-
Radiologists list top 5 CT features for novel coronavirus
Posted by palomamedical on February 5, 2020 at 3:42 amSARS = Severe Acute Respiratory Syndrome
ruszja replied 3 years, 2 months ago 12 Members · 32 Replies -
32 Replies
-
Ha, start listing novel coronavirus in the differential for all CTs with nonspecific bilateral ground glass and consolidative opacities.
-
CT would be very sensitive in detecting lung parenchymal changes as it is in any kind of viral pneumonia. But I am of the opinion that it would not be specific enough to identify Coronavirus infection and differentiate it from other viral pneumonias. It would be more truthful to say that CT is able to detect lung changes in viral infection very early and with a good level of confidence. It is then required to confirm that the infecting agent is indeed is the COVID 19.
Such unqualified claims damages the reputation of the radiology community and smacks of self aggrandisement. I recommend that an editorial be written clarifying the issue.-
Quote from Ipeachan
CT would be very sensitive in detecting lung parenchymal changes as it is in any kind of viral pneumonia. But I am of the opinion that it would not be specific enough to identify Coronavirus infection and differentiate it from other viral pneumonias. It would be more truthful to say that CT is able to detect lung changes in viral infection very early and with a good level of confidence. It is then required to confirm that the infecting agent is indeed is the COVID 19.
Such unqualified claims damages the reputation of the radiology community and smacks of self aggrandisement. I recommend that an editorial be written clarifying the issue.It depends on the setting you are practising in. If you are in a mass-casualty mode in the epidemic area, you CAN make a presumptive diagnosis based on the CT features. That’s no different from sending someone to chemo-embolization based on a MRI finding without biopsy confirmation or a pulmonologist treating IPF based on HRCT findings.
Outside of the ‘hot-zone’, those CT findings are just that, findings that require a virologic confirmation.-
That indeed is the qualification required. Thank you.
Prevalence or pretest probability and the clinical context rule! Not the CT features!!
Lest we start a panic based on the CT findings of the next patient with influenza pneumonia.
Attention catching article titles can be misleading.-
Unknown Member
Deleted UserFebruary 21, 2020 at 6:33 pmCome on guys, very few infectious entities are auntminnies on ct. Im sure corona19 is the same deal, sensitive but far from specific on ct.
-
Quote from Voxeled
Come on guys, very few infectious entities are auntminnies on ct. Im sure corona19 is the same deal, sensitive but far from specific on ct.
Exactly.
Reminds me of an ER CT I read a few years ago. Indication: “Abdominal pain. Appy vs Ebola”.
Impression:
1. Normal appendix.
2. Ebola not excluded.
-
-
Quote from Ipeachan
That indeed is the qualification required. Thank you.
Prevalence or pretest probability and the clinical context rule! Not the CT features!!
Lest we start a panic based on the CT findings of the next patient with influenza pneumonia.
Attention catching article titles can be misleading.
If you have a line of buses outside of your hospital with folks the health department needs to have screened to either send them to a quarantine facility or a field hospital, a quick HRCT with 10 slices may give you all the answer you need in that moment. But that’s going to be the point where you have workers in hazmat suits building tunnels through to your hospital using plastic sheating and national guard stationed at your supply room to keep it from getting raided by the panicked locals.-
Unknown Member
Deleted UserFebruary 25, 2020 at 10:34 amThere’s no containing it, it’s all over. Some people have it and dont even have symptoms, thats why you cant contain it. 1-2% will die from it. They need to hurry up and make a vaccine for it. There have been several movies made of end of world scenarios with viruses killing us off and needing a vaccine to save us. Some day I’m sure there will be a virus a lot deadlier that would do us all in without a vaccine. If the virus only kills then its easy to contain, the issue is when you have so many people who are asymptomatic, carrying the virus without knowing it and spreading it to others.
-
Quote from striker79
There’s no containing it, it’s all over. Some people have it and dont even have symptoms, thats why you cant contain it.
Thats where CT screening comes in. If you have a group of people who are exposed but asymptomatic, you may be able to pick out those who have early CT changes but are not symptomatic. What you are looking for is apparently pretty diffuse, so you don’t need to scan the whole thing at 0.6mm, its enough to run a few axial slices. Nothing is 100% and there are apparently virology positive patients with negative CTs. It’s just another wrench in the toolbox.
SARS eventually ran its course. I doubt COVID is going to be either the ‘spanish flu’ or the black death. But it sure sells more minutes of advertising if you raise that prospect on cable TV.-
Unknown Member
Deleted UserFebruary 25, 2020 at 12:25 pm^ Spot on. These are always overdone.
How many times do we hear “the Flu killed ___ thousands this year.”
Are you scared of the flu? Come on now. I will always help and advise to help every person possible, but the excess or chaff being kept alive by welfare type stuff after years of mistreating themselves wouldn’t make me that sad, big picture, to be honest — that’s how life goes, and much of it has been artificial for some time now. It’s going to happen some time or another.
This disease, even if dangerous, is really only dangerous to unhealthy or really old people, saving except peds population (possibly) here or there.-
Unknown Member
Deleted UserFebruary 25, 2020 at 1:39 pmThis is not the flu, flu only kills .01% or 1 in 1000. So far Coronavirus cases 80,421 with 2,711 deaths or 3.37% death rate which I consider HIGH. But there are many cases that have not been reported, so people are estimating it to be closer to 2% which is still at least 200x more deadly than the flu. 1918 flu pandemic had a similar death rate of 2%, and killed about 1/3 of the world’s population. Of course we are in much better shape now because we have better medical care and can quickly create vaccines. But I consider coronavirus to be a major player, Americans may be taking it too lightly because it has the name Corona in it which reminds us of beer. Flu is not a big deal because its not that deadly, on the other hand very deadly viruses don’t end up being too bad because they simply kill before spreading all over the place. 1918 Spanish flu and this one seem to be big players as they are able to spread and have a lower death rate but enough of a death rate to do lots of damage. I won’t be travelling anywhere anytime soon.
