Imaging and clinical features of patients with 2019 novel coronavirus SARS-CoV-2

Abstract

Background: The pneumonia caused by the 2019 novel coronavirus (SARS-CoV-2, also called 2019-nCoV) recently break out in Wuhan, China, and was named as COVID-19. With the spread of the disease, similar cases have also been confirmed in other regions of China. We aimed to report the imaging and clinical characteristics of these patients infected with SARS-CoV-2 in Guangzhou, China.

Methods: All patients with laboratory-identified SARS-CoV-2 infection by real-time polymerase chain reaction (PCR) were collected between January 23, 2020, and February 4, 2020, in a designated hospital (Guangzhou Eighth People's Hospital). This analysis included 90 patients (39 men and 51 women; median age, 50 years (age range, 18-86 years). All the included SARS-CoV-2-infected patients underwent non-contrast enhanced chest computed tomography (CT). We analyzed the clinical characteristics of the patients, as well as the distribution characteristics, pattern, morphology, and accompanying manifestations of lung lesions. In addition, after 1-6 days (mean 3.5 days), follow-up chest CT images were evaluated to assess radiological evolution.

Findings: The majority of infected patients had a history of exposure in Wuhan or to infected patients and mostly presented with fever and cough. More than half of the patients presented bilateral, multifocal lung lesions, with peripheral distribution, and 53 (59%) patients had more than two lobes involved. Of all included patients, COVID-19 pneumonia presented with ground glass opacities in 65 (72%), consolidation in 12 (13%), crazy paving pattern in 11 (12%), interlobular thickening in 33 (37%), adjacent pleura thickening in 50 (56%), and linear opacities combined in 55 (61%). Pleural effusion, pericardial effusion, and lymphadenopathy were uncommon findings. In addition, baseline chest CT did not show any abnormalities in 21 patients (23%), but 3 patients presented bilateral ground glass opacities on the second CT after 3-4 days.

Conclusion: SARS-CoV-2 infection can be confirmed based on the patient's history, clinical manifestations, imaging characteristics, and laboratory tests. Chest CT examination plays an important role in the initial diagnosis of the novel coronavirus pneumonia. Multiple patchy ground glass opacities in bilateral multiple lobular with periphery distribution are typical chest CT imaging features of the COVID-19 pneumonia.

Keywords: 2019 novel coronavirus pneumonia; COVID-19; Computed tomography; Ground glass opacification; Imaging features; Infection; SARS-CoV-2.

Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Fig. 1

A 49-year-old man with history of recent travel to Wuhan presented with fever and cough for 6 days. a, b Non-contrast enhanced chest CT showed multiple peripheral patchy ground glass opacities in bilateral multiple lobular and subsegmental with obscure boundary (white arrows), as well as thickening of the adjacent pleura (black arrows). Besides, CT scan also demonstrated consolidation in the right lower lobe and air bronchogram sign in the lesion (red arrow)

Fig. 2

A 49-year-old woman with history of recent travel to Wuhan, presented with fever and cough for 8 days. a Non-contrast enhanced chest CT demonstrated multiple ground glass opacification in the both lower lobes (white arrows). b After 4 days, the follow-up CT scan showed enlarged lesions and increased density of the lesions compared with previous images, indicating disease progression (red arrows)

Fig. 3

A 62-year-old man with a history of exposure to a market in Guangzhou, presented with fever and cough for 11 days. a, b Non-contrast enhanced chest CT showed multiple ground glass opacification in the both lower lobes and thickening of the adjacent pleura. The interlobular septal thickening in regions of ground glass opacification, representing crazy paving pattern (red arrows)