Download PDF
CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2021; 31(S 01): S45-S52
DOI: 10.4103/ijri.IJRI_479_20
Review Article

Incidental chest computed tomography findings in asymptomatic Covid-19 patients. A multicentre Indian perspective

Rochita V Ramanan
Departments of Radiology and Infectious Diseases, Apollo Hospitals Chennai
,
Anagha R Joshi
Department of Radiology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion
,
Akash Venkataramanan
Department of Intern, Madras Medical College, Chennai, Tamil Nadu
,
Senthur P Nambi
Department of Infectious Diseases, Apollo Hospitals Chennai
,
Rashmi Badhe
Department of Radiology, Global Hospitals, Mumbai, Maharashtra, India
› Author Affiliations Financial support and sponsorship Nil.
› Further Information
   Permissions and Reprints

Abstract

In December 2019, an unprecedented outbreak of pneumonia of unknown etiology emerged called COVID-19. A vast number of people affected by this disease are asymptomatic and yet contagious with up to 79% of COVID-19 infections reportedly caused by undocumented infections. Surprisingly, these asymptomatic subjects are also known to quietly harbor pneumonia changes on CT scans. RT-PCR, the definitive test for COVID-19, maybe false negative in patients with COVID-19 pneumonia on CT. Incidental findings highly suspicious of COVID-19 pneumonia on CT chest of asymptomatic patients may increase as the community transmission of the virus rises and isolation restrictions are released. It is advisable to be aware of its appearances and the challenges associated with it.

Keywords

Asymptomatic COVID-19 patients - false positive RT-PCR - incidental COVID-19 pneumonia on CT - RT-PCR COVID-19


Publication History

Received: 08 June 2020

Accepted: 06 July 2020

Article published online:
13 July 2021

© 2021. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India

 

