CT Scans Obtained for Nonpulmonary Indications: Associated Respiratory Findings of COVID-19.

May 12, 2020

Contributor: Rydhwana Hossain,Matthew S Lazarus,Alexandra Roudenko,Farouk Dako,Varun Mehta,Jonathan Alis,Benjamin Zalta,Brandon Lei,Linda B Haramati,Charles S White

CT Scans Obtained for Nonpulmonary Indications: Associated Respiratory Findings of COVID-19.

Background Atypical manifestations of 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 non-respiratory symptoms who underwent abdomen/pelvis or cervical spine/neck CT 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 hotspot (area of high prevalence) for COVID-19. Patients without known COVID-19 were included who presented to the emergency room (ER) with primary non-respiratory [gastrointestinal (GI) or neurological] symptoms, had lung parenchymal findings suspicious for COVID-19 on a non-chest CT but no concurrent chest CT and had COVID-19 testing in the ER. Group 1 patients had RT PCR obtained pre-CT read (COVID-19 suspected on presentation); Group 2 had RT PCR obtained post-CT 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(SD ±17) years] and group 2 comprised 57 patients [28 men, 29 women, mean age 63(SD ± 16) years). Cough and fever were more common in group 1 (37/62, 60%, 29/62, 47%) than group 2 (9/57, 16%, 12/57, 21%) respectively, with no significant difference in the remaining symptoms. There were 101 abdomen/pelvis and 18 cervical spine/neck CTs. In Group 1, non-chest CT findings provided the initial evidence of COVID-19 related pneumonia in 32/62 (52%); for Group 2, it was 44/57 (77%). Overall, the most common CT findings were ground glass opacity (114/119, 96%) and consolidation (47/119,40%). 29/119 (24%) patients required major interventions (vasopressor medication or intubation) and 27/119 (23%) died. Patients who underwent cervical spine/neck CT had worse outcomes than those with abdominal/pelvic CT (p =0.01). Conclusion In a substantial percentage of patients with primary non-respiratory symptoms who underwent non-chest CT, the CT provided the first evidence of COVID-19 related pneumonia.

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About The Expert

Rydhwana Hossain

From the Department of Radiology, University of Maryland School of Medicine, Baltimore, MD, 21201 (R.H. F.D. V.M. C.S.W.), Montefiore Medical Center, Radiology 111 East 210th Street Bronx, NY, USA 10467 (M.S.L. J.A. B.Z. L.B.H.), Mount Sinai West Medical Center, Department of Radiology 1000 10th Ave NY NY 100019 (A.R.), Staten Island University Hospital, Department of Radiology Staten Island, NY, USA (B.L.).

Matthew S Lazarus

From the Department of Radiology, University of Maryland School of Medicine, Baltimore, MD, 21201 (R.H. F.D. V.M. C.S.W.), Montefiore Medical Center, Radiology 111 East 210th Street Bronx, NY, USA 10467 (M.S.L. J.A. B.Z. L.B.H.), Mount Sinai West Medical Center, Department of Radiology 1000 10th Ave NY NY 100019 (A.R.), Staten Island University Hospital, Department of Radiology Staten Island, NY, USA (B.L.).

Alexandra Roudenko

From the Department of Radiology, University of Maryland School of Medicine, Baltimore, MD, 21201 (R.H. F.D. V.M. C.S.W.), Montefiore Medical Center, Radiology 111 East 210th Street Bronx, NY, USA 10467 (M.S.L. J.A. B.Z. L.B.H.), Mount Sinai West Medical Center, Department of Radiology 1000 10th Ave NY NY 100019 (A.R.), Staten Island University Hospital, Department of Radiology Staten Island, NY, USA (B.L.).

Farouk Dako

From the Department of Radiology, University of Maryland School of Medicine, Baltimore, MD, 21201 (R.H. F.D. V.M. C.S.W.), Montefiore Medical Center, Radiology 111 East 210th Street Bronx, NY, USA 10467 (M.S.L. J.A. B.Z. L.B.H.), Mount Sinai West Medical Center, Department of Radiology 1000 10th Ave NY NY 100019 (A.R.), Staten Island University Hospital, Department of Radiology Staten Island, NY, USA (B.L.).

Varun Mehta

From the Department of Radiology, University of Maryland School of Medicine, Baltimore, MD, 21201 (R.H. F.D. V.M. C.S.W.), Montefiore Medical Center, Radiology 111 East 210th Street Bronx, NY, USA 10467 (M.S.L. J.A. B.Z. L.B.H.), Mount Sinai West Medical Center, Department of Radiology 1000 10th Ave NY NY 100019 (A.R.), Staten Island University Hospital, Department of Radiology Staten Island, NY, USA (B.L.).

Jonathan Alis

From the Department of Radiology, University of Maryland School of Medicine, Baltimore, MD, 21201 (R.H. F.D. V.M. C.S.W.), Montefiore Medical Center, Radiology 111 East 210th Street Bronx, NY, USA 10467 (M.S.L. J.A. B.Z. L.B.H.), Mount Sinai West Medical Center, Department of Radiology 1000 10th Ave NY NY 100019 (A.R.), Staten Island University Hospital, Department of Radiology Staten Island, NY, USA (B.L.).

Benjamin Zalta

From the Department of Radiology, University of Maryland School of Medicine, Baltimore, MD, 21201 (R.H. F.D. V.M. C.S.W.), Montefiore Medical Center, Radiology 111 East 210th Street Bronx, NY, USA 10467 (M.S.L. J.A. B.Z. L.B.H.), Mount Sinai West Medical Center, Department of Radiology 1000 10th Ave NY NY 100019 (A.R.), Staten Island University Hospital, Department of Radiology Staten Island, NY, USA (B.L.).

Brandon Lei

From the Department of Radiology, University of Maryland School of Medicine, Baltimore, MD, 21201 (R.H. F.D. V.M. C.S.W.), Montefiore Medical Center, Radiology 111 East 210th Street Bronx, NY, USA 10467 (M.S.L. J.A. B.Z. L.B.H.), Mount Sinai West Medical Center, Department of Radiology 1000 10th Ave NY NY 100019 (A.R.), Staten Island University Hospital, Department of Radiology Staten Island, NY, USA (B.L.).

Linda B Haramati

From the Department of Radiology, University of Maryland School of Medicine, Baltimore, MD, 21201 (R.H. F.D. V.M. C.S.W.), Montefiore Medical Center, Radiology 111 East 210th Street Bronx, NY, USA 10467 (M.S.L. J.A. B.Z. L.B.H.), Mount Sinai West Medical Center, Department of Radiology 1000 10th Ave NY NY 100019 (A.R.), Staten Island University Hospital, Department of Radiology Staten Island, NY, USA (B.L.).

Charles S White

From the Department of Radiology, University of Maryland School of Medicine, Baltimore, MD, 21201 (R.H. F.D. V.M. C.S.W.), Montefiore Medical Center, Radiology 111 East 210th Street Bronx, NY, USA 10467 (M.S.L. J.A. B.Z. L.B.H.), Mount Sinai West Medical Center, Department of Radiology 1000 10th Ave NY NY 100019 (A.R.), Staten Island University Hospital, Department of Radiology Staten Island, NY, USA (B.L.).

References

PubMed