OBJECTIVE: To explore the quantitative analysis results of different patterns of chest computed tomography (CT) in patients with coronavirus infection and its relationship with viral load and pathophysiological status. METHODS: A retrospective clinical cohort study was conducted. Patients with coronavirus infection admitted to Qingdao Municipal Hospital from June 9 to 15, 2023 (all patients underwent chest CT examination within 24 hours after diagnosis) were enrolled. The patients were divided into coronavirus infection non-pneumonia group and coronavirus infection associated pneumonia group according to CT findings. Relevant baseline data, such as demographic characteristics, chest CT characteristics, and laboratory indicators within 12 hours before and after CT examination were collected from each group. Spearman correlation test was used to quantitatively analyze the correlation between CT features and laboratory indicators. The receiver operator characteristic curve (ROC curve) was drawn to evaluate the predictive value of each laboratory index for pneumonia in patients infected with coronavirus. Multiple linear regression analysis was used to explore the relationship between different CT patterns such as ground-glass opacity (GGO) and consolidation and ventilatory oxygenation status. RESULTS: A total of 171 patients were enrolled, including 44 patients in the coronavirus infection non-pneumonia group and 127 patients in the coronavirus infection associated pneumonia group (the incidence of pneumonia was 74.3%). Compared with patients with coronavirus infection alone, patients with coronavirus infection associated pneumonia had significantly lower lymphocyte count (LYM), oxygenation index (PaO₂/FiO₂), total lung capacity, GGO volume and GGO ratio, and significantly higher C-reactive protein (CRP), neutrophil/lymphocyte ratio (NLR), D-dimer, fraction of inspired oxygen (FiO₂) level, real volume variation and consolidation ratio, the differences were all statistically significant. There were no statistically significant differences in the nucleocapin protein (N) gene cycle threshold (Ct) value and open reading frame (ORF) gene Ct value between the two groups. ROC curve analysis showed that, after adjusting for age, gender, CRP level and other related factors, compared with N gene Ct value, ORF gene Ct value, N gene Ct value+LYM, ORF gene Ct value+LYM, the LYM had the most potential diagnosis power for coronavirus infection associated pneumonia. The area under the ROC curve (AUC) of LYM for predicting coronavirus infection was 0.703. When the cut-off value of LYM was 0.7×10⁹/L, the sensitivity was 55.5%, and the specificity was 79.5%, respectively. Multiple linear regression analysis showed that, when adjusted for consolidation ratio, age, gender, Hb and D-dimer levels, the GGO ratio in patients with coronavirus infection associated pneumonia was correlated with PaO₂/FiO₂ (β = -2.18, P < 0.001). When adjusted for GGO ratio, age, sex, Hb and D-dimer levels, the proportion of consolidation in patients with coronavirus infection associated pneumonia was correlated with PaCO₂ (β = 0.36, P = 0.004). When adjusted for GGO ratio, the proportion of consolidation in patients with coronavirus infection associated pneumonia was also associated with NLR (β = 0.79, P = 0.006). CONCLUSIONS LYM could be a potential marker for predicting coronavirus associated pneumonia, and the correlation seems to be independent of viral load. In addition, in the analysis of imaging features, GGO is associated with hypoxia, while consolidation is associated with PaCO₂ level and inflammation. The increased proportion of consolidation in the whole lung may be detrimental to lung ventilation.
Humans ; Tomography, X-Ray Computed/methods* ; Retrospective Studies ; COVID-19/diagnostic imaging* ; Viral Load ; Coronavirus Infections/diagnostic imaging* ; ROC Curve ; Male ; Lung/diagnostic imaging* ; Female ; Middle Aged ; C-Reactive Protein/analysis*

