Atypical chest radiological feature in a patient with nCOVID-19

Classical high-resolution computed tomography (HRCT) pattern in nCOVID-19 pneumonia is bilateral, basal, peripheral, subpleural, bronchopneumonia. Ground-glass opacities and consolidation are the most common initial radiological findings. However, chest computed tomography (CT) should not be used as an independent diagnostic tool to exclude or confirm COVID-19. CT is not a standard diagnostic tool for the diagnosis of COVID-19, but CT findings help to suggest the diagnosis in the appropriate setting. Chest CT findings should be correlated with epidemiologic history, clinical presentation, and reverse transcriptase-polymerase chain reaction (RT-PCR) test results. Many other diseases can mimic nCOVID-19 in HRCT and vice versa. We report an atypical radiological feature in RT-PCR-confirmed nCOVID-19 pneumonia case. HRCT showed unilateral peripheral ground-glass opacity. Atypical HRCT features in nCOVID-19 described in literature include central involvement, peribronchovascular involvement, isolated upper lobe involvement, nodular opacities, lobar consolidation, solitary opacity, unilateral lung involvement, mediastinal adenopathy, cavitory lesions, pleural and pericardial effusion, and subpleural sparing. When radiological manifestations are atypical, diagnosis of nCOVID-19 pneumonia should be by exclusion of other causes for the radiological abnormality. © Medical Journal of Dr. D.Y. Patil Vidyapeeth 2022.

Role of chest radiography in the diagnosis of pulmonary tuberculosis during nCovid19 pandemic.

Pulmonary tuberculosis and nCovid 19 share many common risk factors. nCovid19 may increase the risk to develop pulmonary tuberculosis. Pulmonary tuberculosis may precede, co-exist or follow nCovid19. Careful evaluation of chest radiography is useful to differentiate tuberculosis from nCovid19 bronchopneumonia. Symptoms of tuberculosis may be mistaken for long covid. A normal chest x ray in the absence of sputum production may help to rule out tuberculosis in such cases. All patients with nCovid19 bronchopneumonia should undergo a careful chest x ray evaluation for any lesions suggestive of tuberculosis. All patients with chest radiological abnormality should undergo sputum examination to rule tuberculosis as atypical radiological manifestations may be more common in patients with nCovid19. Symptoms, signs, clinical features and chest radiographic features of Pulmonary tuberculosis and nCovid19 bronchopneumonia may overlap in some cases. Correlation of chest radiographic findings with epidemiologic history, clinical presentation, and RT-PCR test results or in later stages antibody titres will help in confirming or excluding the diagnosis in suspected cases of nCovid19. In pulmonary tuberculosis definitive diagnosis should be established by bacteriological confirmation. Molecular diagnostic tools should be used to confirm or exclude tuberculosis in suspect cases as the results are rapid, accurate and reliable.

Atypical chest radiological features in Covid 19: Case based review

Chest imaging plays an important role in the diagnosis and management of patients with COVID-19. Some patients may have atypical lesions on chest image. Awareness about the atypical imaging features is essential to avoid misdiagnosis/delayed diagnosis. Atypical chest imaging features in COVID-19 include central involvement, peribronchovascular involvement, isolated upper lobe involvement, nodular involvement, lobar consolidation, solitary involvement, unilateral lung involvement, interstitial emphysema, pneumomediastinum, subcutaneous emphysema, pneumothorax, hydropneumothorax, mediastinal adenopathy, cavitory lesions, bulls eye sign, necrotizing pneumonia with abscess, empyema, pleural and pericardial effusion, and subpleural sparing. In patients with atypical chest imaging features, when RT-PCR test results are positive diagnosis is certain. Diagnostic difficulty may arise when RT-PCR test results are negative. In such cases a proper epidemiologic history, typical clinical features, and exclusion of other causes for a similar chest imaging features may help in diagnosis. Causes for atypical chest imaging features include early stage of the disease when lesion can be unilateral or focal or single, late stage of the disease when lesions regress, coexisting diseases/conditions, preexisting lung parenchymal diseases, fluid overload, complications like other bacterial/ fungal infection/tuberculosis/barotrauma or involvement of other organs like kidney, heart, or liver which may lead to pleural effusion. Iatrogenic trauma, barotrauma, or drug-induced immunosuppression leading to opportunistic infections can also lead to chest imaging features. Some of the CT features like cavitory lesion, mediastinal adenopathy, and pleural and pericardial effusion may be due to complications during the course of the disease or coexistent diseases. In this pictorial essay we discuss some atypical chest images with salient learning points from each case. Awareness about the atypical chest imaging features is essential to avoid misdiagnosis/delayed diagnosis. Some of the atypical features may require further evaluation/follow up and management.