COVID 19 RADIOLOGY (New Updates)

-
Since COVID 19 is the pandemic that has put everyone of us in some or the other situations, take time to read this new and recent advances and findings in COVID 19, via the radiodiagnostic point of view. 

Generally we do RT - PCR, but the thing is this is highly specific and less sensitive which varies from 60 - 90% (in sensitivity). Thus radiological findings help us determine more clearly. 

NOTE - RADIOLOGICAL FINDINGS OR RADIODIAGNOSTICS CANNOT BE THE DIAGNOSTIC CRITERIA FOR COVID 19, RT - PCR IS STILL CARRIED OUT....
RADIOLOGY IS DONE ONLY TO SEE THE EXTENT OF THE DISEASE AND PREDICT THE FURTHER COMPLICATIONS

The general lab findings in COVID 19 Patients - Decreased Lymphocyte count (lymphocytopenia)
                                                                               High and increased C- reactive proteins (CRP)

Things that are sen on radiological scanning are divided into three parts - 

1. TYPICAL
2. ATYPICAL
3. VERY ATYPICAL

Typical findings are - multifocal ground glass opacities which are bilateral, peripheral in distribution with subpleural involvement; generally at the ends of the lobes of lungs, round in shape.
Spider web appearance, vascular thickenings, crazy pavement signs.
Organising pneumonia - reverse HALO sign (aka ATOLL sign).

Atypical signs - lymphadenopathy, central or peribronchovascular involvement.

Very atypical - Cavitation, Calcification, Tree bud appearance (similar to Tuberculosis) hence Differential diagnosis is considered as TB; Bronchiolitis, Mass, Pleural thickening.

Crazy pavement sign is seen in other condition like pulmonary alveolar proteinosis, where proteins start accumulating in the alveoli.

The ground glass opacities (GGO) are the precursor to the consolidations.
Thus, main difference between the GGO and consolidation is, GGO shows underlying vascular structures and are less white. 



COVID 19 patient showing GGO in X ray and CT scan.


Consolidation of lung, as opposed to GGO shown in earlier image.

To Access the situation, there is a new SCORING system called as BREXIA'S Scoring system.
Here, the lung is divided into 6 zones labelled A to F, and are divided into 3 groups by 2 lines A and line B. Line A is present below the aortic notch or aortic knuckle. Line B is present below hila of lungs.


 Scoring is done by assigning a maximum of 3 points to each zone from A to F, this makes the total BREXIA score of 18 (6x3 = 18)

Score 0 - no abnormalities
Score 1 - interstitial infiltration
Score 2 - interstitial + alveolar infiltration with interstitial predominance
Score 3 - interstitial + alveolar infiltration with alveolar predominance

How to differentiate the interstitial or alveolar infiltration?
Simple - Interstitial involvement means the changes seen in between the alveolar spaces or in between the cellular spaces, hence these changes will be liner, sharp and discrete. Where as alveolar will be coalescent, with cotton wool appearance.  


This image shows alveolar infiltrates. 


Comments

Post a Comment

Popular posts from this blog

Neurosurgery - Telovelar approach

-
Image
 Telovelar approach is carried out for the removal of any pathology that is present inside the 4th ventricle or the rhomboid fossa of the brain. The Space seen here behind the cerebellum is the rhomboid fossa (Fossa is just a trench or a channel). This rhomboid fossa forms a part of the 4th ventricle, which is connected to the third ventricle above by cerebral aqueduct and then runs downwards into the spinal cord as the central canal of the spinal cord, carrying the CSF (CerebroSpinal Fluid). The part behind the PONS and between the white core of cerebellum is called as the 4th ventricle. {For more information on anatomy of brain, please refer to our another blog on BRAIN}
Read more

CAH - CONGENITAL ADRENAL HYPERPLASIA

-
Image
C   ongenital Adrenal Hyperplasia or CAH, is a disorder which is characterised by defects in enzyme that lead to various effects.  The most common enzyme affected in CAH is 21 hydroxylases enzyme. The second most common enzyme to be affected is 11-β-hydroxylase enzyme. The gene CYP 21A 2 is affected, this is the same gene that codes for 21 hydroxylases. The following image shows the steroid pathway that takes place in the adrenal glands, where cholesterol is the basic material used for synthesis.  Here 21 OH stands for 21 Hydroxylase, 11 beta signifies 11-β-hydroxylase. As the normal physiological process, 21 hydroxylase enzyme acts as an important enzyme for synthesis of corticosteroids and mineralocorticoids. As there is 21 hydroxylase deficiency there will be reduction in the production of corticosteroids and mineralocorticoids. Due to deficiency of mineralocorticoids, there will be salt and water wasting. As the levels of corticosteroids decrease
Read more

THE BRAIN

-
Image
T he Human brain is by far the most complex structure to be ever build. Its complexity has dazzled majority of the people since last century and is still the topic of research. The adult brain weighs about 1.3 – 1.5 kg and is approximately 2% of or total body weight, with Surface area of approximately 1120 cc in males and 1130 cc in females. In spite of its small size it contains millions and billions of neurons that carry out daily functions of the body and may be create someone like Einstein whose brain is still preserved for research purposes. The basic functional unit of brain is called as a neuron. It is a specialised type of cell that has the capacity to conduct and transfer electrical impulses, but once damaged can take years to regenerate. There are various types of neurons and are classified according to – A)   The number of dendrites/processes B)    The length of axons According to number of processes they are 1.     Unipolar 2.    
Read more