To summarize the clinical characteristics and chest CT findings of coronavirus disease 2019(COVID-19)patients in Peking Union Medical College Hospital(PUMCH). A total of 13 patients with COVID-19 confirmed at PUMCH from January 20 to February 6,2020 were selected as the research subjects.Their epidemiological histories,clinical characteristics,laboratory tests,and chest CT findings were analyzed retrospectively.The location,distribution,density,and other accompanying signs of abnormal lung CT lesions were recorded,and the clinical types of these patients were assessed. The clinical type was "common type" in all these 13 patients aged(46.8±14.7)years(range:27-68 years).Ten patients had a travel history to Wuhan or direct contact with patients from Wuhan,2 cases had recent travel histories,and 1 case had a travel history to Beijing suburb.The white blood cell(WBC)count was normal or decreased in 92.3% of the patients and the lymphocyte count decreased in 15.4% of the patients.Twelve patients(92.3%)had a fever,among whom 11 patients were admitted due to fever and 2 patients(15.4%)had low fever.Eight patients(61.5%)had dry cough.The CT findings in these 13 patients were all abnormal.The lesions were mainly distributed along the bronchi and under the pleura.The lesions were relatively limited in 8 patients(affecting 1-3 lobes,predominantly in the right or left lower lobe),and diffuse multiple lesions of bilateral lungs were seen in 5 patients.The CT findings mainly included ground glass opacities(GGOs)(=10,76.9%),focal consolidation within GGOs(=7,53.8%),thickened vascular bundle passing through the lesions(=10,76.9%),bronchial wall thickening(=12,92.3%),air bronchogram(=10,76.9%),vacuole signs in the lesions(=7,53.8%),fine reticulation and interlobular septal thickening(=3,23.1%),reversed halo-sign(=2,15.4%),crazy-paving pattern(=2,15.4%),and pleural effusion(=2,15.4%). Most of our patients diagnosed with COVID-19 at PUMCH had a travel history to Wuhan or direct contact with patients from Wuhan.The first symptoms of COVID-19 mainly include fever and dry cough,along with normal or reduced counts of WBC and lymphocytes.CT may reveal that the lesions distribute along the bronchi and under the pleura;they are typically localized GGOs in the early stage but can become multiple GGOs and infiltrative consolidation in both lungs in the advanced stage.Scattered vacuole signs may be visible inside the lesions in some patients.
Adult ; Aged ; Betacoronavirus ; Coronavirus Infections ; diagnostic imaging ; Humans ; Lung ; Middle Aged ; Pandemics ; Pneumonia, Viral ; diagnostic imaging ; Retrospective Studies ; Tomography, X-Ray Computed

To investigate the computed tomographc(CT)features of mild/moderate and severe/critical cases of coronavirus disease 2019(COVID-19)in the recovery phase. Totally 63 discharged patients in Wuhan,China,who underwent both chest CT and reverse transcription-polymerase chain reaction(RT-PCR)from February 1 to February 29,2020,were included.With RT-PCR as a gold standard,the performance of chest CT in diagnosing COVID-19 was assessed.Patients were divided into mild/moderate and severe/critical groups according to the disease conditions,and clinical features such as sex,age,symptoms,hospital stay,comorbidities,and oxygen therapy were collected.CT images in the recovery phase were reviewed in terms of time from onset,CT features,location of lesions,lobe score,and total CT score. There were 37 patients in the mild/moderate group and 26 in the severe/critical group. Compared with the mild/moderate patients,the severe/critical patients had older age [(43±16) years (52±16) years; =2.10, =0.040], longer hospital stay [(15±6)d (19±7)d; =2.70, =0.009], higher dyspnea ratio (5.41% 53.85%; =18.90, <0.001), lower nasal oxygen therapy ratio (81.08% 19.23%;=23.66, <0.001), and higher bi-level positive airway pressure ventilation ratio (0 57.69%; =25.62, <0.001). Time from onset was (23±6) days in severe/critical group, significantly longer than that in mild/moderate group [(18±7) days] (=3.40, <0.001). Severe/critical patients had significantly higher crazy-paving pattern ratio (46.15% 10.81%;=4.24, =0.039) and lower ground-glass opacities ratio (15.38% 67.57%; =16.74, <0.001) than the mild/moderate patients. The proportion of lesions in peripheral lung was significantly higher in mild/moderate group than in severe/critical group (78.38% 34.61%; =13.43, <0.001), and the proportion of diffusely distributed lesions was significantly higher in severe/critical group than in mild/moderate group (65.38% 10.81%; =20.47, <0.001). Total CT score in severe/critical group was also significantly higher in severe/critical group than in mild/moderate group [11 (8,17) points 7 (4,9) points; =3.81, <0.001]. The CT features in the recovery stage differ between mild/moderate and severe/critical COVID-19 patients.The lung infiltration is remarkably more severe in the latter.
Adult ; Aged ; Betacoronavirus ; China ; Coronavirus Infections ; diagnostic imaging ; Humans ; Middle Aged ; Pandemics ; Pneumonia, Viral ; diagnostic imaging ; Retrospective Studies ; Tomography, X-Ray Computed

