Value Of High-Resolution Computed Tomography in the Differential Diagnosis of Imported COVID-19 and Seasonal Influenza Pneumonia

IRCMJ logo
Iranian Red Crescent Medical Journal
PDF
HTML

Keywords

CT
Influenza
Novel coronavirus
Pneumonia

How to Cite

Li, Y., Long, S., Zhao, Y., Ge, Z., Wu, W., & Xia, J. (2020). Value Of High-Resolution Computed Tomography in the Differential Diagnosis of Imported COVID-19 and Seasonal Influenza Pneumonia. Iranian Red Crescent Medical Journal, 22(9). https://doi.org/10.32592/ircmj.2020.22.9.109

Abstract

Background: Nowadays, the world is facing COVID-19 pandemic, and seasonal influenza is also sweeping the world. Therefore, it is essential to make an early differential diagnosis between imported COVID-19 and seasonal influenza pneumonia.

Objectives: The present study aimed to determine the diagnostic value of high-resolution computed tomography (HRCT) imaging characteristics for imported coronavirus disease 2019 (COVID-19) and seasonal influenza pneumonia.

Methods: The HRCT imaging features with 22 cases of imported COVID-19 and 39 cases of seasonal influenza pneumonia were retrospectively analyzed in the current study. The patients with COVID-19 or influenza were diagnosed according to the World Health Organization guidelines and were confirmed following positive reverse transcription-polymerase chain reaction(RT-PCR) analysis of respiratory secretion samples. 

Results: Both imported COVID-19 and influenza demonstrated multiple lesions. In the former, the lesions were mostly distributed in the subpleural of peripheral lung (90.9%), and some of them showed an anti-butterfly wing sign (18.2%; P<0.05). In the latter, the lesions were distributed around the bronchial vascular tree with subpleural lesions in peripheral lung (33.3%); nonetheless, they were fewer than those observed in the former (P<0.05). There were some differences in ground-glass opacity (GGO) (95.5% vs. 66.7%, respectively, P<0.05), consolidation (68.2% vs. 12.8%, respectively, P<0.05), and crazy paving sign (86.4% vs. 10.3%, respectively, P<0.05). The air bronchogram sign in the former appeared earlier than those in the latter. When both GGO lesions were mixed, the latter had more solid areas and higher density.

Conclusions: The different chest HRCT features of COVID-19 and seasonal influenza pneumonia can provide considerable evidence for the early diagnosis of imported COVID-19 and seasonal influenza pneumonia and can be of great help for the prevention and control of COVID-19.

