Top

Published in:

Open Access 01-12-2021 | Pulmonary Edema | Educational Review

Mimickers of novel coronavirus disease 2019 (COVID-19) on chest CT: spectrum of CT and clinical features

Authors: Ali H. Elmokadem, Nihal M. Batouty, Dalia Bayoumi, Basma N. Gadelhak, Rihame M. Abdel-Wahab, Mona Zaky, Sherif A. Abo-Hedibah, Ahmed Ehab, Ahmed El-Morsy

Published in: Insights into Imaging | Issue 1/2021

Abstract

COVID-19 (coronavirus disease 2019) is a recently emerged pulmonary infection caused by severe acute respiratory syndrome coronavirus (SARS-CoV-2). It started in Wuhan, China, in December 2019 and led to a highly contagious disease. Since then COVID-19 continues to spread, causing exponential morbidity and mortality and threatening economies worldwide. While the primary diagnostic test for COVID-19 is the reverse transcriptase–polymerase chain reaction (RT-PCR) assay, chest CT has proven to be a diagnostic tool of high sensitivity. A variety of conditions demonstrates CT features that are difficult to differentiate from COVID-19 rendering CT to be of low specificity. Radiologists and physicians should be aware of imaging patterns of these conditions to prevent an erroneous diagnosis that could adversely influence management and patients’ outcome. Our purpose is to provide a practical review of the conditions that mimic COVID-19. A brief description of the forementioned clinical conditions with their CT features will be included.

Available only for authorised users

Zhu N, Zhang D, Wang W et al (2020) A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med 382(8):727–733. https://doi.org/10.1056/NEJMoa2001017CrossRefPubMedPubMedCentral

World Health Organization. WHO Director-General's opening remarks at the media briefing on COVID-19; Available from: https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020 [accessed 11 April 2020].

World Health Organization. Coronavirus Disease 2019 (COVID-19) weekly epidimiological report –November 10, 2020. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports. Accessed 14th November 2020.

Fang Y, Zhang H, Xie J et al (2020) Sensitivity of Chest CT for COVID-19: Comparison to RT-PCR. Radiology 296(2):E115–E117. https://doi.org/10.1148/radiol.2020200432CrossRefPubMed

Xie X, Zhong Z, Zhao W, Zheng C, Wang F, Liu J (2020) Chest CT for typical 2019-nCoV pneumonia: relationship to negative RT-PCR testing. Radiology 296(2):E41–E45. https://doi.org/10.1148/radiol.20202003439CrossRefPubMed

Bernheim A, Mei X, Huang M et al (2020) Chest CT findings in coronavirus disease-19 (COVID-19): relationship to duration of infection. Radiology 295(3):200463. https://doi.org/10.1148/radiol.2020200463CrossRefPubMed

Pan F, Ye T, Sun P et al (2019) Time course of lung changes on chest CT during recovery from novel coronavirus (COVID-19) pneumonia. Radiology 295(3):715–721CrossRef

Ai T, Yang Z, Hou H et al (2019) Correlation of chest CT and RT-PCR testing in coronavirus disease (COVID-19) in China: a report of 1014 cases. Radiology 2020:200642. https://doi.org/10.1148/radiol.2020200642

Bai HX, Hsieh B, Xiong Z et al (2020) Performance of radiologists in differentiating COVID-19 from viral pneumonia on chest CT. Radiology 200823. https://doi.org/10.1148/radiol.2020200823.

10.

Guan WJ, Ni ZY, Hu Y et al (2020) Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 382(18):1708–1720. https://doi.org/10.1056/NEJMoa2002032CrossRefPubMed

11.

Simpson S, Kay FU, Abbara S et al (2020) 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. Radiology Cardiothorac Imaging. https://doi.org/10.1148/ryct.2020200152

12.

Chen N, Zhou M, Dong X et al (2020) Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 395(10223):507–513. https://doi.org/10.1016/S0140-6736(20)30211-7CrossRefPubMedPubMedCentral

13.

Tan L, Wang Q, Zhang D et al (2020) Lymphopenia predicts disease severity of COVID-19: a descriptive and predictive study. Signal Transduct Target Ther 5(1):1–3

14.

