radiological findings of 2019-ncov pneumonia pmh...
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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)
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• Reviewed the first 9 thoracic CXR and CT scans of the confirmed patients with 2019-nCoV pneumonia
• Summarized the findings and observed a pattern
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CXR findings are non-specific
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Findings in common: • Bilateral air-space opacities/ infiltrates • No pleural effusion
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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%)
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The Important –ve CT Findings
1. Pleural effusion (0%)
2. Lymphadenopathy (0%)
3. Lung nodule (0%)
4. Specific zonal predominance (variable)
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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
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Examples
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Ground-glass opacities (GGO)
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Ground-glass opacities (GGO)
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Ground-glass opacities (GGO)
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Ground-glass opacities (GGO)
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Involvement of multiple lobes
• Often more than one lobes (if not all) show GGO +/- consolidations
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Involvement of multiple lobes
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Involvement of multiple lobes
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Peripheral/ subpleural distribution
• Peripheral/ subpleural regions are almost invariably involved
• Central regions are often spared/ or involved in a later stage
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Peripheral/ subpleural distribution
• Peripheral/ subpleural regions are almost invariably involved
• Central regions are often spared/ or involved in a later stage
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Peripheral/ subpleural distribution
• Peripheral/ subpleural regions are almost invariably involved
• Central regions are often spared/ or involved in a later stage
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Peripheral/ subpleural distribution
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Consolidations
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Consolidations
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Consolidations
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Consolidations
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Septal thickening
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Septal thickening
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Septal thickening + GGO crazy-paving pattern
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Septal thickening + GGO crazy-paving pattern
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Bronchial dilatation + wall thickening
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Bronchial dilatation + wall thickening
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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%)
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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
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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
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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
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