https://doi.org/10.32592/ircmj.2020.22.9.109
PDF
HTML

References

  1. Wu F, Zhao S, Yu B, Chen YM, Wang W, Song ZG, et al. A new coronavirus associated with human respiratory disease in China. Nature. 2020;579(7798):265-9. doi: 10.1038/s41586-020-2008-3. [PubMed: 32015508].
  2. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054-62. doi: 10.1016/S0140-6736(20)30566-3. [PubMed: 32171076].
  3. Lu R, Zhao X, Li J, Niu P, Yang B, Wu H, et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet. 2020;395(10224):565-74. doi: 10.1016/S0140-6736(20)30251-8. [PubMed: 32007145].
  4. Lai CC, Shih TP, Ko WC, Tang HJ, Hsueh PR. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): the epidemic and the challenges. Int J Antimicrob Agents. 2020;55(3):105924. doi: 10.1016/j.ijantimicag.2020.105924. [PubMed: 32081636].
  5. Yuen KS, Ye ZW, Fung SY, Chan CP, Jin DY. SARS-CoV-2 and COVID-19: the most important research questions. Cell Biosci. 2020;10:40. doi: 10.1186/s13578-020-00404-4. [PubMed: 32190290].
  6. Keilman LJ. Seasonal influenza (Flu). Nurs Clin North Am. 2019;54(2):227-43. doi: 10.1016/j.cnur.2019.02.009. [PubMed: 31027663].
  7. Petrova VN, Russell CA. The evolution of seasonal influenza viruses. Nat Rev Microbiol. 2018;16(1):47-60. doi: 10.1038/nrmicro.2017.118. [PubMed: 29081496].
  8. Webster RG, Govorkova EA. Continuing challenges in influenza. Ann N Y Acad Sci. 2014;1323(1):115-39. doi: 10.1111/nyas.12462. [PubMed: 24891213].
  9. Henritzi D, Hoffmann B, Wacheck S, Pesch S, Herrler G, Beer M, et al. A newly developed tetraplex real-time RT-PCR for simultaneous screening of influenza virus types A, B, C and D. Influenza Other Respir Viruses. 2019;13(1):71-82. doi: 10.1111/irv.12613. [PubMed: 30264926].
  10. To J, Torres J. Viroporins in the influenza virus. Cells. 2019;8(7):654. doi: 10.3390/cells8070654. [PubMed: 31261944].
  11. Mahase E. Covid-19: WHO declares pandemic because of "alarming levels" of spread, severity, and inaction. BMJ. 2020;368:m1036. doi: 10.1136/bmj.m1036. [PubMed: 32165426].
  12. Cucinotta D, Vanelli M. WHO declares COVID-19 a pandemic. Acta Biomed. 2020;91(1):157-60. doi: 10.23750/abm.v91i1.9397. [PubMed: 32191675].
  13. Brody H. Influenza. Nature. 2019;573(7774):S49. doi: 10.1038/d41586-019-02750-x. [PubMed: 31534258].
  14. Moriyama M, Hugentobler WJ, Iwasaki A. Seasonality of respiratory viral infections. Annu Rev Virol. 2020;In Press. doi: 10.1146/annurev-virology-012420-022445. [PubMed: 32196426].
  15. Li Y, Yao L, Li J, Chen L, Song Y, Cai Z, et al. Stability issues of RT-PCR testing of SARS-CoV-2 for hospitalized patients clinically diagnosed with COVID-19. J Med Virol. 2020;92(7):903-7. doi: 10.1002/jmv.25786. [PubMed: 32219885].
  16. Xie X, Zhong Z, Zhao W, Zheng C, Wang F, Liu J. Chest CT for typical 2019-nCoV pneumonia: relationship to negative RT-PCR testing. Radiology. 2020;296(2):E41-5. doi: 10.1148/radiol.2020200343. [PubMed: 32049601].
  17. Ai T, Yang Z, Hou H, Zhan C, Chen C, Lv W, et al. Correlation of chest CT and RT-PCR testing in coronavirus disease 2019 (COVID-19) in China: a report of 1014 cases. Radiology. 2020;296(2):E32-40. doi: 10.1148/radiol.2020200642. [PubMed: 32101510].
  18. Xiong Y, Sun D, Liu Y, Fan Y, Zhao L, Li X, et al. Clinical and high-resolution CT features of the COVID-19 infection: comparison of the initial and follow-up changes. Invest Radiol. 2020;55(6):332-9. doi: 10.1097/RLI.0000000000000674. [PubMed: 32134800].
  19. Tanaka N, Emoto T, Suda H, Kunihiro Y, Matsunaga N, Hasegawa S, et al. High-resolution computed tomography findings of influenza virus pneumonia: a comparative study between seasonal and novel (H1N1) influenza virus pneumonia. Jpn J Radiol. 2012;30(2):154-61. doi: 10.1007/s11604-011-0027-6. [PubMed: 22180185].
  20. Chung M, Bernheim A, Mei X, Zhang N, Huang M, Zeng X, et al. CT imaging features of 2019 novel coronavirus (2019-nCoV). Radiology. 2020;295(1):202-7. doi: 10.1148/radiol.2020200230. [PubMed: 32017661].
  21. Amorim VB, Rodrigues RS, Barreto MM, Zanetti G, Hochhegger B, Marchiori E. Influenza A (H1N1) pneumonia: HRCT findings. J Bras Pneumol. 2013;39(3):323-9. doi: 10.1590/S1806-37132013000300009. [PubMed: 23857688].
  22. Pan Y, Guan H, Zhou S, Wang Y, Li Q, Zhu T, et al. Initial CT findings and temporal changes in patients with the novel coronavirus pneumonia (2019-nCoV): a study of 63 patients in Wuhan, China. Eur Radiol. 2020;30(6):3306-9. doi: 10.1007/s00330-020-06731-x. [PubMed: 32055945].
  23. Duan YN, Qin J. Pre- and posttreatment chest CT findings: 2019 novel coronavirus (2019-nCoV) Pneumonia. Radiology. 2020;295(1):21. doi: 10.1148/radiol.2020200323. [PubMed: 32049602].
  24. Kim MC, Kim MY, Lee HJ, Lee SO, Choi SH, Kim YS, et al. CT findings in viral lower respiratory tract infections caused by parainfluenza virus, influenza virus and respiratory syncytial virus. Medicine (Baltimore). 2016;95(26):e4003. doi: 10.1097/MD.0000000000004003. [PubMed: 27368011].
  25. Ishiguro T, Takayanagi N, Kanauchi T, Uozumi R, Kawate E, Takaku Y, et al. Clinical and radiographic comparison of influenza virus-associated pneumonia among three viral subtypes. Intern Med. 2016;55(7):731-7. doi: 10.2169/internalmedicine.55.5227. [PubMed: 27041156].
  26. El-Badrawy A, Zeidan A, Ebrahim MA. 64 multidetector CT findings of influenza A (H1N1) virus in patients with hematologic malignancies. Acta Radiol. 2012;53(6):662-7. doi: 10.1258/ar.2012.120038. [PubMed: 22734081].
  27. Asai N, Suematsu H, Sakanashi D, Kato H, Hagihara M, Watanabe H, et al. A severe case of Streptococcal pyogenes empyema following influenza A infection. BMC Pulm Med. 2019;19(1):25. doi: 10.1186/s12890-019-0787-9. [PubMed: 30691434].
  28. Zhou Z, Guo D, Li C, Fang Z, Chen L, Yang R, et al. Coronavirus disease 2019: initial chest CT findings. Eur Radiol. 2020;30(8):4398-406. doi: 10.1007/s00330-020-06816-7. [PubMed: 32211963].
  29. Zhou S, Wang Y, Zhu T, Xia L. CT features of coronavirus disease 2019 (COVID-19) pneumonia in 62 patients in Wuhan, China. AJR Am J Roentgenol. 2020;214(6):1287-94. doi: 10.2214/AJR.20.22975. [PubMed: 32134681].
  30. Kloth C, Forler S, Gatidis S, Beck R, Spira D, Nikolaou K, et al. Comparison of chest-CT findings of Influenza virus-associated pneumonia in immunocompetent vs. immunocompromised patients. Eur J Radiol. 2015;84(6):1177-83. doi: 10.1016/j.ejrad.2015.02.014. [PubMed: 25796425].