Chung M, Bernheim A, Mei X et al (2020) CT imaging features of 2019 novel coronavirus (2019-nCoV). Radiology 295(1):200230. https://doi.org/10.1148/radiol.2020200230CrossRef

15.

Kong W, Agarwal PP (2020) Chest imaging appearance of COVID-19 infection. Radiology Cardiothorac Imaging 2(1):200028CrossRef

16.

Salehi S, Abedi A, Balakrishnan S (2019) Coronavirus disease (COVID-19): a systematic review of imaging findings in 919 patients. AJR Am J Roentgenol 2020:1–7. https://doi.org/10.2214/AJR.20.23034CrossRef

17.

Zhou S, Wang Y, Zhu T, Xia L (2020) CT features of coronavirus disease 2019 (COVID-19) pneumonia in 62 patients in Wuhan, China. AJR Am J Roentgenol 214(6):1–8. https://doi.org/10.2214/AJR.20.22975CrossRef

18.

Wang Y, Dong C, Hu Y et al (2020) Temporal changes of CT findings in 90 patients with COVID-19 pneumonia: a longitudinal study. Radiology 200843. https://doi.org/10.1148/radiol.2020200843.

19.

Oikonomou A, Prassopoulos P (2013) Mimics in chest disease: interstitial opacities. Insights Imaging 4(1):9–27CrossRefPubMed

20.

Zhao W, Zhong Z, Xie X, Yu Q, Liu J (2020) Relation between chest CT findings and clinical conditions of coronavirus disease (COVID-19) pneumonia: a multicenter study. AJR Am J Roentgenol 214(5):1072–1077CrossRefPubMed

21.

Leonard-Lorant I, Delabranche X, Severac F et al (2020) Acute pulmonary embolism in COVID-19 patients on CT angiography and relationship to D-dimer levels. Radiology 201561

22.

Song F, Shi N, Shan F et al (2020) Emerging 2019 novel coronavirus (2019-nCoV) pneumonia. Radiology 295(1):200274. https://doi.org/10.1148/radiol.2020200274CrossRef

23.

Koo HJ, Lim S, Choe J, Choi SH, Sung H, Do KH (2018) Radiographic and CT features of viral pneumonia. Radiographics 38(3):719–739. https://doi.org/10.1148/rg.2018170048CrossRefPubMed

24.

Marcos MA, Esperatti M, Torres A (2009) Viral pneumonia. Curr Opin Inf Dis 22(2):143–147. https://doi.org/10.1097/QCO.0b013e328328cf65CrossRef

25.

Kim MC, Kim MY, Lee HJ et al (2016) CT findings in viral lower respiratory tract infections caused by parainfluenza virus, influenza virus and respiratory syncytial virus. Medicine (Baltimore) 95(26):e4003. https://doi.org/10.1097/MD.0000000000004003CrossRef

26.

Marchiori E, Zanetti G, D’Ippolito G et al (2011) Swine-origin influenza A (H1N1) viral infection: thoracic findings on CT. AJR Am J Roentgenol 196(6):W723–W728. https://doi.org/10.2214/AJR.10.5109CrossRefPubMed

27.

Al-Tawfiq JA, Zumla A, Memish ZA (2014) Coronaviruses: severe acute respiratory syndrome coronavirus and Middle East respiratory syndrome coronavirus in travelers. Curr Opin Inf Dis 27(5):411–417. https://doi.org/10.1097/QCO.0000000000000089CrossRef

28.

Lee JW, Lee KS, Lee HY et al (2010) Cryptogenic organizing pneumonia: serial high-resolution CT findings in 22 patients. AJR Am J Roentgenol 195(4):916–922. https://doi.org/10.2214/AJR.09.3940CrossRefPubMed

29.

Zare Mehrjardi M, Kahkouee S, Pourabdollah M (2017) Radio-pathological correlation of organizing pneumonia (OP): a pictorial review. Br J Radiol 90(1071):20160723. https://doi.org/10.1259/bjr.20160723CrossRefPubMedPubMedCentral

30.

