Radiological findings of 2019 n cov pneumonia

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Nicolas Ugarte

Hallazgos radiológicos de la experiencia de neumonía PMH de 2019-nCoV

Health & Medicine

Radiological Findings of
2019-nCoV Pneumonia
PMH Experience
Prepared by Dr SK Li and & Dr YC Lee
Department of Radiology
Caritas Medical Centre/ North Lantau Hospital/ Princess
Margaret Hospital/ Yan Chai Hospital
10 Feb 2020
For internal circulation only
by COC(Rad)

• Reviewed the first 9 thoracic CXR and CT scans of the confirmed
patients with 2019-nCoV pneumonia
• Summarized the findings and observed a pattern
2

Findings in common:
• Bilateral air-space opacities/ infiltrates
• No pleural effusion
4

The Key +ve CT Findings
1. Ground-glass opacities (100%)
2. Involvement of multiple lobes (100%)
3. Subpleural or peripheral distribution (often central-sparing) (100%)
4. Consolidations (77.8%)
5. Septal thickening (55.6%)
6. Bronchial dilation and wall thickening (55.6%)
5

The Important –ve CT Findings
1. Pleural effusion (0%)
2. Lymphadenopathy (0%)
3. Lung nodule (0%)
4. Specific zonal predominance (variable)
6

Patient demographics and imaging features
Total scans included 9
Age 63.7 (39-75)
Sex
Male 6
Female 3
Days from diagnosis to CT 2.8 (39-75)
CT technique
HRCT 7
Conventional CT 2
CT findings
GGO 9 (100%)
All lobes involvement 8 (88.9%)
Upper lobes sparing 1
Peripheral subpleural distribution 9 (100%)
Zonal predominance
Upper 3 (33.3%)
Basal 3 (33.3%)
Diffuse 3 (33.3%)
Interlobular/ intralobular septal thickening 5 (55.6%)
Consolidation 7 (77.8%)
Bronchial wall thickening or dilatation 5 (55.6%)
Centrilobular nodule 0 (0%)
Pleural effusion 0 (0%)
Lymph node enlargement 0 (0%)
Age and days expressed in means with range in brackets
CT findings expressed in case number with proportions in brackets
7

Involvement of multiple lobes
• Often more than one lobes (if not all) show GGO +/- consolidations
13

Peripheral/ subpleural distribution
• Peripheral/ subpleural regions are
almost invariably involved
• Central regions are often spared/ or
involved in a later stage
16

Septal thickening + GGO  crazy-paving pattern
26

Septal thickening + GGO  crazy-paving pattern
27

Bronchial dilatation + wall thickening
28

Bronchial dilatation + wall thickening
29

The Important –ve CT Findings
1. Pleural effusion (0%)
2. Lymphadenopathy (0%)
3. Lung nodule (0%)
4. Specific zonal predominance (variable, upper/basal/diffuse
distribution each 33.3%)
30

Why imaging is important
• There have been reports of cases with serial –ve PCR test results
ending up +ve later
• Typical CT findings in combination of suspicious clinical findings probably
warrant management as potential carriers even if PCR tests show –ve results
• Community outbreak is inevitable
• Some outpatient/ routine scans may be performed for other indications
• If typical nCoV CT findings are seen, these reports require early attention and
possible further investigations ASAP
31

What’s next for Radiology
• Progress CT findings for different clinical courses including improving,
worsening, critical cases
• Follow-up CT findings for patients with prior infection to monitor
pulmonary sequalae
• Work in close collaboration with clinicians down the road
32

Special thanks
• To our PMH Infectious Disease team members who are working under
great risk in managing the isolated patients and providing us with
invaluable clinical information
33

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