How should the radiologist proceed when faced with lung abnormalities identified on CT scans of the abdomen during the SARSCoV-2 pandemic?
The findings of pulmonary lesions in COVID-19 include ground-glass opacities and peripheral consolidations, which may have a nodular appearance and a basal predominance. 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 radiologist's responsibility to include it in the differential diagnosis and report his suspicion to the attending physician and, if necessary, to consult a specialized professional. The use of the term “viral pneumonia” is recommended in these cases (3). We do not recommend carrying out a new chest computed tomography exam, unless this exam may have an impact on clinical management or if the clinical condition worsens; in these cases, try to perform the examination with low radiation dose.
Other non-thoracic imaging methods (radiographs, CT scans, neck, spine and abdomen MRIs) can demonstrate lung changes, and it is recommended that the procedure be performed in a similar way to abdominal CT.
An early diagnosis is useful not only in patient care, but also because it allows health professionals to be prepared with adequate personal protective equipment.
São Paulo, May 15, 2020.
(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 symtoms. Am J Roentgenol 2020; 215: 1-3.
To download the document, access here.