Assayag D, Elicker BM, Urbania TH et al (2014) Rheumatoid arthritis–associated interstitial lung disease: radiologic identification of usual interstitial pneumonia pattern. Radiology 270(2):583–588. https://doi.org/10.1148/radiol.13130187CrossRefPubMedPubMedCentral

31.

Ferguson EC, Berkowitz EA (2012) Lung CT: part 2, the interstitial pneumonias?? Clinical, histologic, and CT manifestations. AJR Am J Roentgenol 199(4):W464–W476. https://doi.org/10.2214/AJR.10.7309CrossRefPubMed

32.

Rossi SE, Erasmus JJ, McAdams HP, Sporn TA, Goodman PC (2000) Pulmonary drug toxicity: radiologic and pathologic manifestations. Radiographics 20(5):1245–1259. https://doi.org/10.1148/radiographics.20.5.g00se081245CrossRefPubMed

33.

Rosenow EC III, Myers JL, Swensen SJ, Pisani RJ (1992) Drug-induced pulmonary disease: an update. Chest 102(1):239–250CrossRefPubMed

34.

Sakao S, Tatsumi K (2012) Molecular mechanisms of lung-specific toxicity induced by epidermal growth factor receptor tyrosine kinase inhibitors. Oncol Lett 4(5):865–867. https://doi.org/10.3892/ol.2012.872CrossRefPubMedPubMedCentral

35.

Mueller-Mang C, Grosse C, Schmid K, Stiebellehner L, Bankier AA (2007) What every radiologist should know about idiopathic interstitial pneumonias. Radiographics 27(3):595–615CrossRefPubMed

36.

Choi SH, Huh JW, Hong SB et al (2015) Clinical characteristics and outcomes of severe rhinovirus-associated pneumonia identified by bronchoscopic bronchoalveolar lavage in adults: comparison with severe influenza virus-associated pneumonia. J Clin Virol 62:41–47. https://doi.org/10.1016/j.jcv.2014.11.010CrossRefPubMed

37.

Nambu A, Ozawa K, Kobayashi N, Tago M (2014) Imaging of community-acquired pneumonia: Roles of imaging examinations, imaging diagnosis of specific pathogens and discrimination from noninfectious diseases. World J Radiol 6(10):779–793. https://doi.org/10.4329/wjr.v6.i10.779CrossRefPubMedPubMedCentral

38.

Miyashita N, Sugiu T, Kawai Y et al (2009) Radiographic features of Mycoplasma pneumoniae pneumonia: differential diagnosis and performance timing. BMC Med Imaging 9:7. https://doi.org/10.1186/1471-2342-9-7CrossRefPubMedPubMedCentral

39.

Hardak E, Brook O, Yigla M (2010) Radiological features of pneumocystisjirovecii pneumonia in immunocompromised patients with and without AIDS. Lung 188(2):159–163CrossRefPubMed

40.

Kanne JP, Yandow DR, Meyer CA (2012) Pneumocystis jirovecii pneumonia: high-resolution CT findings in patients with and without HIV infection. AJR Am J Roentgenol 198(6):W555–W561CrossRefPubMed

41.

Assaad S, Kratzert WB, Shelley B, Friedman MB, Perrino Jr A (2018) Assessment of pulmonary edema: principles and practice. J Cardiothorac Vasc Anesth 32(2):901–914. https://doi.org/10.1053/j.jvca.2017.08.028CrossRefPubMed

42.

Yacoub W, Attia M, Affes M, et al. Ground-glass opacities on chest CT scans: how to deal with them? 2019. European Congress of Radiology 2019.

43.

Desai SR, Wells AU, Suntharalingam G, Rubens MB, Evans TW, Hansell DM (2001) Acute respiratory distress syndrome caused by pulmonary and extrapulmonary injury: a comparative CT study. Radiology 218(3):689–693. https://doi.org/10.1148/radiology.218.3.r01mr31689CrossRefPubMed

44.

Magee AL, Montner SM, Husain A, Adegunsoye A, Vij R, Chung JH (2016) Imaging of hypersensitivity pneumonitis. Radiol Clin 54(6):1033–1046. https://doi.org/10.1016/j.rcl.2016.05.013CrossRef

45.

