Department of Medicine and Surgery, Unit of "Scienze Radiologiche", University of Parma, Parma, Italy.
Department of Radiology, UW-Madison School of Medicine and Public Health, Madison, WI, USA.
Br J Radiol. 2021 Feb 1;94(1118):20200716. doi: 10.1259/bjr.20200716. Epub 2021 Jan 20.
Ground-glass opacity and consolidation are recognized typical features of Coronavirus disease-19 (COVID-19) pneumonia on Chest CT, yet ancillary findings have not been fully described. We aimed to describe ancillary findings of COVID-19 pneumonia on CT, to define their prevalence, and investigate their association with clinical data.
We retrospectively reviewed our CT chest cases with coupled reverse transcriptase polymerase chain reaction (rt-PCR). Patients with negative rt-PCR or without admission chest CT were excluded. Ancillary findings included: vessel enlargement, subpleural curvilinear lines, dependent subpleural atelectasis, centrilobular solid nodules, pleural and/or pericardial effusions, enlarged mediastinal lymph nodes. Continuous data were expressed as median and 95% confidence interval (95% CI) and tested by Mann-Whitney test.
Ancillary findings were represented by 106/252 (42.1%, 36.1 to 48.2) vessel enlargement, 50/252 (19.8%, 15.4 to 25.2) subpleural curvilinear lines, 26/252 (10.1%, 7.1 to 14.7) dependent subpleural atelectasis, 15/252 (5.9%, 3.6 to 9.6) pleural effusion, 15/252 (5.9%, 3.6 to 9.6) mediastinal lymph nodes enlargement, 13/252 (5.2%, 3 to 8.6) centrilobular solid nodules, and 6/252 (2.4%, 1.1 to 5.1) pericardial effusion. Air space disease was more extensive in patients with vessel enlargement or centrilobular solid nodules ( < 0.001). Vessel enlargement was associated with longer history of fever ( = 0.035) and lower admission oxygen saturation ( = 0.014); dependent subpleural atelectasis with lower oxygen saturation ( < 0.001) and higher respiratory rate ( < 0.001); mediastinal lymph nodes with shorter history of cough ( = 0.046); centrilobular solid nodules with lower prevalence of cough ( = 0.023), lower oxygen saturation ( < 0.001), and higher respiratory rate ( = 0.032), and pericardial effusion with shorter history of cough ( = 0.015). Ancillary findings associated with longer hospital stay were subpleural curvilinear lines ( = 0.02), whereas centrilobular solid nodules were associated with higher rate of intensive care unit admission ( = 0.01).
Typical high-resolution CT findings of COVID-19 pneumonia are frequently associated with ancillary findings that variably associate with disease extent, clinical parameters, and disease severity.
Ancillary findings might reflect the broad range of heterogeneous mechanisms in severe acute respiratory syndrome from viral pneumonia, and potentially help disease phenotyping.
磨玻璃影和实变是新型冠状病毒肺炎（COVID-19）胸部 CT 的典型特征，但辅助发现尚未得到充分描述。本研究旨在描述 COVID-19 肺炎 CT 的辅助发现，确定其发生率，并探讨其与临床数据的关系。
我们回顾性分析了我院经配对逆转录聚合酶链反应（rt-PCR）检测的胸部 CT 病例。排除 rt-PCR 阴性或无入院时胸部 CT 的患者。辅助发现包括：血管增粗、胸膜下线、叶间裂下坠性肺不张、小叶中心型实性结节、胸腔和/或心包积液、纵隔淋巴结肿大。连续数据以中位数和 95%置信区间（95%CI）表示，采用 Mann-Whitney 检验进行检验。
106/252 例（42.1%，36.1%至 48.2%）患者存在血管增粗，50/252 例（19.8%，15.4%至 25.2%）患者存在胸膜下线，26/252 例（10.1%，7.1%至 14.7%）患者存在叶间裂下坠性肺不张，15/252 例（5.9%，3.6%至 9.6%）患者存在胸腔积液，15/252 例（5.9%，3.6%至 9.6%）患者存在纵隔淋巴结肿大，13/252 例（5.2%，3.0%至 8.6%）患者存在小叶中心型实性结节，6/252 例（2.4%，1.1%至 5.1%）患者存在心包积液。存在血管增粗或小叶中心型实性结节的患者肺部空气腔病变更为广泛（ < 0.001）。血管增粗与发热时间较长（ = 0.035）和入院时血氧饱和度较低（ = 0.014）相关；叶间裂下坠性肺不张与较低的血氧饱和度（ < 0.001）和较高的呼吸频率（ < 0.001）相关；纵隔淋巴结肿大与咳嗽时间较短（ = 0.046）相关；小叶中心型实性结节与咳嗽发生率较低（ = 0.023）、血氧饱和度较低（ < 0.001）和呼吸频率较高（ = 0.032）相关，心包积液与咳嗽时间较短（ = 0.015）相关。与住院时间延长相关的辅助发现是胸膜下线（ = 0.02），而小叶中心型实性结节与入住重症监护病房的比例较高（ = 0.01）相关。
COVID-19 肺炎的典型高分辨率 CT 表现常与各种辅助发现相关，这些发现与疾病严重程度、临床参数相关。
这些辅助发现可能反映了病毒性肺炎导致的严重急性呼吸综合征中广泛存在的多种不同发病机制，可能有助于疾病表型的分析。
