Pitfalls of Computed Tomography in the Coronavirus 2019 (COVID-19) Era: A New Perspective on Ground-Glass Opacities

Mehrabi S, Fontana S, Mambrin F, Nguyen HQ, Righi E, Tacconelli E, Mansueto G.

Cureus. 2020 May 16;12(5):e8151. doi: 10.7759/cureus.8151., 05/2020.

Aim  To study ground-glass opacities (GGO) not only from the coronavirus  2019 (COVID-19) pneumonia" perspective but also as a radiological  presentation of other pathologies with comparable features. Methods We  enrolled 33 patients admitted to Policlinico Universitario G. B. Rossi  who underwent non-contrast-enhanced (NCE) or contrast-enhanced (CE)  chest computed tomography (CT) between March 12 and April 12. All  patients with CT-detected ground-glass opacity (GGO) were included. All  patients resulted as COVID-19 negative at the reverse  transcription-polymerase chain reaction (RT-PCR) assay. We studied the  different pathologies underlying GGO features: neoplastic diseases and  non-neoplastic diseases (viral pneumonias, interstitial pneumonias, and  cardiopulmonary diseases) in order to avoid pitfalls and to reach the  correct diagnosis. Results All CT scans detected GGOs. Symptomatic  patients were 25/33 (75.7%). At the clinical presentation, they reported  fever and dry cough; in six out of 25 cases, dyspnea was also reported  (24%). Thirty-three (33; 100%) showed GGO at CT: 15/33 (45.45%)  presented pure GGO, and 18/33 (54.54%) showed GGO with consolidation.  The RT-PCR assay was negative in 100%. We investigated other potential  underlying diseases to explain imaging features: neoplastic causes  (8/33, 24.24%) and non-neoplastic causes, in particular, infectious  pneumonias (16/33, 48,48 %, viral and fungal), interstitial pneumonias  (4/33, 12,12%), and cardio-pulmonary disease (5/33, 15,15%). Conclusions  GGO remains a diagnostic challenge. Although CT represents a  fundamental diagnostic tool because of its sensitivity, it still needs  to be integrated with clinical data to achieve the best clinical  management. In the presence of typical imaging features (e.g. GGO and  consolidation), the radiologist should focus on the pandemic and manage a  suspect patient as COVID-19 positive until proven to be negative.

Keywords: computed  tomography; covid 19; ct; emphysema; ground-glass opacity; interstitial  pneumonia; lung adenocarcinoma; multi-viral pneumonia.

Copyright © 2020, Mehrabi et al.