Since the global outbreak of severe acute respiratory syndrome (SARS) in 2003, China has gradually built a robust prevention and control system for sudden infectious diseases. All large hospitals have a fever clinic that isolates patients with all kinds of acute communicable diseases as the first line of medical defense. The emergency department, as the second line of medical defense in hospitals, is constantly shouldering the heavy responsibility of screening communicable diseases while also treating all kinds of other non-communicable acute and critical diseases (Zhang et al., 2012; Zhu et al., 2015; Wang et al., 2017; Feng et al., 2018; Lu, 2018; Xu and Lu, 2019). An outbreak of pneumonia of unknown etiology that began in Wuhan city (China) has spread rapidly in China since December 2019 (Huang et al., 2020; WHO, 2020; Zhu et al., 2020). In February 2020, the National Health Commission of China named the disease a novel coronavirus pneumonia (NCP); then, it was formally named the coronavirus disease 2019 (COVID-19) by the World Health Organization (WHO) on Feb. 11, 2020. The Coronavirus Study Group of the International Committee on Taxonomy of Viruses designated this causative virus as SARS coronavirus 2 (SARS-CoV-2). SARS-CoV-2 belongs to the β coronavirus genus, and its pathogenic mechanism has not been clarified, which requires further study. To better understand the clinical characteristics of COVID-19 and more effectively prevent and control this disease, we retrospectively analyzed four representative cases of COVID-19 that had recently been screened and diagnosed in our emergency department.
Adult ; Betacoronavirus ; China ; epidemiology ; Coronavirus Infections ; diagnosis ; Emergency Service, Hospital ; Female ; Humans ; Lung ; diagnostic imaging ; Male ; Middle Aged ; Pandemics ; Patient Isolation ; Pneumonia, Viral ; diagnosis ; Tomography, X-Ray Computed

OBJECTIVE: To analyze the CT findings of patients with different clinical types of coronavirus disease 2019 (COVID-19). METHODS: A total of 67 patients diagnosed as COVID-19 by nucleic acid testing were included and divided into 4 groups according to the clinical staging based on . The CT imaging characteristics were analyzed among patients with different clinical types. RESULTS: Among 67 patients, 3 (4.5%) were mild cases, 35 (52.2%) were ordinary cases, 22 (32.8%) were severe cases, and 7 (10.4%) were critically ill. There were no abnormal CT findings in mild cases. In 35 ordinary cases, there were single lesions in 3 cases (8.6%) and multiple lesions in 33 cases (91.4%), while in severe case 1 case had single lesion (4.5%) and 21 had multiple lesions (95.5%). CT images of ordinary patients were mainly manifested as solid plaque shadow and halo sign (18/35, 51.4%); while fibrous strip shadow with ground glass shadow was more frequent in severe cases (7/22, 31.8%). Consolidation shadow as the main lesion was observed in 7 cases, and all of them were severe or critical ill patients. CONCLUSIONS CT images in patients with different clinical types of COVID-19 have characteristic manifestations, and solid shadow may predict severe and critical illness.
Betacoronavirus ; Clinical Laboratory Techniques ; Coronavirus Infections ; diagnosis ; diagnostic imaging ; Humans ; Lung ; diagnostic imaging ; pathology ; Pneumonia, Viral ; diagnostic imaging ; pathology ; Severity of Illness Index ; Tomography, X-Ray Computed ; methods

