COVID 19 RADIOLOGY (New Updates)

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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. 


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