Rabia Shahid 1 , Muhammad Saleem Akhter 2 , Muhammad Waseem 3 , Maryam Rafiq 4
1House officer, Department of Pulmonology ,Sahiwal Teaching hospital, Sahiwal.
2Assistant Professor and Head of Department, Radiology, Sahiwal Teaching Hospital, Sahiwal.
3Assistant Professor and Head of Department, Pulmonology, Sahiwal Teaching Hospital, Sahiwal.
4 Assistant Professor, Department of Chemical Pathology, Sahiwal Teaching Hospital, Sahiwal.
Background: High resolution computed tomography (HRCT) chest has proven to be a helpful radiological modality to
assess the course of disease. The main objective of the study was to analyze the pattern of lung involvement on HRCT
chest among post-Covid patients.
Methodology:This cross-sectional study was carried out in the post Covid patients (30 days after discharge) from Nov
2020 to July 2021 in Sahiwal Teaching Hospital, Pakistan. Total 180 patients were selected through non probability
consecutive sampling technique. Whole body Multi Slice CT scan, 128 Slices by GE discovery was used to get HRCT of
chest and to document various patterns and stages of pulmonary fibrosis in the post-COVID patients. The data was
analyzed using the IBM SPSS 28.0.0 2021. Various radiological findings were expressed in percentages.
Results:Results: A total of 77.8% patients had bilateral lung involvement, while 22.2% had unilateral lung involvement after
one month of disease. Ground Glass Haze was the commonest radiological pattern, found in 140 (77.8%) cases. Other
radiological patterns were Air Space Opacification (47.2%), Septal Thickening (20%) and Fibrotic Bands (26.1%).
Traction Bronchiectasis (10%) and Honey Combing (7.8%) were among the lesser ones reported. About 62% patients
had mixed findings on HRCT Chest. Diagnosis of Organizing Pneumonia was made in 166 (92.22%) patients while 14
(7.78%) patients were labelled as Usual Interstitial Pneumonia (UIP) with honey-combing in HRCT chest. The
involvement of Right Lower Lobe was in 165 (91.7%) of cases. Right Middle Lobe remained fairly spared and was seen
in 120 (66.7%) cases.
Conclusion: TPatchy ground glass haze seen bilaterally in lower lung lobes are the commonest abnormalities in HRCT
chest of post-COVID patients.
Keywords:Covid-19, Pneumonia, Radiology
The modern-day world is plagued by many disease
epidemics. Once every few decades, there comes a
microorganism that puts human life at halt. Arising
from Wuhan, China in December 2019, the disease
caused by Novel Coronavirus or SARS-CoV-2 was
ORIGINAL ARTICLE
declared as a Public Health Emergency of
International Concern on 30 th January 2020. It was
labelled a Global Pandemic by the World Health
Organization on 11 th March 2020. 1 While the
leading researchers and scientists took it upon
themselves to serve humanity by developing cure
and preventive vaccines within record time, the
virus had already wreaked havoc. As of August
2021, there have been a total of more than 200
million confirmed cases and over 4 million deaths
worldwide. 1
The disease presents itself as a respiratory tract
infection with symptoms such as fever, cough,
dyspnea, muscle pain and fatigue. 2With the newer
variants, such as, delta, the symptoms had
broadened to include diarrhea and flu. 3 Diagnosis is
made chiefly, based on a combination of history of
exposure, symptoms and radiological and
laboratory findings. Chest X-rays are helpful in
establishing diagnosis; however, High Resolution
Computed Tomography chest has been employed
as a useful tool in observing the course of disease
recovery and/or fibrosis in post-COVID patients. 4 A
raised CRP (C-Reactive Protein) and LDH (Lactate
Dehydrogenase) along with a low lymphocyte count
have been found to be associated with severe
disease and predict poor prognosis. 5
Though the death rate of the disease is still around
2%, the after-effects of Covid continue to alarm the
world. 6 Moving forward, more and more research is
being conducted and proving that this is deadlier
than the infectious diseases that normally prevail in
the community, with an increased propensity of
harming the old and the immunocompromised.
The burden on healthcare has been crippling for
even the most developed of nations. The most
worrisome part remains to be the fact that long
after the virus leaves the person’s body, its
damaging effects persist. Those with pre-existing
comorbidities are thought to be somewhat more
susceptible than those who have a perfectly
healthy immune system. 7 The various stages of lung
parenchymal involvement in post COVID-19 patients are documented in this study using HRCT
chest, to better visualize lung damage in affected
individual after hospital discharge. There are
limited studies which involve radiological follow up
of COVID patients so this study will add to the
existing body of knowledge by detecting post Covid
changes in lung parenchyma these may help health
care providers to detect those adverse changes
timely and treat them effectively.
This cross-sectional study was conducted in the Pulmonology Department of Sahiwal Teaching Hospital, Sahiwal, after approval from the institutional ethical review board through letter no 155/DME/SLMC/SWL dated 08-10-2020. The study was conducted from Nov 2020 to July 2021 in District Sahiwal, Punjab, Pakistan. A sample size of 151 was calculated through open epi website by taking confidence level as 95%, level of precision as 5% and prevalence of post covid HRCT changes in COVID patients as 89 %. 8 In total 180 patients of both genders were included by non-probability consecutive sampling technique. Inclusion criteria was COVID PCR Positive patients admitted in hospital with follow up HRCT chest done 30 days after discharge. Patients with active COVID-19 virus, pregnant females and those with history of chronic interstitial lung disease and preexisting lung conditions like allergic alveolitis, tuberculosis or other infections were excluded from the study. Whole body Multi Slice CT scan 128 Slices by GE discovery was used to get HRCT of chest and to visualize and document various patterns and stages of pulmonary fibrosis in the post-COVID patients. The changes on HRCT chest were evaluated and reported by three consultant radiologists, having experience of more than five years in reporting HRCT chest. The data was documented and analyzed using the IBM SPSS 28.0.0 2021. Various radiological findings were expressed in percentages.
