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COVID-19 Curbside Consults

Thoracic imaging in COVID-19

Ruchi Yadav, MD, Debasis Sahoo, MD, FCCP and Ruffin Graham, MD
Cleveland Clinic Journal of Medicine August 2020, 87 (8) 469-476; DOI: https://doi.org/10.3949/ccjm.87a.ccc032
Ruchi Yadav
Departments of Diagnostic Radiology and Nuclear Medicine, Imaging Institute, Cleveland Clinic; Clinical Assistant Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
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  • For correspondence: [email protected]
Debasis Sahoo
Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic; Clinical Assistant Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
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Ruffin Graham
Section Head, Department of Diagnostic Radiology, Imaging Institute, Cleveland Clinic; Assistant Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
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    Figure 1

    Portable chest radiographs of a patients with COVID-19 demonstrating classic bilateral, multifocal peripheral airspace opacities in the mid-lower-lung zones.

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    Figure 2

    Portable chest radiographs of patients with COVID-19 demonstrating atypical features of diffuse bilateral interstitial changes (A) and unilateral consolidation (B).

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    Figure 3

    Serial chest radiographs in a 53-year-old woman with COVID-19 demonstrate peripheral opacities on the day of onset of symptoms (A) with rapid worsening by day 3 (B). The patient was subsequently intubated, with the peak severity of parenchymal findings on day 11 (C).

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    Figure 4

    (Left) Setup for obtaining chest radiographs through the glass wall of the room of a patient with suspected or confirmed COVID-19. (Middle) A radiograph obtained in the conventional manner. (Right) A radiograph obtained through the glass.

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    Figure 5

    Typical computed tomographic features of COVID-19. Unenhanced axial images of the lungs of 4 different patients with COVID-19 demonstrate bilateral, multifocal, peripheral ground-glass opacities, and consolidation, most with rounded morphology. “Crazy paving” (ground-glass opacities with superimposed interlobular septal thickening and intralobular lines) is seen in (C) (white arrow).

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    Figure 6

    CT scans in a 73-year-old man with COVID-19 demonstrate resolution of subpleural consolidation with residual reticular and fibrotic changes.

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    Figure 7

    CT images of 2 different patients with COVID-19 demonstrating pulmonary embolism.

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    TABLE 1

    Stages of COVID-19 on chest CT

    Early stage (0–2 days)
    Approximately 50% of patients have negative chest CT
    The remaining have ground-glass opacities (44%) and consolidation (17%), more often unilateral
    The less pulmonary consolidation identified on CT, the greater the probability of initial negative reverse transcriptase polymerase chain reaction results11
    Intermediate stage (3–5 days)
    9% of patients have negative chest CT
    88% have ground-glass opacities with or without crazy paving (a sign of progression or peak stage), and 55% have consolidation (bilateral in 76%, peripheral in distribution in 64% with rounded morphology)12
    Late phase (6–12 days)
    Most patients have positive CT findings
    Progressive consolidation, evolving linear consolidation, and organizing pneumonia
    Reverse-halo appearance (a sign of healing or evolving lesion)12
    Ground-glass opacities in 88% with or without crazy paving
    Severe phase
    Massive pulmonary consolidation and “white lungs”
    Recovery phase
    Parenchymal abnormalities resolve with residual linear opacities (Figure 6)
    • Based on information from references 5 and 11–14.

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Cleveland Clinic Journal of Medicine: 87 (8)
Cleveland Clinic Journal of Medicine
Vol. 87, Issue 8
1 Aug 2020
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Thoracic imaging in COVID-19
Ruchi Yadav, Debasis Sahoo, Ruffin Graham
Cleveland Clinic Journal of Medicine Aug 2020, 87 (8) 469-476; DOI: 10.3949/ccjm.87a.ccc032

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Thoracic imaging in COVID-19
Ruchi Yadav, Debasis Sahoo, Ruffin Graham
Cleveland Clinic Journal of Medicine Aug 2020, 87 (8) 469-476; DOI: 10.3949/ccjm.87a.ccc032
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  • Article
    • ABSTRACT
    • CHEST RADIOGRAPHY IN COVID-19
    • RADIOGRAPHY ‘THROUGH GLASS’ TO AVOID SPREADING THE VIRUS
    • COMPUTED TOMOGRAPHY IN COVID-19
    • THE RADIOLOGICAL SOCIETY OF NORTH AMERICA CONSENSUS STATEMENT
    • ROLE OF CT IN COVID-19
    • CURRENT RECOMMENDATIONS
    • FLEISCHNER SOCIETY STATEMENT
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