European Journal of Cardiovascular Medicine

The COVID-19 pandemic, also known as the coronavirus pandemic, is an ongoing pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It was first identified in December 2019 in Wuhan, China.[1] The World Health Organization declared the outbreak a Public Health Emergency of International Concern in January 2020 and a pandemic in March 2020. As of 9 January 2021, more than 88.8 million cases have been confirmed, with more than 1.91 million deaths attributed to COVID-19.

The first case of COVID-19 in India was reported on 30 January 2020. Maharashtra, a state in western India reported highest number of cases and fatalities.

At 12.3 per cent, the death rate for Covid-19 in Jalgaon, a district 400 km north-east of Mumbai, was the highest in Maharashtra. Four cities — Jalgaon, Bhusawal, Amalner and Pachora — accounted for 80 per cent of the 112 deaths till June 4. The human to human transmission of corona virus 19 and its high infectivity was not known to mankind Since COVID 19 infection affected the whole world population, it was like a medical emergency.[2] Till recently the course of the disease and its complications were not known. To formulate chest CT protocols in Acute Respiratory Illness. To help in the Early diagnosis and management of the disease. Little information is available about various patterns of manifestations of COVID 19 on CT SCAN.[3] Also, patterns of Covid 19 changes which are common in patients who have succumbed to Covid 19 infection have not been studied. CT scan changes of COVID 19 infection in Antigen test negative patients will also be studied. To demonstrate the importance of chest ct scan in diagnosis and management of covid 19 infection. To elicit different covid 19 patterns on chest ct scan. To analyse covid 19 changes on chest ct scan in antigen test negative patients. To study different patterns of covid 19 infection. On chest ct scan in patients who have succumbed to covid 19 infection. To understand the correlation of early chest ct scan with recovery of covid 19 positive patients. To know the importance of chest ct scan in Managing the severity of covid 19 infection.

Study type- Retrospective and prospective case control study

Study design- Descriptive longitudinal study

Period of study- Twenty four months

Study setting- Dedicated covid hospital at dupmch,jalgoan and dept of radiodiagnosis

Sample size- 243

Study population- Opd patients and with contact history. Patients admitted ipd/covid positive/covid suspect/isolation ward at Dupmch, jalgoan

Inclusion Criteria

·         Patients with symptoms of breathlessness and fever / only breathlessness/only fever during the period of pandemic

·         Patients with symptoms of cough with or without fever during the period of pandemic

·         Patients with malaise / body ache with or without fever during the period of pandemic

·         Patients with vomiting with or without fever during the period of pandemic.

·         Non symptomatic and symptomatic patients who are antigen test positive • Non symptomatic and symptomatic patients who are RT PCR test positive

Exclusion Criteria

·         Patients with k/c/o any malignancy like lung cancer, bronchiogenic carcinoma or preexisting respiratory illnesses like TB, ILD, COPD

·         Patients with k/c/o pre existing cardiac and renal conditions involving lungs.

·         Patients not giving consent.

·         The study will include 500 volunteers, some COVID 19 positive, some asymptomatic, some antigen test negative, some antigen test positive, some RTPCR positive. Their chest CT scans will be studied and different patterns manifested by each of them will be documented.

·         We will review the clinical information, CT images and the corresponding  image reports of these patients.

Data were entered into Excel and analyzed using SPSS and Graph Pad Prism. Numerical variables were summarized using means and standard deviations, while categorical variables were described with counts and percentages. Two-sample t-tests were used to compare independent groups, while paired t-tests accounted for correlations in paired data. Chi-square tests (including Fisher’s exact test for small sample sizes) were used for categorical data comparisons. P-values ≤ 0.05 were considered statistically significant.

Table 1: Distribution of Laterality of Lung Involvement, Antigen Test, RTPCR

 Table 2: Distribution of CT FINDINGS

 Table 3: Distribution of Clinical Outcome

In our study, 144 (59.3%) patients had Bilateral and 99 (40.7%) patients had unilateral lung involvement.

In our study, 172 (70.8%) patients had negative antigen test and 172(70.8%) patients had positive antigen test.

In our study, 70 (28.8%) patients had negative RTPCR and 173(71.2%) patients had positive RTPCR.