OBJECTIVE: Coronavirus disease 2019 (COVID-19) has raised concern around the world as an epidemic or pandemic. As data on COVID-19 has grown, it has become clear that older adults have a disproportionately high rate of death from COVID-19. This study describes the early clinical characteristics of COVID-19 in patients with more than 80 years of age. METHODS: Epidemiological, clinical, laboratory, radiological, and treatment data from 17 patients diagnosed with COVID-19 between January 20 and February 20, 2020 were collected and analyzed retrospectively. Treatment outcomes among subgroups of patients with non-severe and severe symptoms of COVID-19 were compared. RESULTS: Of the 17 hospitalized patients with COVID-19, the median age was 88.0 years (interquartile range, 86.6-90.0 years; range, 80.0-100.0 years) and 12 (70.6%) were men. The age distribution of patients was not significantly different between non-severe group and severe group. All patients had chronic pre-existing conditions. Hypertension and cardiovascular diseases were the most common chronic conditions in both subgroups. The most common symptoms at the onset of COVID-19 were fever (n = 13; 76.5%), fatigue (n = 11; 64.7%), and cough (n = 5; 29.4%). Lymphopenia was observed in all patients, and lymphopenia was significantly more severe in the severe group than that in non-severe group (0.4 × 10/L vs 1.2 × 10/L, P = 0.014). The level of serum creatinine was higher in the severe group than in the non-severe group (99.0 μmol/L vs 62.5 μmol/L, P = 0.038). The most common features of chest computed tomography images were nodular foci in 10 (58.8%) patients and pleural thickening in 7 (41.2%) patients. All patients received antiviral therapy, while some patients also received intravenous antibiotics therapy (76.5%), Chinese medicinal preparation therapy (Lianhuaqingwen capsule, 64.7%), corticosteroids (35.3%) or immunoglobin (29.4%). Eight patients (47.1%) were transferred to the intensive care unit because of complications. Ten patients (58.8%) received intranasal oxygen, while 3 (17.6%) received non-invasive mechanical ventilation, and 4 (23.5%) received high-flow oxygen. As of June 20, 7 (41.2%) patients had been discharged and 10 (58.8% of this cohort, 77.8% of severe patients) had died. CONCLUSION The mortality of patients aged 80 years and older with severe COVID-19 symptoms was high. Lymphopenia was a characteristic laboratory result in these patients, and the severity of lymphopenia was indicative of the severity of COVID-19. However, the majority of patients with COVID-19 in this age cohort had atypical symptoms, and early diagnosis depends on prompt use of a viral nucleic acid test.
Age Factors ; Aged, 80 and over ; Antiviral Agents ; therapeutic use ; China ; epidemiology ; Clinical Laboratory Techniques ; Coronavirus Infections ; diagnosis ; epidemiology ; pathology ; Female ; Humans ; Lung ; diagnostic imaging ; pathology ; Male ; Pandemics ; Pneumonia, Viral ; diagnosis ; epidemiology ; pathology ; Retrospective Studies ; Tomography, X-Ray Computed ; Treatment Outcome

