Distribution of Chest Computed Tomography Findings in 202 Saudi Patients with COVID-19

ORIGINAL ARTICLE
Tasneem S. A. Elmahdi, Mayson Wanasi, Awadia Gareeballah, Mahasin G. Hassan, Walaa Alsharif, Mariam Khogaly Elamin, Zohida A. Abdelgabar

 
International Journal of Biomedicine. 2023;13(2):250-254.
DOI: 10.21103/Article13(2)_OA8
Originally published June 5, 2023

Abstract: 

Background: Computed tomography (CT) is one radiographic imaging modality that plays an essential role in detecting, characterizing, and assessing the complications of COVID-19. The aim of this study was to determine the distribution of chest CT findings (typical and associated) in 202 Saudi patients with COVID-19.
Methods and Results: Medical records of 202 patients diagnosed in Ohod and Al-Madinah National Hospitals (Al-Madinah Al-Monwarahwith) with positive COVID-19 infection from February 1 to March 1, 2021, were analyzed in this retrospective study. A verbal ethical agreement was obtained from the radiology department in these hospitals. Patients' demographic data and chest CT findings were evaluated.
The majority of the sample was male 128(63.4%), and the largest age group was 50–64 years (41.1%). The typical chest CT findings for COVID-19 pneumonia (ground-glass opacification) were bilateral in peripheral lung fields (91.58%), subpleural zones (1.98%), and central zones (0.59%). Among COVID-19-associated findings, septal thickening was found in 4(2.0%) cases, air bronchogram in 13(6.4%) cases, lung fibrosis in 3(1.5%) cases, the atelectatic in 5(2.5%) cases, pleural effusion in 15(7.4%) cases, and pulmonary embolism in 1(0.5%) case. There was no significant difference in the COVID-19-associated findings among different age groups and genders.
Conclusion: Pleural effusion and air bronchogram were the most common findings associated with ground-glass opacification in unenhanced chest CT.

Keywords: 
COVID-19 • ground-glass opacification • plural effusion • computed tomography
References: 

1. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, Qiu Y, Wang J, Liu Y, Wei Y, Xia J, Yu T, Zhang X, Zhang L. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020 Feb 15;395(10223):507-513. doi: 10.1016/S0140-6736(20)30211-7.
2. Madabhavi I, Sarkar M, Kadakol N. COVID-19: a review. Monaldi Arch Chest Dis. 2020 May 14;90(2). doi: 10.4081/monaldi.2020.1298.
3. AlJishi JM, Alhajjaj AH, Alkhabbaz FL, AlAbduljabar TH, Alsaif A, Alsaif H, Alomran KS, Aljanobi GA, Alghawi Z, Alsaif M, Al-Tawfiq JA. Clinical characteristics of asymptomatic and symptomatic COVID-19 patients in the Eastern Province of Saudi Arabia. J Infect Public Health. 2021 Jan;14(1):6-11. doi: 10.1016/j.jiph.2020.11.002.
4. Saudi Arabia: Coronavirus Pandemic Country Profile. Available from:  https://ourworldindata.org/coronavirus/country/saudi-arabia
5. Yang W, Sirajuddin A, Zhang X, Liu G, Teng Z, Zhao S, Lu M. The role of imaging in 2019 novel coronavirus pneumonia (COVID-19). Eur Radiol. 2020 Sep;30(9):4874-4882. doi: 10.1007/s00330-020-06827-4.
6. Aljondi R, Alghamdi S. Diagnostic Value of Imaging Modalities for COVID-19: Scoping Review. J Med Internet Res. 2020 Aug 19;22(8):e19673. doi: 10.2196/19673.
7. Assiri A, Al-Tawfiq JA, Al-Rabeeah AA, Al-Rabiah FA, Al-Hajjar S, Al-Barrak A, Flemban H, Al-Nassir WN, Balkhy HH, Al-Hakeem RF, Makhdoom HQ, Zumla AI, Memish ZA. Epidemiological, demographic, and clinical characteristics of 47 cases of Middle East respiratory syndrome coronavirus disease from Saudi Arabia: a descriptive study. Lancet Infect Dis. 2013 Sep;13(9):752-61. doi: 10.1016/S1473-3099(13)70204-4.
8. Inui S, Gonoi W, Kurokawa R, Nakai Y, Watanabe Y, Sakurai K, Ishida M, Fujikawa A, Abe O. The role of chest imaging in the diagnosis, management, and monitoring of coronavirus disease 2019 (COVID-19). Insights Imaging. 2021 Nov 2;12(1):155. doi: 10.1186/s13244-021-01096-1.
9. Zhou H, Xu K, Shen Y, Fang Q, Chen F, Sheng J, Zhao F, Lou H. Coronavirus disease 2019 (COVID-19): chest CT characteristics benefit to early disease recognition and patient classification-a single center experience. Ann Transl Med. 2020 Jun;8(11):679. doi: 10.21037/atm-20-2119a.
10. Fan N, Fan W, Li Z, Shi M, Liang Y. Imaging characteristics of initial chest computed tomography and clinical manifestations of patients with COVID-19 pneumonia. Jpn J Radiol. 2020 Jun;38(6):533-538. doi: 10.1007/s11604-020-00973-x.
11. Wang H, Wei R, Rao G, Zhu J, Song B. Characteristic CT findings distinguishing 2019 novel coronavirus disease (COVID-19) from influenza pneumonia. Eur Radiol. 2020 Sep;30(9):4910-4917. doi: 10.1007/s00330-020-06880-z. 
12. Salehi S, Abedi A, Balakrishnan S, Gholamrezanezhad A. Coronavirus Disease 2019 (COVID-19): A Systematic Review of Imaging Findings in 919 Patients. AJR Am J Roentgenol. 2020 Jul;215(1):87-93. doi: 10.2214/AJR.20.23034.
13. Porcel JM. Pleural diseases and COVID-19: ubi fumus, ibi ignis. Eur Respir J. 2020 Nov 19;56(5):2003308. doi: 10.1183/13993003.03308-2020. 
14. Zhou S, Wang Y, Zhu T, Xia L. CT Features of Coronavirus Disease 2019 (COVID-19) Pneumonia in 62 Patients in Wuhan, China. AJR Am J Roentgenol. 2020 Jun;214(6):1287-1294. doi: 10.2214/AJR.20.22975.
15. Aljondi R, Alghamdi S, Tajaldeen A, Abdelaziz I, Bushara L, Alghamdi HA, Alhinishi H, Alharbi B, Alshehri R, Aljehani A, Almotairi M. Chest Radiological Findings and Clinical Characteristics of Laboratory-Confirmed COVID-19 Patients from Saudi Arabia. Med Sci Monit. 2021 Sep 14;27:e932441. doi: 10.12659/MSM.932441. 
16. Capuano A, Rossi F, Paolisso G. Covid-19 Kills More Men Than Women: An Overview of Possible Reasons. Front Cardiovasc Med. 2020 Jul 17;:131. doi: 10.3389/fcvm.2020.00131.
17. Mendes A, Serratrice C, Herrmann FR, Genton L, Périvier S, Scheffler M, Fassier T, Huber P, Jacques MC, Prendki V, Roux X, Di Silvestro K, Trombert V, Harbarth S, Gold G, Graf CE, Zekry D. Predictors of In-Hospital Mortality in Older Patients With COVID-19: The COVIDAge Study. J Am Med Dir Assoc. 2020 Nov;21(11):1546-1554.e3. doi: 10.1016/j.jamda.2020.09.014.
18. Pakdemirli E, Mandalia U, Monib S. Characteristics of Chest CT Images in Patients With COVID-19 Pneumonia in London, UK. Cureus. 2020 Sep 7;12(9):e10289. doi: 10.7759/cureus.10289.
19. Simpson S, Kay FU, Abbara S, Bhalla S, Chung JH, Chung M, Henry TS, Kanne JP, Kligerman S, Ko JP, Litt H. 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 - Secondary Publication. J Thorac Imaging. 2020 Jul;35(4):219-227. doi: 10.1097/RTI.0000000000000524. 
