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Normal chest CT in 1091 symptomatic patients with confirmed Covid-19: frequency, characteristics and outcome

Authors
  • Leonard-Lorant, Ian1
  • Severac, François2
  • Bilbault, Pascal3
  • Muller, Joris4
  • Leyendecker, Pierre1
  • Roy, Catherine1
  • Ohana, Mickaël1
  • 1 Hôpitaux Universitaires de Strasbourg, Service de Radiologie, Nouvel Hôpital Civil,
  • 2 Hôpitaux Universitaires de Strasbourg, Groupe Méthodes en Recherche Clinique (GMRC), Hôpital Civil,
  • 3 Hôpitaux Universitaires de Strasbourg, Service de Médecine d’Urgence, Nouvel Hôpital Civil,
  • 4 Hôpitaux Universitaires de Strasbourg, Service de Santé Publique, Nouvel Hôpital Civil,
Type
Published Article
Journal
European Radiology
Publisher
Springer-Verlag
Publication Date
Jan 13, 2021
Pages
1–6
Identifiers
DOI: 10.1007/s00330-020-07593-z
PMID: 33439316
PMCID: PMC7804574
Source
PubMed Central
Keywords
Disciplines
  • Chest
License
Unknown

Abstract

Objective Frequency of normal chest CT in symptomatic COVID-19 patients as well as the outcome of these patients remains unknown. The objectives of this work were to assess the incidence of initially normal chest CT in a cohort of consecutive confirmed COVID-19 patients with respiratory symptoms and to compare their clinical characteristics and their outcome to matched patients with typical COVID-19 lesions at initial CT. Methods From March 6th to April 22nd, all consecutive adult patients referred to the COVID-19 clinic of our Emergency Department were retrospectively analyzed. Each patient with a positive SARS-CoV-2 RT-PCR and a normal initial chest CT after second reading was 1:1 matched based on sex, age and date of CT acquisition to a patient with positive RT-PCR and initial chest CT with typical COVID-19 lesions. Clinical data, laboratory results and outcomes (major being mechanical ventilation and/or death) were compared between both groups, using Wilcoxon signed-rank test, McNemar’s chi-squared test and/or exact McNemar’s test where appropriate. Results Fifty-seven chest CT out of 1091 (5.2%, 95% CI 4.0–6.7) in symptomatic patients with positive RT-PCR were normal, with a median onset of symptoms of 4.5 days (IQR [1.25–10.25]). After a median follow-up of 43 days, death and/or mechanical ventilation occurred in 3 patients (5.3%) in the study group, versus 11 (19.3%) in the control group ( p = 0.011). Conclusions Normal initial chest CT occurred in 5.2% of symptomatic confirmed COVID-19 cases in our cohort. While better than those with abnormal chest CT, outcome was not entirely benign with 5.3% death and/or mechanical ventilation. Key Points • In a cohort of 1091 symptomatic COVID-19 patients, initial chest CT was normal in 5.2% of cases. • Normal chest CT in confirmed COVID-19 is frequent even when onset of symptoms is greater than 3 days. • The outcome of COVID-19 patients with initial normal chest CT, while better than those with abnormal CT, was not entirely benign with 5.3% death and/or mechanical ventilation.

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