Hanak V, Golbin JM, and Ryu JH. Causes and presenting features in 85 consecutive patients with hypersensitivity pneumonitis. in Mayo Clinic Proceedings. 2007. Elsevier.

46.

Jeong YJ, Kim KI, Seo IJ et al (2007) Eosinophilic lung diseases: a clinical, radiologic, and pathologic overview. Radiographics 27(3):617–637. https://doi.org/10.1148/rg.273065051CrossRefPubMed

47.

Castañer E, Alguersuari A, Gallardo X, Andreu M, Pallardó Y, Mata JM, Ramírez J (2010) When to suspect pulmonary vasculitis: radiologic and clinical clues. Radiographics 30(1):33–53CrossRefPubMed

48.

Kroll RR, Kumar S, Grossman RF, Price C, Srigley JR (2016) Rare presentation of pulmonary alveolar proteinosis causing acute respiratory failure. Can Respir J. https://doi.org/10.1155/2016/4064539CrossRefPubMedPubMedCentral

49.

Akira M, Inoue Y, Arai T et al (2016) Pulmonary fibrosis on high-resolution CT of patients with pulmonary alveolar proteinosis. AJR Am J Roentgenol 207(3):544–551CrossRefPubMed

50.

Hatabu H, Hunninghake GM, Lynch DA (2019) Interstitial lung abnormality: recognition and perspectives. Radiology 291(1):1–3. https://doi.org/10.1148/radiol.2018181684CrossRefPubMed

51.

Washko GR, Hunninghake GM, Fernandez IE et al (2011) Lung volumes and emphysema in smokers with interstitial lung abnormalities. N Engl J Med 364(10):897–906CrossRefPubMedPubMedCentral

52.

Jin GY, Lynch D, Chawla A et al (2013) Interstitial lung abnormalities in a CT lung cancer screening population: prevalence and progression rate. Radiology 268(2):563–571CrossRefPubMedPubMedCentral

53.

Miller WT Jr, Mickus TJ, Barbosa E Jr et al (2011) CT of viral lower respiratory tract infections in adults: comparison among viral organisms and between viral and bacterial infections. AJR Am J Roentgenol 197(5):1088–1095CrossRefPubMed

54.

Rafat C, Klouche K, Ricard JD et al (2013) Severe measles infection: the spectrum of disease in 36 critically ill adult patients. Medicine (Baltimore) 92(5):257. https://doi.org/10.1097/MD.0b013e3182a713c2CrossRef

Title: Mimickers of novel coronavirus disease 2019 (COVID-19) on chest CT: spectrum of CT and clinical features
Authors: Ali H. Elmokadem
Nihal M. Batouty
Dalia Bayoumi
Basma N. Gadelhak
Rihame M. Abdel-Wahab
Mona Zaky
Sherif A. Abo-Hedibah
Ahmed Ehab
Ahmed El-Morsy
Publication date: 01-12-2021
Publisher: Springer International Publishing
Keywords: Pulmonary Edema
Pleural Effusion
Pneumonia
Acute Respiratory Distress-Syndrome
COVID-19
Published in: Insights into Imaging / Issue 1/2021
Electronic ISSN: 1869-4101
DOI: https://doi.org/10.1186/s13244-020-00956-6

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Mimickers of novel coronavirus disease 2019 (COVID-19) on chest CT: spectrum of CT and clinical features

Abstract

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 1/2021

Preprocedural fasting for contrast-enhanced CT: when experience meets evidence

Detection of lung lesions in breath-hold VIBE and free-breathing Spiral VIBE MRI compared to CT

CT facilitates improved diagnosis of adult intestinal malrotation: a 7-year retrospective study based on 332 cases

Computed tomography-based multiple body composition parameters predict outcomes in Crohn’s disease

Saliency-based 3D convolutional neural network for categorising common focal liver lesions on multisequence MRI

Clinical value of 3'-deoxy-3'-[18F]fluorothymidine-positron emission tomography for diagnosis, staging and assessing therapy response in lung cancer