Spectrum of Chest Ct Findings in Confirmed Covid-19 Patients at Kenyatta National Hospital

Abstract

Background: Coronavirus disease-19 (COVID-19) is a viral disease that has rapidly spread worldwide. Identifying individuals with suspected Coronavirus disease-19 (COVID-19) is important in terms of isolation of positive patients. The reverse transcription-polymerase chain reaction (RT-PCR) test is the standard confirmation tool used for diagnosing severe acute respiratory syndrome coronavirus 2. However, chest computed tomography (CT) is a key tool to use when there is evidence of worsening respiratory status. It determines the baseline pulmonary status and detects any pre-existing cardiopulmonary abnormalities or alternative diagnoses. Chest CT is also used as a problem solver in patients who have clinical features of COVID-19 but have a negative RT-PCR test. CT performed for other reasons may incidentally detect common or atypical features of COVID-19 pneumonia. Aim: This study aimed to determine the spectrum of chest computed tomography (CT) findings in confirmed Coronavirus disease-19 (COVID-19) patients at the Kenyatta National Hospital (KNH). Methodology: A retrospective cross-sectional study was conducted at Kenyatta National Hospital, Radiology department Study Duration: One year from 1st May 2020 to 31st May 2021. Study Population: Patients with reverse transcription-polymerase chain reaction( RT-PCR) confirmed Coronavirus disease-19 (COVID-19) who had undergone chest CT at the Kenyatta National Hospital (KNH) either 5 days before the positive reverse transcription-polymerase chain reaction( RT-PCR) test and up to 5 days after the positive reverse transcription-polymerase chain reaction( RT-PCR) test. Sample Size: A total of 138 CT of patients with RT-PCR confirmed COVID-19 who had undergone chest CT at the Kenyatta National Hospital (KNH) either 5 days before the positive RT-PCR test or up to 5 days after the positive RT-PCR test were recruited into the study Data Management: Demographic and clinical features of the patients were presented as frequencies and percentages for categorical data, and as means with standard deviation or median with interquartile range for continuous data. The CT chest patterns and distribution of chest CT findings of COVID-19 and the CO-RADS score were analyzed and presented as frequencies and percentages. Patients' demographics were presented as mean, range, and percentages. Statistical Analysis: Data analysis was done using Statistical Package of Social Sciences (SPSS) version 25. Results was presented in the form of text, tables, graphs, and charts. Results : A total of 138 patients with COVID-19 PCR positive were included in this study. Their ages ranged between 26 and 87 years. The median age was 50 years (IQR, 41 to 60 years). The male-to-female ratio was 1.6:1. There were 84 males (60.9%) and 54 females (39.1%). The proportion of males was statistically significantly more than females, p = 0.011. Out of the 138 study participants, 128 (92.8%) had positive chest CT imaging findings, while 10 (7.2%) did not show any lung abnormalities. Of the positive chest CT studies, mixed ground-glass opacification with consolidation(50%) was the most common pattern of chest CT findings, followed by pure Ground glass opacities (GGOs) pattern (44.2%), interlobular septal thickening (36.7%), and vascular thickening (30.5%). Less common patterns included fibrosis (19.5%), pleural thickening( 12.5% ), and crazy paving( 10.2% ) . Rare findings consisted of pulmonary nodules(5.5%), air-filled lesions(5.5% ), pleural effusion( 5.5% ), pure consolidation( 3.9% ), and tree in the bud( 1.6%). Bilateral affection was seen in 124 out of 128 cases (96.9%). Peripheral distribution was noted in 84/128 (65.6%) and posterior predominance was seen in 93/128 (72.7%). There was no lobar predilection. There was no statistically significant difference ( p = 0.587) between the proportion of the upper lobes affected and the lower lobes affected. The most common CO-RADS category was category 5; 105/138 (76.1%). Conclusion: COVID-19 tends to have typical imaging patterns on chest CT. The most common CT chest findings were bilateral, multifocal, posterior ground-glass opacities with or without consolidations. There was no lobar predominance. Recognition of this pattern of chest involvement is highly suggestive of COVID-19 infection and thus will have an impact on clinical decision-making and patient management. Overall, CT imaging is valuable in assessing complications and for follow-up.