2020-06-03 14:44:31 - 11
How should the radiologist proceed when faced with pulmonary abnormalities identified on CT scans of the abdomen during the SARSCoV-2 pandemic?
Findings of lung lesions in COVID-19 include ground-glass opacities and peripheral consolidations, which may have a nodular appearance and predominance at baseline. Pleural effusions are not commonly seen (1,2). Although not specific, these findings should lead to the suspicion of SARS-CoV-2 infection in this pandemic period. The radiologist should always review the lung bases when analyzing CT scans of the abdomen. If pulmonary abnormalities suggestive of pneumonia are identified, even when there is no clinical suspicion of COVID-19, it is the responsibility of the radiologist to include it in the differential diagnosis and communicate his suspicion to the attending physician and, if necessary, consult a specialized professional. The use of the term “viral pneumonia” is recommended in these cases (3). We do not recommend performing a new dedicated chest computed tomography scan, unless this test could have an impact on the clinical management or if there is a worsening of the clinical condition; in these cases, try to perform the examination with a low dose of radiation. Other non-thoracic imaging methods (X-rays, CT scans, MRIs of the neck, spine and abdomen) may show pulmonary alterations, and it is recommended to proceed in a similar way to that of CT of the abdomen. An early diagnosis is useful not only in patient care, but also in allowing healthcare professionals to be prepared with adequate personal protective equipment. São Paulo, May 15, 2020. References: (1) Zhao W, Zhong Z, Xie X et al. Relation between chest CT findings and clinical conditions of coronavirus disease (COVID-19) pneumonia: a multicenter study. Am J Roentgenol 2020; 214:1072-1077. (2) Simpson S, Kay FU, Abbara S et al. Radiological Society of North America consensus statement on reporting chest CT findings related to COVID-19. Endorsed by the Society of Thoracic Radiology, the American College of Radiolofy, and RSNA. J Thorac Imaging 2020; doi: 10.1097/RTI.0000000000000524. (3) Siegel A, Chang PJ, Jarou ZJ et al. Lung base findings of coronavirus disease (COVID-19) on abdominal CT in patients with predominant gastrointestinal symptoms. Am J Roentgenol 2020; 215:1-3. To download the document, access here.