Out of 180 post-Covid patients, 108(60%) were males and 72(40%) females. The mean age of the participants was found to be 54.1 ± 14.525 years. A wide array of radiological findings was seen in the HRCT chest of 1-month post-COVID patients. These varied from slight ground glass haze or mild air space opacification to traction bronchiectasis and honeycombing. The frequency of these changes, as seen in the HRCT chest of patients has been tabulated below in Table 1.
Table I: Radiological Findings in HRCT Chest of Post-COVID Patients. (n= 180) |
|
RADIOLOGICAL FINDINGS |
NO. OF CASES (Percentage) |
Ground Glass Haze |
140 (77.8) |
Air Space Opacification |
85 (47.2) |
Fibrotic Bands |
47 (26.1) |
Septal Thickening |
36 (20.0) |
Mediastinal Lymphadenopathy |
23 (12.8) |
Consolidation |
22 (12.2) |
Traction Bronchiectasis |
18 (10.0) |
Honeycombing |
14 (7.8) |
140 out of 180 patients (77.8%) had bilateral lung involvement, while 40 (22.2%) had unilateral lung involvement after one month of the disease. Right Lower Lobe was found to be the most commonly involved, with involvement in 165 (91.7%) cases. Right Middle Lobe was the least commonly involved, with changes shown in only 120 (66.7%) out of 180 cases. Different patterns of distribution were also observed, with patchy distribution being the most common ( 85.3% ). The different patterns of distribution, along with the frequency of involvement of various lung lobes are shown in table 2.
Table II: Distribution of Histological Changes in HRCT Chest of Post-COVID patients. |
||
Pattern |
Distribution |
No. of cases (Percentage) |
Patchy |
151(85.3%) |
|
Diffuse |
15(8.5%) |
|
Sub-Pleural |
75(42.4%) |
|
Peripheral |
76(42.9%) |
|
Lobes Involved |
Right Upper Lobe |
159(88.3%) |
Right Middle Lobe |
120(66.7%) |
|
Right Lower Lobe |
165(91.7%) |
|
Left Upper Lobe |
137(76.1%) |
|
Left Lower Lobe |
145(80.6%) |
Radiological diagnosis of 166 (92.22%) patients was,made to be Organizing Pneumonia while 14 (7.78%) patients were labelled as Usual Interstitial Pneumonia (UIP) with honey-combing depicted in their HRCT chest.
COVID-19 has trapped the world in a frenzy, where
scientific knowledge is limited and our resources
are being exhausted at an alarming rate. It is
imperative to play our part in these trying times
and gather enough reliable information for the
betterment of humanity. This study is one of few
conducted in Pakistani Patients. COVID-19 is posing
enormous threat to our healthcare system because
of the continued damage that might lead to lung
fibrosis in the absence of timely intervention. 9,10
As shown by previous research data, males are at
an increased risk of developing COVID and
resultantly post-COVID interstitial lung disease
(ILD)/fibrosis. 11 60% of the cases were males while
40% were females, which is consistent with similar
studies conducted worldwide.
Increased age has been shown to be a significant
risk-factor via different studies. 12 The mean age of
affected patients was 54.1 + 14.52 years consistent
with study reported by Shi in which mean age of
infected individuals was reported to be 49 years. 13
Role of repeat CT scan in follow up of Lung Disease
has been well-established now and HRCT chest is
far superior to the conventional CXR. 14,15 HRCT chest
was repeated at a one-month interval post-COVID.
Individuals with known ILD such as Hypersensitivity
Pneumonitis (HP) were excluded from this study to
allow a clear deduction of results. Various
histological changes were apparent in the HRCT
Chest. The most common finding was a Ground
Glass Haze (seen in 77.8% of cases), which is
consistent with the findings of previously
conducted similar studies. 16
Few other studies revealed similar results with
ground glass opacites being the commonest
finding. 17,18 A spectrum of radiological changes was
reported, from Air Space Opacification (47.2%) to
Septal Thickening (20%) and Fibrotic Bands (26.1%).
Traction Bronchiectasis (10%) and Honey Combing
(7.8%) were relatively rare and can be considered
to be more late/severe changes on the path to Lung
Fibrosis. The criteria used for various radiological
findings such as Ground Glass Haze and Air Space
Opacification was according to Fleischner society
glossary of terms for thoracic imaging. 19
Bilateral Lower Lobe involvement was seen most
commonly, while the Right Middle Lobe remained
relatively spared. There is a lot of room for further
key variables to be explored in future studies. There
might be a correlation in the lobes being involved
and gender, occupation or smoking status of an
individual.
We can save the crippling healthcare infrastructure
by adequately treating and dealing with all the
complications associated with this deadly
pandemic. HRCT Chest can be used as a very helpful
radiological tool for close follow-up of
improvement or deterioration in a post-COVID
patient. The goal is to predict, investigate and then
intervene timely to reduce morbidity and mortality.
Furthermore, the small number of patients
recruited at a single facility limit any definitive
conclusions, although they do indicate the
necessity for a more thorough follow-up of COVID-
19 patients.
An Official Publication of
Islamabad Medical & Dental College
Volume 11 Issue 3
Maryam Rafiq
Email:
mariamsheikh15@yahoo.com
Cite this article.SShahid R, Akhter S M, Waseem M, Rafiq M. High Resolution Computed Tomography (HRCT) Chest Findings Among Post-COVID Patients. J Islamabad Med Dental Coll. 2022;11(3): 164-168 DOI: https://doi.org/10.35787/jimdc.v11i3.789