  • References

  • 1 Gandhi M, Yokoe DS, Havlir DV. Asymptomatic transmission, the Achilles’ heel of current strategies to control Covid-19. N Engl J Med 2020; 382: 2158-60
    CrossrefPubMedGoogle Scholar
  • 2 Li R, Pei S, Chen B, Song Y, Zhang T, Yang W, Shaman J. Substantial undocumented infection facilitates the rapid dissemination of novel coronavirus (SARS-CoV-2). Science 2020; 368: 489-93
    CrossrefPubMedGoogle Scholar
  • 3 Mizumoto K, Kagaya K, Zarebski A, Chowell G. Estimating the asymptomatic proportion of coronavirus disease 2019 (COVID-19) cases on board the Diamond Princess cruise ship, Yokohama, Japan, 2020. Eurosurveillance 2020; 25: 2000180
    CrossrefPubMedGoogle Scholar
  • 4 Nishiura H, Kobayashi T, Miyama T, Suzuki A, Jung S, Hayashi K. et al. Estimation of the asymptomatic ratio of novel coronavirus infections (COVID-19). medRxiv 2020. doi: 10.1101/2020.02.03.20020248.
  • 5 Shi H, Han X, Jiang N, Cao Y, Alwalid O, Gu J. et al. Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: A descriptive study. Lancet Infect Dis 2020; 20: 425-34
    CrossrefPubMedGoogle Scholar
  • 6 Inui S, Fujikawa A, Jitsu M, Kunishima N, Watanabe S, Suzuki Y. et al. Chest CT findings in cases from the cruise ship “Diamond Princess” with coronavirus disease 2019 (COVID-19). Radiol Cardiothorac Imaging 2020; 2: e200110
    CrossrefPubMedGoogle Scholar
  • 7 Ottestad W, Søvik S. COVID-19 patients with respiratory failure: What can we learn from aviation medicine? Br J Anaesth 2020. doi: 10.1016/j.bja.2020.04.012.
  • 8 Coen M, Allali G, Adler D, Serratrice J. Hypoxemia in COVID-19; Comment on: “The neuroinvasive potential of SARS-CoV2 may play a role in the respiratory failure of COVID-19 patients”. J Med Virol 2020. doi: 10.1002/jmv.26020.
  • 9 Simpson S, Kay FU, Abbara S, Bhalla S, Chung JH, Chung M. et al. Radiological society of North America Expert consensus statement on reporting chest CT findings related to COVID-19. Endorsed by the society of thoracic radiology, the American College of Radiology, and RSNA. Radiol Cardiothorac Imaging 2020; 2: e200152
    CrossrefPubMedGoogle Scholar
  • 10 Albano D, Bertagna F, Bertoli M, Bosio G, Lucchini S, Motta F. et al. Incidental findings suggestive of COVID-19 in asymptomatic patients undergoing nuclear medicine procedures in a high-prevalence region. J Nucl Med 2020; 61: 632-6
    CrossrefPubMedGoogle Scholar
  • 11 Barajas RF, Rufener G, Starkey J, Duncan T, Fuss C. Asymptomatic COVID-19: What the neuroradiologist needs to know about pulmonary manifestations. Am J Neuroradiol 2020; 41: 966-8
    CrossrefPubMedGoogle Scholar
  • 12 Rubin GD, Ryerson CJ, Haramati LB, Sverzellati N, Kanne JP, Raoof S. et al. The role of chest imaging in patient management during the COVID-19 pandemic: A multinational consensus statement from the Fleischner Society. Chest 2020; 158: 106-16
    CrossrefPubMedGoogle Scholar
  • 13 Salehi S, Abedi A, Balakrishnan S, Gholamrezanezhad A. Coronavirus disease 2019 (COVID-19): A systematic review of imaging findings in 919 patients. Am J Roentgenol 2020; 215: 87-93
    CrossrefPubMedGoogle Scholar
  • 14 Bernheim A, Mei X, Huang M, Yang Y, Fayad ZA, Zhang N. et al. Chest CT findings in coronavirus disease-19 (COVID-19): Relationship to duration of infection. Radiology 2020; 295: 200463
    CrossrefPubMedGoogle Scholar
  • 15 Wang Y, Dong C, Hu Y, Li C, Ren Q, Zhang X, Shi H, Zhou M. Temporal changes of CT findings in 90 patients with COVID-19 pneumonia: A longitudinal study. Radiology 2020:200843. doi: 10.1148/radiol.2020200843.
  • 16 Hani C, Trieu NH, Saab I, Dangeard S, Bennani S, Chassagnon G. et al. COVID-19 pneumonia: A review of typical CT findings and differential diagnosis. Diagn Interv Imaging 2020; 101: 236-8
    CrossrefPubMedGoogle Scholar
  • 17 Meng H, Xiong R, He R, Lin W, Hao B, Zhang L. et al. CT imaging and clinical course of asymptomatic cases with COVID-19 pneumonia at admission in Wuhan, China. J Infect 2020; 81: e33-9
    CrossrefPubMedGoogle Scholar
  • 18 Pozzessere C, Rotzinger DC, Ghaye B, Lamoth F, Beigelman-Aubry C. Incidentally discovered COVID-19 pneumonia: The role of diagnostic imaging. European Radiol 2020; May 4: 1-3 DOI: 10.1007/s00330-020-06914-6.
    CrossrefPubMedGoogle Scholar
  • 19 Kucirka LM, Lauer SA, Laeyendecker O, Boon D, Lessler J. Variation in false-negative rate of reverse transcriptase polymerase chain reaction–based SARS-CoV-2 tests by time since exposure. Ann Intern Med 2020. doi: 10.7326/M20-1495.
  • 20 Xie X, Zhong Z, Zhao W, Zheng C, Wang F, Liu J. Chest CT for typical 2019-nCoV pneumonia: Relationship to negative RT-PCR testing. Radiology 2020. doi: 10.1148/radiol.2020200343.
  • 21 Hope MD, Raptis CA, Shah A, Hammer MM, Henry TS. A role for CT in COVID-19? What data really tell us so far. Lancet 2020; 395: 1189-90
    CrossrefPubMedGoogle Scholar
  • 22 Ai T, Yang Z, Hou H, Zhan C, Chen C, Lv W. et al. Correlation of chest CT and RT-PCR testing in coronavirus disease 2019 (COVID-19) in China: A report of 1014 cases. Radiology 2020:200642. doi: 10.1148/radiol.2020200642.
  • 23 Merkus PJ, Klein WM. The value of chest CT as a COVID-19 screening tool in children. Eur Respir J 2020; 55: 2001241
    CrossrefPubMedGoogle Scholar