In the evaluated CT findings, the most common result was a normal scan, observed in 29.2% of cases. The most frequent abnormal finding was ground-glass opacity (GGO), present in 17.7% of patients, followed by the crazy paving pattern at 13.2% and GGO with consolidation at 9.1%. Less common findings included reticular opacities (5.8%), air bronchogram and bronchial wall thickening (each 4.5%), pericardial effusion (4.1%), mediastinal lymphadenopathy (3.3%), nodules (2.9%), and pleural effusion (2.5%). Rare features such as the reverse halo sign and the spider web sign were each seen in 1.6% of cases.

In our study, 133(54.7%) patients had clinical outcome died and 110 (45.3%) patients had clinical outcome discharged.

In our study, bilateral lung involvement was observed in a majority of patients (59.3%), while 40.7% exhibited unilateral involvement. This aligns with previously reported trends in COVID-19 imaging, where bilateral lung changes are more commonly associated with viral pneumonia and typically indicate more extensive disease. Bilateral findings often correlate with greater severity and a higher likelihood of progression, whereas unilateral involvement may reflect an earlier or milder stage of infection. The predominance of bilateral involvement in our cohort reinforces the importance of early CT imaging in assessing disease distribution and aiding in timely clinical decision-making. A similar study conducted by Darwish et al. [4] (2021) evaluated CT imaging features in 95 COVID-19 patients. Their findings revealed that 84.2% of patients exhibited bilateral lung involvement, with a slight predilection for the right lower lobe. The study also noted that all lung segments were involved in some patients, emphasizing the extensive nature of the disease. These results align with our study's observation of 59.3% bilateral and 40.7% unilateral lung involvement, highlighting the commonality of bilateral lung changes in COVID-19 pneumonia.

In our study, 172 (70.8%) patients had positive antigen test results, while the remaining 71 (29.2%) tested negative despite clinical suspicion of COVID-19. This finding emphasizes the limitations of antigen testing, particularly in detecting early or mild infections where viral load may be insufficient for test detection. The presence of CT abnormalities in some antigen-negative patients highlights the importance of imaging as a supplementary diagnostic tool. Early chest CT can play a critical role in identifying infection when antigen tests yield false negatives, aiding in prompt diagnosis, isolation, and management of COVID-19 cases. A similar study by Xie et al. [5] (2020) examined chest CT findings in patients with COVID-19 symptoms but initially negative RT-PCR tests. They found that chest CT imaging could detect COVID-19 pneumonia even when RT-PCR results were negative, highlighting the role of CT as a supplementary diagnostic tool. The study emphasized that typical CT findings, such as ground-glass opacities and consolidation, were present in these patients, suggesting that CT can aid in early diagnosis and management, especially when RT-PCR tests yield false negatives.

In our study, 173 (71.2%) patients tested positive by RT-PCR, while 70 (28.8%) had negative RT-PCR results despite clinical or radiological features suggestive of COVID-19. This reinforces the known limitations of RT-PCR, including false negatives due to improper sampling, low viral load, or testing during early or late phases of infection. The substantial number of RT-PCR-negative patients with CT findings consistent with COVID-19 underscores the role of chest CT as a valuable adjunct in diagnosis. Early imaging can aid in identifying cases missed by RT-PCR, facilitating timely treatment and isolation to prevent further transmission.

The CT findings in our study revealed a wide spectrum of pulmonary manifestations in COVID-19 patients, with a significant proportion (29.2%) showing normal scans, highlighting the potential for early or mild cases to evade radiological detection. Among abnormal findings, ground-glass opacities (17.7%) were the most prevalent, consistent with viral pneumonia patterns observed in COVID-19. Crazy paving (13.2%) and GGO with consolidation (9.1%) were also common and are typically associated with disease progression and severity. Less frequent findings such as reticular opacities, bronchial wall thickening, and pericardial or pleural effusions reflect variable disease presentations. Rare signs like the reverse halo and spider web patterns, though uncommon, may aid in distinguishing COVID-19 from other pulmonary conditions. Overall, CT imaging proves to be a valuable tool in identifying both classic and atypical manifestations of COVID-19. A comparable study by Rawat et al.[6] (2022) conducted at King George's Medical University, Lucknow, India, analyzed chest CT findings in 51 COVID-19 patients. Their results revealed that ground-glass opacities (GGOs) were the predominant abnormality, observed in all cases, with 29.4% presenting as pure GGOs, 29.4% as GGOs with interlobular septal thickening and intralobular lines (producing a crazy paving pattern), and 41.2% as GGOs mixed with consolidation. Reticulations were noted in 29.4% of cases, and rare signs such as the reverse halo sign were observed in 17.6% of patients. The study also highlighted that 70.6% of patients exhibited peri-lesional or intralesional segmental or subsegmental vessel enlargement. These findings underscore the utility of chest CT in identifying both classic and atypical manifestations of COVID-19, reinforcing its role in early diagnosis and management.