Objective: To identify the characteristics including clinical features and pulmonary computed tomography (CT) features of heart failure and COVID-19. Methods: This study was a retrospective study. A total of 7 patients with heart failure and 12 patients with COVID-19 in the Second Xiangya Hospital of Central South University between December 1, 2019 and February 15, 2020 were enrolled. The baseline clinical and imaging features of the two groups were statistically analyzed. Results: There was no significant difference in age and sex between the two groups(both P>0.05), but the incidence of epidemiological contact history, fever or respiratory symptoms in the COVID-19 group was significantly higher than that in the heart failure group (12/12 vs. 0, P<0.001; 12/12 vs. 4/7, P=0.013). While the proportion of cardiovascular diseases and impaired cardiac function was significantly less than that of the heart failure group(2/12 vs.7/7, P<0.001；0 vs.7/7, P<0.001). For imaging features, both groups had ground-glass opacity and thickening of interlobular septum, but the ratio of central and gradient distribution was higher in patients with heart failure than that in patients with COVID-19 (4/7 vs. 1/12, P=0.04). In heart failure group, the ratio of the expansion of pulmonary veins was also higher (3/7 vs. 0，P=0.013), and the lung lesions can be significantly improved after effective anti-heart failure treatment. Besides, there were more cases with rounded morphology in COVID-19 group（9/12 vs. 2/7, P=0.048）. Conclusions: More patients with COVID-19 have epidemiological history and fever or respiratory symptoms. There are significant differences in chest CT features, such as enlargement of pulmonary veins, lesions distribution and morphology between heart failure and COVID-19.
Betacoronavirus ; COVID-19 ; Coronavirus Infections/diagnostic imaging* ; Heart Failure/etiology* ; Humans ; Pandemics ; Pneumonia, Viral/diagnostic imaging* ; Retrospective Studies ; SARS-CoV-2 ; Tomography, X-Ray Computed

In December 2019, coronavirus disease 2019 (COVID-19), a new de novo infectious disease, was first identified in Wuhan, China and quickly spread across China and around the world. The etiology was a novel betacoronavirus, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Lu et al., 2020). On Mar. 11, 2020, World Health Organization (WHO) characterized COVID-19 as a global pandemic. As of Mar. 22, 2020, over 292 000 confirmed COVID-19 cases have been reported globally. To date, COVID-19, with its high infectivity, has killed more people than severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) combined (Wu and McGoogan, 2020).
Adult ; Betacoronavirus ; COVID-19 ; COVID-19 Testing ; China ; Clinical Laboratory Techniques ; Coronavirus Infections/diagnostic imaging* ; Female ; Fever/virology* ; Humans ; Lymphocyte Count ; Male ; Middle Aged ; Pandemics ; Pneumonia, Viral/diagnostic imaging* ; Radiography, Thoracic ; SARS-CoV-2 ; Tomography, X-Ray Computed ; Treatment Outcome

The coronavirus disease 2019 (COVID-19) is typically diagnosed by specific assays that detect viral nucleic acid from the upper respiratory tract; however, this may miss infections involving only the lower airways. Computed tomography (CT) has been described as a diagnostic modality in the COVID-19 diagnosis and treatment plan. We present a case series with virologically confirmed COVID-19 pneumonia. Variable CT features were observed: consolidation with ground-glass opacities, ground-glass opacities with subpleural reticular bands, and an anterior-posterior gradient of lung abnormalities resembling that of acute respiratory distress syndrome. Evolution of CT findings was observed in one patient, where there was interval resolution of bilateral lung consolidation with development of bronchiolectasis and subpleural fibrotic bands. While sensitive for detecting lung parenchymal abnormalities in COVID-19 pneumonia, the use of CT for initial diagnosis is discouraged and should be reserved for specific clinical indications. Interpretation of chest CT findings should be correlated with duration of symptoms to better determine the disease stage and aid in patient management.
Aged ; Betacoronavirus ; Coronavirus Infections ; diagnosis ; Diagnosis, Differential ; Female ; Humans ; Lung ; diagnostic imaging ; Male ; Middle Aged ; Pandemics ; Pneumonia, Viral ; diagnosis ; Tomography, X-Ray Computed ; methods

Betacoronavirus ; Coronavirus Infections ; diagnosis ; Diagnosis, Differential ; Diagnostic Imaging ; methods ; Humans ; Male ; Middle Aged ; Pandemics ; Pneumonia, Viral ; diagnosis ; virology ; Radiography, Thoracic ; methods ; Tomography, X-Ray Computed ; methods