Pulmonary fibrosis in critical ill patients recovered from COVID-19 pneumonia: Preliminary experience.

OBJECTIVE: To investigate chest computed tomography (CT) findings associated with severe COVID-19 pneumonia in the early recovery period. METHODS: We retrospectively analyzed the cases of patients diagnosed with severe COVID-19 pneumonia at a single center between January 12, 2020, and March 16, 2020. The twelve ICU patients studied had been diagnosed SARS-CoV-2 (COVID-19) nucleic acid positive. Patient clinical symptoms were relieved or disappeared, and basic clinical information and laboratory test results were collected. The study focused on the most recent CT imaging characteristics. RESULTS: The average age of the 12 patients was 58.8 ± 16.2 years. The most prevalent symptoms were fever (100%), dyspnea (100%), and cough (83.3%). All patients experienced acute respiratory distress syndrome (ARDS), of which 9 were moderate to severe. Six patients used noninvasive ventilators, and 4 patients used mechanical ventilation. One patient was treated with extracorporeal membrane oxygenation (ECMO). The lymphocyte count decreased to 0.67 ± 0.3 (× 10 9/L). The average day from illness onset to the last follow-up CT was 56.1 ± 7.7 d. The CT results showed a decrease in ground glass opacities (GGO), whereas fibrosis gradually increased. The common CT features included GGO (10/12, 83.3%), subpleural line (10/12, 83.3%), fibrous stripes (12/12, 100%), and traction bronchiectasis (10/12, 83.3%). Eight patients (66.7%) showed predominant reticulation and interlobular thickening. Four patients (33.3%) showed predominant GGO. Lung segments involved were 174/216 (80.6%). CONCLUSIONS: Fibrous stripes and GGO are common CT signs in critically ill patients with COVID-19 pneumonia in the early recovery period. Signs of pulmonary fibrosis in survivors should be carefully monitored.

Coronavirus disease 2019: initial chest CT findings.

OBJECTIVES: To systematically analyze CT findings during the early and progressive stages of natural course of coronavirus disease 2019 and also to explore possible changes in pulmonary parenchymal abnormalities during these two stages. METHODS: We retrospectively reviewed the initial chest CT data of 62 confirmed coronavirus disease 2019 patients (34 men, 28 women; age range 20-91 years old) who did not receive any antiviral treatment between January 21 and February 4, 2020, in Chongqing, China. Patients were assigned to the early-stage group (onset of symptoms within 4 days) or progressive-stage group (onset of symptoms within 4-7 days) for analysis. CT characteristics and the distribution, size, and CT score of pulmonary parenchymal abnormalities were assessed. RESULTS: In our study, the major characteristic of coronavirus disease 2019 was ground-glass opacity (61.3%), followed by ground-glass opacity with consolidation (35.5%), rounded opacities (25.8%), a crazy-paving pattern (25.8%), and an air bronchogram (22.6%). No patient presented cavitation, a reticular pattern, or bronchial wall thickening. The CT scores of the progressive-stage group were significantly greater than those of the early-stage group (p = 0.004). CONCLUSIONS: Multiple ground-glass opacities with consolidations in the periphery of the lungs were the primary CT characteristic of coronavirus disease 2019. CT score can be used to evaluate the severity of the disease. If these typical alterations are found, then the differential diagnosis of coronavirus disease 2019 must be considered. KEY POINTS: • Multiple GGOs with consolidations in the periphery of the lungs were the primary CT characteristic of COVID-19. • The halo sign may be a special CT feature in the early-stage COVID-19 patients. • Significantly increased CT score may indicate the aggravation of COVID-19 in the progressive stage.