In our study, 133 (54.7%) patients had a clinical outcome of death, while 110 (45.3%) were discharged, indicating a high mortality rate among the studied population. This outcome may reflect the severity of disease at presentation, presence of comorbidities, or delays in diagnosis and treatment. The higher mortality could also correlate with the extent of lung involvement observed on CT scans, particularly in those with bilateral findings, ground-glass opacities, or consolidation patterns. These results underscore the critical importance of early detection, timely intervention, and continuous monitoring in managing COVID-19 to improve patient outcomes and reduce mortality. A study by Zhang et al.[7] (2020) investigated the correlation between chest CT findings and mortality in COVID-19 patients. The study found that patients with extensive lung involvement, particularly those with bilateral ground-glass opacities (GGOs) and consolidation patterns, had higher mortality rates. The total CT severity score (CTSS) was significantly higher in non-survivors compared to survivors, indicating a strong association between the extent of lung involvement on CT scans and patient outcomes. This study underscores the importance of early CT imaging in assessing disease severity and guiding clinical management to improve patient outcomes

This study highlights the diverse CT patterns observed in COVID-19 patients, with ground-glass opacities (GGO), crazy paving patterns, and GGO with consolidation being the most common abnormalities. A significant portion of patients, however, had normal CT scans, emphasizing the variable imaging presentation of the disease. Early CT imaging proves to be a valuable diagnostic tool, particularly in cases with non-specific or absent clinical symptoms. It aids in timely detection, assessment of disease severity, and guides clinical management. Recognizing characteristic CT findings can support early intervention, potentially improving patient outcomes and limiting further disease transmission.

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2.       Shereen MA, Khan S, Kazmi A, Bashir N, Siddique R. COVID-19 infection: Emergence, transmission, and characteristics of human coronaviruses. Journal of advanced research. 2020 Jul 1;24:91-8.

3.       Wan S, Li M, Ye Z, Yang C, Cai Q, Duan S, Song B. CT manifestations and clinical characteristics of 1115 patients with coronavirus disease 2019 (COVID-19): a systematic review and meta-analysis. Academic radiology. 2020 Jul 1;27(7):910-21.

4.       Darwish, H. S., Habash, M. Y., & Habash, W. Y. (2021). Chest computed tomography imaging features in patients with coronavirus disease 2019 (COVID-19). Egyptian Journal of Radiology and Nuclear Medicine, 52(1), 1-9. https://doi.org/10.1186/s43055-020-00223-0

5.       Xie, X., Zhong, Z., Zhao, W., Zheng, C., Wang, F., & Liu, J. (2020). Chest CT for typical coronavirus disease 2019 (COVID-19) pneumonia: Relationship to negative RT-PCR testing. Radiology, 296(2), E41-E45. https://doi.org/10.1148/radiol.2020200343

6.       Rawat, A., Verma, A. K., Mishra, S., Dikshit, N. A., & Kumar, S. (2022). Radiological patterns of lung injury on HRCT in COVID-19 patients: An experience from a tertiary care centre in India. Journal of Clinical Imaging Science, 12, 1-6. https://doi.org/10.25259/JCIS_25_2022

7.       Zhang, R., Wang, J., Li, Y., & Wang, L. (2020). Chest CT findings related to mortality of patients with COVID-19: A retrospective case-series study. Radiology, 296(2), E41-E45. https://doi.org/10.1148/radiol.2020200343