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COVID-19 CHEST CT imaging findings
Can COVID-19 “pneumonia” be usefully distinguished by COVID-19 related cryptogenic organizing pneumonia by chest CT?
To me, most cases I can recognize as probably being related to COVID-19 looks like COP: peripheral and peribronchovascular, subpleural, basilar GGO’s.
And once severe and extensive, COVID can manifest as any of the histologic patterns of lung injury, including DAD and AFOP, no? And my understanding is that mixed patterns of injury can co-exist in the same patient. So what is the use trying, when we can’t determine, short of biopsy ?
Supposedly recognizing COP in Covid-19 could assist in better tailoring steroid use clinically but does radiology have any role? -
4 Replies
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When I first started reading about Covid-19, I thought the description was the same as COP. So whenever I see what I used to call COP, I come down hard on Covid-19 – I don’t think radiology’s rule is to get them diagnosed wit Cvoid-19, radiology’s role is simple to get them tested for Covid-19. Thats the way I see it. So in today’s age, instead of just saying COP it should be highly suspicious for covid-19, and cop also in differential. COP and Covid-19 look exactly the same to me.
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That is what I had thought and that is what I have been doing. But recently I was taken aback when some internist asked me what test to order to best evaluate for COP in a Covid + patient, either regular CT or high resolution. I was nonplussed. I said hi-res would prob be better but return the same conclusion: can’t really tell.
Then I googled and some September article seemed to suggest there may be some utility in coming to a more specific dx of COP in Covid patients, as steroid treatment could be more specifically tailored, that is, pulsed in high doses.-
It does look like COP now that it is pointed out.
But they test for it and show it on EPIC, so I don’t have to guess whether it is covid or not.-
I wouldn’t call it cryptogenic – I’d use OP as we have a cause[8|]
I’ve seen it evolve into fibrosing OP – it was a patient who had been in ICU for a long time with a tracheostomy. Is anyone doing any research into what proportion of Covid patients get OP and then what proportion of those turn in to fibrosing OP?
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