Post by Nadica (She/Her) on Nov 2, 2024 5:56:22 GMT
CT Scans Obtained for Nonpulmonary Indications: Associated Respiratory Findings of COVID-19 - Published May 11, 2020
Abstract
Background
Atypical manifestations of coronavirus disease 2019 (COVID-19) are being encountered as the pandemic unfolds, leading to non–chest CT scans that may uncover unsuspected pulmonary disease.
Purpose
To investigate patients with primary nonrespiratory symptoms who underwent CT of the abdomen or pelvis or CT of the cervical spine or neck with unsuspected findings highly suspicious for pulmonary COVID-19.
Materials and Methods
This retrospective study from March 10, 2020, to April 6, 2020, involved three institutions, two in a region considered a hot spot (area of high prevalence) for COVID-19. Patients without known COVID-19 were included who presented to the emergency department (ED) with primary nonrespiratory (gastrointestinal or neurologic) symptoms, had lung parenchymal findings suspicious for COVID-19 at non–chest CT but not concurrent chest CT, and underwent COVID-19 testing in the ED. Group 1 patients had reverse transcription polymerase chain reaction (RT-PCR) results obtained before CT scan reading (COVID-19 suspected on presentation); group 2 had RT-PCR results obtained after CT scans were read (COVID-19 not suspected). Presentation and imaging findings were compared, and outcomes were evaluated. Descriptive statistics and Fisher exact tests were used for analysis.
Results
Group 1 comprised 62 patients (31 men, 31 women; mean age, 67 years ±17 [standard deviation]), and group 2 comprised 57 patients (28 men, 29 women; mean age, 63 years ± 16). Cough and fever were more common in group 1 (37 of 62 [60%] and 29 of 62 [47%], respectively) than in group 2 (nine of 57 [16%] and 12 of 57 [21%], respectively), with no significant difference in the remaining symptoms. There were 101 CT scans of the abdomen or pelvis and 18 CT scans of the cervical spine or neck. In group 1, non–chest CT findings provided the initial evidence of COVID-19–related pneumonia in 32 of 62 (52%) patients. In group 2, the evidence was found in 44 of 57 (77%) patients. Overall, the most common CT findings were ground-glass opacity (114 of 119, 96%) and consolidation (47 of 119, 40%). Major interventions (vasopressor medication or intubation) were required for 29 of 119 (24%) patients, and 27 of 119 (23%) died. Patients who underwent CT of the cervical spine or neck had worse outcomes than those who underwent abdominal or pelvic CT (P = .01).
Conclusion
In a substantial percentage of patients with primary nonrespiratory symptoms who underwent non–chest CT, CT provided evidence of coronavirus disease 2019–related pneumonia.
Summary
Radiologists should maintain a high index of suspicion with respect to the lungs in patients with primary extrapulmonary clinical symptoms who undergo non–chest CT studies to facilitate earlier diagnosis of coronavirus disease 2019–related pneumonia.
Key Results
■ The presence of pneumonia in the visualized lung parenchyma was established on the basis of non–chest CT scans in 76 of 119 (64%) patients and led to a diagnosis of coronavirus disease 2019 (COVID-19) in 44 of 119 (37%) patients.
■ Overall, patients with a diagnosis of COVID-19 presenting with primary nonrespiratory symptoms often had poor outcomes, developing severe symptoms requiring major interventions, and, in many cases, these patients ultimately died (23%).
Abstract
Background
Atypical manifestations of coronavirus disease 2019 (COVID-19) are being encountered as the pandemic unfolds, leading to non–chest CT scans that may uncover unsuspected pulmonary disease.
Purpose
To investigate patients with primary nonrespiratory symptoms who underwent CT of the abdomen or pelvis or CT of the cervical spine or neck with unsuspected findings highly suspicious for pulmonary COVID-19.
Materials and Methods
This retrospective study from March 10, 2020, to April 6, 2020, involved three institutions, two in a region considered a hot spot (area of high prevalence) for COVID-19. Patients without known COVID-19 were included who presented to the emergency department (ED) with primary nonrespiratory (gastrointestinal or neurologic) symptoms, had lung parenchymal findings suspicious for COVID-19 at non–chest CT but not concurrent chest CT, and underwent COVID-19 testing in the ED. Group 1 patients had reverse transcription polymerase chain reaction (RT-PCR) results obtained before CT scan reading (COVID-19 suspected on presentation); group 2 had RT-PCR results obtained after CT scans were read (COVID-19 not suspected). Presentation and imaging findings were compared, and outcomes were evaluated. Descriptive statistics and Fisher exact tests were used for analysis.
Results
Group 1 comprised 62 patients (31 men, 31 women; mean age, 67 years ±17 [standard deviation]), and group 2 comprised 57 patients (28 men, 29 women; mean age, 63 years ± 16). Cough and fever were more common in group 1 (37 of 62 [60%] and 29 of 62 [47%], respectively) than in group 2 (nine of 57 [16%] and 12 of 57 [21%], respectively), with no significant difference in the remaining symptoms. There were 101 CT scans of the abdomen or pelvis and 18 CT scans of the cervical spine or neck. In group 1, non–chest CT findings provided the initial evidence of COVID-19–related pneumonia in 32 of 62 (52%) patients. In group 2, the evidence was found in 44 of 57 (77%) patients. Overall, the most common CT findings were ground-glass opacity (114 of 119, 96%) and consolidation (47 of 119, 40%). Major interventions (vasopressor medication or intubation) were required for 29 of 119 (24%) patients, and 27 of 119 (23%) died. Patients who underwent CT of the cervical spine or neck had worse outcomes than those who underwent abdominal or pelvic CT (P = .01).
Conclusion
In a substantial percentage of patients with primary nonrespiratory symptoms who underwent non–chest CT, CT provided evidence of coronavirus disease 2019–related pneumonia.
Summary
Radiologists should maintain a high index of suspicion with respect to the lungs in patients with primary extrapulmonary clinical symptoms who undergo non–chest CT studies to facilitate earlier diagnosis of coronavirus disease 2019–related pneumonia.
Key Results
■ The presence of pneumonia in the visualized lung parenchyma was established on the basis of non–chest CT scans in 76 of 119 (64%) patients and led to a diagnosis of coronavirus disease 2019 (COVID-19) in 44 of 119 (37%) patients.
■ Overall, patients with a diagnosis of COVID-19 presenting with primary nonrespiratory symptoms often had poor outcomes, developing severe symptoms requiring major interventions, and, in many cases, these patients ultimately died (23%).