key: cord-0686692-0agij3z3
authors: Sun, Qiulian; Li, Qianyun; Gao, Feng; Li, Jingjing; Xu, Xinjian; Huang, Xiangzhong
title: Evolution of computed tomography manifestations of eleven patients with severe coronavirus disease 2019 (COVID‐19) pneumonia
date: 2020-08-08
journal: Int J Clin Pract
DOI: 10.1111/ijcp.13654
sha: 1bfccecfdd8f0274ef989cc2dff6f2e523a18fff
doc_id: 686692
cord_uid: 0agij3z3

PURPOSE: Severe coronavirus disease 2019 (COVID‐19) pneumonia is associated with a high mortality. However, the evolution of computed tomography (CT) manifestations of severe COVID‐19 pneumonia remains unclear, more evidence regarding its evolution process is urgent needed. METHOD: The clinical, laboratory and imaging data of eleven patients with severe COVID‐19 pneumonia were collected to investigate the evolution process of severe COVID‐19 cases. RESULTS: The main initial CT manifestations of severe COVID‐19 pneumonia were multiple ground‐glass opacities and/or consolidation. Evolution of CT manifestations showed that acute exudative lesions of severe COVID‐19 pneumonia could be gradually resolved after active intervention. CONCLUSIONS: Most of patients with severe COVID‐19 pneumonia showed marked improvement of acute exudative lesions on chest imagings, and satisfactory prognosis of severe COVID‐19 pneumonia could be achieved after active treatment.

The coronavirus disease 2019 outbroke, which initially emerged in Wuhan City, Hubei Province, China, has spread to multiple countries around the world, with the number of confirmed cases increasing every day [1] [2] [3] [4] . It poses a great threaten to the global public health and human life. As of Mar 3, 2020, China reported 80302 patients, including 2946 fatalities [5] . Severe type of COVID-19 pneumonia [6] , accounting for approximately 20% of COVID-19 cases [5] , caused the most COVID-19 deaths [5] . Based on the diagnostic and treatment protocols of COVID-19 (6th edition) published by National Health Commission of the People's Republic of China [6] , severe type of COVID-19 pneumonia need to meet any of the following conditions: 1.

significantly increased respiration rate (RR): RR ≥ 30/min. 2. hypoxia in resting state: pulse oxygen saturation (SpO2) ≤ 93%. 3. arterial partial pressure of oxygen (PaO 2 ) / fraction of inspiration O 2 (FiO 2 ) ≤300 mmHg. Chest computed tomography (CT) imaging plays an important role in early diagnosis and judgment of disease progress as well as efficacy evaluation of COVID-19 pneumonia; however, currently limited information exists regarding the evolution of chest CT manifestations of severe COVID-19 pneumonia. Here, we report the clinical, laboratory and evolution of chest CT manifestations of eleven patients with severe COVID-19 pneumonia.

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Eleven patients admitted to Taizhou Hospital of Wenzhou Medical University from January 24 to February 10, 2020 were diagnosed with severe COVID-19 pneumonia. Six patients were male and five patients were female, with a median age of 52 years (range 33-75 years). All eleven patients were confirmed by real-time-polymerase chain reaction (RT-PCR) tests of throat swabs. The initial symptoms of patients were fever (n=10), cough (n=8), and pharyngodynia (n=3). Two patients with diabetes, one patient with hypertension, one patient with hypothyroidism, one patient with renal insufficiency, and one patient with gout.

On admission, ten patients had decreased lymphocytes count (0.4×10 9 -0.8×10 9 /L); three patients had increased white blood cell count (10.1×10 9 -17.1×10 9 /L); five patients had increased neutrophil count (7.0×10 9 -15.9×10 9 /L); ten patients had elevated C-reactive protein (CRP) (10.40-101.89 mg/L), one patients had elevated myoglobin (227.6 ng/ml) and two patients had decreased myoglobin (11.6-13.6 ng/ml).

All patients were treated in isolation. Eleven patients received antiviral treatment (interferon alfa-2b injection, arbidol hydrochloride, lopinaviritonavir, oseltamivir), Four patients received antibiotic treatment (azithromycin, levofloxacin, roxithromycin). Eleven patients were treated with cortisol, immunoglobulin, and oxygen therapy.

The main manifestations on initial chest CT scans were multiple ground-glass opacities (Figure1a, 1e, 2c, 3a, 3g, 4a, 4g, 5a, 5e and 5i) with or without consolidation (Figure1a, 1e, 1i, 2a-2b, 3a, 3g, 4a, 4g, 5a and 5e) involving multiple lung lobes. A small amount of pleural effusion was observed in two patients (Figure 1e and 3a, 3d). Ten patients (Figure1a, 1e, 1i, 2a-2c, 3a, 3g, 4a, 5a, 5e and 5i) had bilateral involvement and the common involved areas were subpleural regions (Figure1a, 1e, 1i, 2a-2c, 3a, 3g, 4g, 5a and 5e).

All eleven patients showed marked improvement of chest radiographic manifestations after active intervention. In the early and mid-term follow-up CT, one patient (Figure 2d-2f) had increased consolidation and ground-glass opacities, ten patients (Figure1b-c, 1f-g, 1j-k, 3b, 3h, 4b-e, 4h-k, 5b-c, 5f-g and 5j-k) had a

This article is protected by copyright. All rights reserved decrease in consolidation and ground-glass opacities, a small amount of pleural effusion observed in two patients was gradually resolved (Figure 1f -g, 3b and 3e). In the late follow-up CT, all eleven patients showed significantly reduced ground-glass opacities, ten patients (Figure 1d, 1h, 1l, 3c, 3i, 4f, 4l, 5d, 5h and 5l) showed a small amount of patchy ground-glass opacities remained, six patients (Figure 1d , 1h, 2j-2l, 3i, 4f and 5h) showed fibrous-like stripes remained. The pleural effusion observed in two patients was completely resolved (Figure 1h, 3c and 3f).

As of Mar 3, 2020, four patients with severe COVID-19 pneumonia had been cured and discharged.

Clinical cure standard [6] included temperature returning to normal for at least three consecutive days, marked improvement of acute exudative lesions on chest CT imaging and viral clearance in respiratory samples from upper respiratory tract (two consecutive negative results of COVID-19).

This article is protected by copyright. All rights reserved 

This article is protected by copyright. All rights reserved 

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