Computed Tomography (CT)

 The first of three clinical scenarios presented to the panel with final recommendations. Mild features refer to absence of significant pulmonary dysfunction or damage. Pre-test probability is based upon background prevalence of disease and may be further modified by individual’s exposure risk. The absence of resource constraints corresponds to sufficient availability of personnel, personal protective equipment, COVID-19 testing, hospital beds, and/or ventilators with the need to rapidly triage patients. Contextual detail and considerations for imaging with CXR (chest radiography) versus CT (computed tomography) are presented in the text. (Pos=positive, Neg=negative, Mod=moderate). [Although not covered by this scenario and not shown in the figure, in the presence of significant resources constraints, there is no role for imaging of patients with mild features of COVID-19.] Image courtesy of the journal Radiology

Chest CT findings of pediatric patients with COVID-19 on transaxial images. Male, 2 months old, 2 days after symptom onset. Patchy ground-glass opacities GGO in the right lower lobe. Image courtesy of Radiology: Cardiothoracic Imaging

Sonogram taken under rib cage shows liver (grey) with curved diaphragm-lung border (white). Arrows point to vertical B lines (white) demonstrating diseased lung tissue. The more B lines the worse the disease. Healing is measured by reduction in the number of B lines.

CT scoring criteria were applied to images from sequential chest CT examinations. A, Initial chest CT image obtained 2 days after onset of symptoms shows small region of subpleural ground-glass opacities in right lower lobe, for CT score of 1. B, Chest CT image obtained on day 3 of treatment shows slightly enlarged region of subpleural ground-glass opacities with partial crazy-paving pattern and consolidation, for CT score of 3. C, Chest CT image obtained on day 5 of treatment shows partial resolution of consolidation, for CT score of 2. D, Chest CT image obtained on day 14 of treatment shows continued resolution of consolidation with minimal residual ground-glass opacities, for CT score of 1. Image courtesy of American Journal of Roentgenology (AJR)

Fig 1. A sample scoring on CT images of a 63-year-old woman from mortality group demonstrated a total score of 63. It was calculated as: for upper zone (A), 3 (consolidation) × 3 (50–75% distribution) × 2 (both right and left lungs) + 2 (ground glass opacity) ×1 (< 25% distribution) × 2 (both right and left lungs); for middle zone (B), 3 (consolidation) × 2 (25–50% distribution) × 2 (both right and left lungs) + 2 (ground glass opacity) × 2 (25–50% distribution) × 2 (both right and left lungs); for lower zone (C), 3 (consolidation) × (2 (25–50% distribution of the right lung) + 3 (50–75% distribution of the left lung)) + 2 (ground glass opacity) × (2 (25–50% distribution of the right lung) + 1 (< 25% distribution of the left lung)) Yuan et al, 2020 (CC BY 4.0)