnosed with SARS-CoV-2 Pneumonia

In 2019, a novel coronavirus, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), was associated with several cases of pneumonia. The rapid spread of this virus resulted in the 2019 coronavirus disease (COVID-19) pandemic. Even today, there is no specific treatment for SARS-CoV-2 infection. It is generally recommended that individuals infected with this virus be quarantined. However, severely infected patients may require oxygen support, invasive mechanical ventilation, steroid administration, antibiotic treatment for secondary bacterial infections, and fluid management.

Background

CT must be considered for diagnosis in patients with suspected pneumonia. Tomographic imaging of the lungs of patients with SARS-CoV-2 pneumonia revealed peripherally distributed multifocal ground-glass patterns. These patterns were irregular and biased toward the posterior or lower lobe.

Imaging of patients with atypical pneumonia is challenging as approximately 17% of COVID-19 patients with mild pneumonia-like symptoms have no pulmonary tomographic findings on admission.

Recent Case report of respiratory medicine A study reported lung tomography findings in a heavily infected COVID-19 patient with severe pneumonia. In addition, this study aimed to determine 30-day mortality in this group of patients, along with those with acute respiratory distress syndrome (ARDS) and those suffering from varying levels of lung disease.

About research

This observational and retrospective study included patients admitted to hospitals in Mexico with severe SARS-CoV-2 pneumonia between June 2020 and March 2021. The cohort consisted of adult patients of both genders. Additionally, these patients underwent a contrast-enhanced chest CT examination at the time of sample collection for PCR to confirm the diagnosis of COVID-19. In addition to PCR-confirmed SARS-CoV-2 infection, detailed patient information on disease progression up to 30 days of admission was included.

Demographic variables such as age, sex, weight, height, clinical variables (such as comorbidities and length of hospital stay), and treatment management were obtained from medical records. Patient health status was assessed by the Sequential Organ Failure Assessment (SOFA), Charlson coorbidity index (CCI), and Acute Physiology and Chronic Health Evaluation (APACHE IV).

Blinded radiological classification was used to classify CT scans showing COVID-19 and non-COVID-19 infection. Tomographic findings were classified as ground-glass patterns, presence of ganglia, consolidation pattern, vascular hypertrophy pattern, nodule pattern, and presence of thrombosis.

Survey results

A serial case series of 490 COVID-19 patients was evaluated using computed tomography and various disease severity scales to determine whether patients required ventilator support and their risk of death at 30 days. was judged. We observed that SOFA, APACHE IV, CCI, and Lung Injury Severity Index can positively predict the need for invasive mechanical ventilation.

No statistically different survival rates were observed between patients who were severely infected with pneumonia and COVID-19 and required invasive ventilator support and those who did not. Nevertheless, 84.35% of his patients with a high Lung Injury Severity Index died within 30 days of admission. However, 25.91% of patients with moderate lung injury and 2.42% of patients with mild lung injury also died within the study period.

A previously conducted comparative study reported that tomographic findings were associated with: viral pneumonia SARS-CoV-2 infection was associated with a higher incidence of peripheral lesions, fine reticular opacities, ground-glass opacities, and vascular thickening patterns compared with non-COVID-19 infections. In contrast, pleural effusion, central and peripheral distribution, and lymphadenopathy were found more frequently in non-COVID-19 than in SARS-CoV-2 infection.

In this study, 89.80% of patients presented with ground-glass opacities, followed by radiologic signs of consolidation (81.63%), vascular thickening pattern (42.45%), lymphadenopathy (37.55%), pleural effusion (14.90%), and pulmonary effusion (14.90%). showed thrombosis. (2.65%). In addition, 91.02% of patients had bilateral disease, 85.51% had peripheral disease, and 75.92% had basal lobe disease.

A higher Lung Injury Severity Index indicated the need for a ventilator. Age, diabetes, and chronic obstructive pulmonary disease were some of the main factors associated with severe pneumonia due to COVID-19.

Research limitations

Lack of radiological follow-up is a significant limitation of this study. This lack of data allowed the authors to interpret only the initial radiological assessment and not disease progression. Another limitation of the study cohort is that some participants received prior treatment with corticosteroids and antibiotics, which may affect the tomographic findings. Co-infection was not considered as it could confound CT results. No lung biopsy was performed to confirm the tomographic findings. Nevertheless, the current study linked lung injury and acute respiratory distress syndrome with CT severity index and 30-day mortality.