20. Zhou S, Zhu T, Wang Y, Xia L. Imaging features and evolution on CT in 100 COVID-19 pneumonia patients in Wuhan, China. Eur Radiol. 2020 Oct;30(10):5446-5454. doi: 10.1007/s00330-020-06879-6. 
21. Fang Y, Zhang H, Xie J, Lin M, Ying L, Pang P, Ji W. Sensitivity of Chest CT for COVID-19: Comparison to RT-PCR. Radiology. 2020 Aug;296(2):E115-E117. doi: 10.1148/radiol.2020200432.
22. Yang W, Cao Q, Qin L, Wang X, Cheng Z, Pan A, Dai J, Sun Q, Zhao F, Qu J, Yan F. Clinical characteristics and imaging manifestations of the 2019 novel coronavirus disease (COVID-19):A multi-center study in Wenzhou city, Zhejiang, China. J Infect. 2020 Apr;80(4):388-393. doi: 10.1016/j.jinf.2020.02.016. 
23. Hussein M, Haq IU, Hameed M, Thomas M, Elarabi A, Allingawi M, Al-Bozom I. Pleural effusion as an isolated finding in COVID-19 infection. Respir Med Case Rep. 2020 Oct 21;31:101269. doi: 10.1016/j.rmcr.2020.101269.
24. Chong WH, Saha BK, Conuel E, Chopra A. The incidence of pleural effusion in COVID-19 pneumonia: State-of-the-art review. Heart Lung. 2021 Jul-Aug;50(4):481-490. doi: 10.1016/j.hrtlng.2021.02.015.
25.Guo Y, Zhang L, Li R, Tian S, Dong W. Clinical characteristics of COVID‑19 complicated with pleural and pericardial effusion in 10 patients. Med J Wuhan Univ. 2021;42(6):878–883.
26. Wei XS, Wang X, Ye LL, Niu YR, Peng WB, Wang ZH, Zhang JC, Zhou Q. Pleural effusion as an indicator for the poor prognosis of COVID-19 patients. Int J Clin Pract. 2021 Jun;75(6):e14123. doi: 10.1111/ijcp.14123.
27. Hansell DM, Bankier AA, MacMahon H, McLoud TC, Müller NL, Remy J. Fleischner Society: glossary of terms for thoracic imaging. Radiology. 2008 Mar;246(3):697-722. doi: 10.1148/radiol.2462070712.
28. Song F, Shi N, Shan F, Zhang Z, Shen J, Lu H, Ling Y, Jiang Y, Shi Y. Emerging 2019 Novel Coronavirus (2019-nCoV) Pneumonia. Radiology. 2020 Dec;297(3):E346. doi: 10.1148/radiol.2020209021. Erratum for: Radiology. 2020 Apr;295(1):210-217.
29. Yoon SH, Lee KH, Kim JY, Lee YK, Ko H, Kim KH, Park CM, Kim YH. Chest Radiographic and CT Findings of the 2019 Novel Coronavirus Disease (COVID-19): Analysis of Nine Patients Treated in Korea. Korean J Radiol. 2020 Apr;21(4):494-500. doi: 10.3348/kjr.2020.0132.
30. Yuan M, Yin W, Tao Z, Tan W, Hu Y. Association of radiologic findings with mortality of patients infected with 2019 novel coronavirus in Wuhan, China. PLoS One. 2020 Mar 19;15(3):e0230548. doi: 10.1371/journal.pone.0230548.
31. Wu J, Wu X, Zeng W, Guo D, Fang Z, Chen L, Huang H, Li C. Chest CT Findings in Patients With Coronavirus Disease 2019 and Its Relationship With Clinical Features. Invest Radiol. 2020 May;55(5):257-261. doi: 10.1097/RLI.0000000000000670. 
32.Li K, Wu J, Wu F, Guo D, Chen L, Fang Z, Li C. The Clinical and Chest CT Features Associated With Severe and Critical COVID-19 Pneumonia. Invest Radiol. 2020 Jun;55(6):327-331. doi: 10.1097/RLI.0000000000000672.
33.Xie Y, Wang X, Yang P, Zhang S. COVID-19 Complicated by Acute Pulmonary Embolism. Radiol Cardiothorac Imaging. 2020 Mar 16;2(2):e200067. doi: 10.1148/ryct.2020200067.
34.Grillet F, Behr J, Calame P, Aubry S, Delabrousse E. Acute Pulmonary Embolism Associated with COVID-19 Pneumonia Detected with Pulmonary CT Angiography. Radiology. 2020 Sep;296(3):E186-E188. doi: 10.1148/radiol.2020201544.
35.Oudkerk M, Büller HR, Kuijpers D, van Es N, Oudkerk SF, McLoud T, Gommers D, van Dissel J, Ten Cate H, van Beek EJR. Diagnosis, Prevention, and Treatment of Thromboembolic Complications in COVID-19: Report of the National Institute for Public Health of the Netherlands. Radiology. 2020 Oct;297(1):E216-E222. doi: 10.1148/radiol.2020201629.
36.Léonard-Lorant I, Delabranche X, Séverac F, Helms J, Pauzet C, Collange O, Schneider F, Labani A, Bilbault P, Molière S, Leyendecker P, Roy C, Ohana M. Acute Pulmonary Embolism in Patients with COVID-19 at CT Angiography and Relationship to d-Dimer Levels. Radiology. 2020 Sep;296(3):E189-E191. doi: 10.1148/radiol.2020201561.
37.Poyiadji N, Cormier P, Patel PY, Hadied MO, Bhargava P, Khanna K, Nadig J, Keimig T, Spizarny D, Reeser N, Klochko C, Peterson EL, Song T. Acute Pulmonary Embolism and COVID-19. Radiology. 2020 Dec;297(3):E335-E338. doi: 10.1148/radiol.2020201955.

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Received March 6, 2023.
Accepted April 6, 2023.
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