-
Quote from striker79
1918 flu pandemic had a similar death rate of 2%, and killed about 1/3 of the world’s population.
Huh ?
The 1918 pandemic infected 1/3 and killed about 1.7%.
The plague killed 1/3 of the population in the areas it went through.
-
[link=https://pubs.rsna.org/doi/10.1148/radiol.2020200432]https://pubs.rsna.org/doi.0.1148/radiol.2020200432[/link]
According to this garbage paper, all it takes is a 6 mm GG nodule and youve got the coronavirus. Get your thin slice ctd ready!
-
Unknown Member
Deleted UserFebruary 25, 2020 at 6:00 pmsorry infected 1/3 of the worlds population
-
I find it interesting to consider the who, why and how of the people that are more hysterical about this being truly that much different than anything else.
I’m not saying this hasn’t, or won’t, cause a disruption. I’m just surprised at how paranoid or alarmist most are. But I guess anything can be done in this environment of the highly politicized and published 24 hour news cycle. -
Unknown Member
Deleted UserFebruary 27, 2020 at 10:00 am56% of patients that have COVID19 and present within 2 days of symptom onset have normal chest CT scans.
It is highly sensitive after 3-5 days, but nor specific.
Please read the following:
[link=https://www.rsna.org/news/2020/January/Coronavirus-Update]https://www.rsna.org/news…ary/Coronavirus-Update[/link]
-
Interesting that we have warnings about Covid-19 possibly becoming a pandemic but the CDC is seen as having a bloated budget with doctors apparently hanging around doing nothing as “they” are not needed.
Not to worry though, even with massive CDC cutbacks, the government can hire all the doctors it needs. And then fire them when no needed anymore. After all, we don’t want doctors getting paid for idling around doing nothing, do we? Everyone, stand down. Nothing to worry about.
Running government like a seasonal business. Much more efficient that way.
[link=https://www.msn.com/en-us/news/politics/trump-defends-huge-cuts-to-the-cdc-e2-80-99s-budget-by-saying-the-government-can-hire-more-doctors-e2-80-98when-we-need-them-e2-80-99-during-crises/ar-BB10tlE7]https://www.msn.com/en-us…ing-crises/ar-BB10tlE7[/link]
President Trump defended his huge budget cuts to the Centers for Disease Control and Prevention [link=https://twitter.com/MSNBC/status/1232826297237278720]during[/link] a Wednesday press conference on the federal government’s response to the coronavirus.
He maintained that it was easy to bolster the public health agency, and cited his business approach towards running the federal government.
[b]”I’m a businessperson, I don’t like having thousands of people around when you don’t need them,” Trump said. “When we need them, we can get them back very quickly.” [/b]
[b]The president said that some of the experts targeted by the cuts “hadn’t been used for many years,” and that additional federal money and new medical staffers could be obtained swiftly since “we know all the good people.” [/b]
The remarks come amid warnings from CDC experts that the virus’ spread in the US was “inevitable” and urged Americans to prepare. But the Trump administration [link=https://www.businessinsider.com/trump-cuts-programs-responsible-for-fighting-coronavirus-2020-2?utm_source=msn.com&utm_medium=referral&utm_content=msn-story&utm_campaign=bodyurl]has spent the last two years[/link] gutting critical positions and programs that health experts say weakened the federal government’s ability to manage a health crisis. -
Unknown Member
Deleted UserFebruary 29, 2020 at 11:51 amCOVID 19 has 2% mortality rate, no good way of knowing who has it and who doesnt. Anyone with a really bad pneumonia COULD have it. I don’t see a great role for CT yet, other than basically screening who has pneumonia or who doesnt, but you can do that pretty good with XRAY. Lots of patients have coronavirus and have no symptoms, that is why it is spreading all over like the spanish flu with similar mortality rate of 2%. The media hype is warranted and now that we have more US cases people will pay more attention. This is not a common cold, this is a 2% killer. Things could get a lot worse I think, until someone comes out with a vaccine. Theres obviously no containing this virus. If you wanted to contain this, everyone wears a mask but that is not going to happen. The mask is more for stopping people from spreading it, than it is from getting the virus. Also CT is not to screen people for coronavirus, many people have it and are healthy with clear lungs. CT’s role is to help diagnose those with COVID 19 pneumonia – So chest xray shows pneumonia, role of ct COULD BE to see if patient has a pattern consistent with COVID 19 pneumonia.
-
Unknown Member
Deleted UserFebruary 29, 2020 at 12:28 pmRemoved due to GDPR request
-
I would disagree on xray being fine vs CT. Radiograph is not going to cut it for screening. Way too easy to miss small GG stuff.
-
Some of these comments suggest to me a lack of real experience seeing chest X-ray and CT cases of Covid-19.
With the right context, a history highly suspicious for Covid (e.g., loss of smell and flu like symptoms) or a recent + test, the dx of Covid pneumonia can be highly suggested by imaging. The GGO’s can be picked up in the subtle cases if u look carefully for them. CXRs have their limitations as ground glass opacities sometimes can not be confidently detected even in a normal lung (that is, one w/o COPD for example), even if widespread. This should be obvious to those who have read many of these cases.
What I don’t understand about the article is that they have not seen much adenopathy. That has been my experience too, but I think there is a subset of patients, maybe in later stages, when perhaps there is some effective immune response, where I think I have clearly seen reactive adenopathy, which then resolves/improves with clinical improvement. -
Quote from Doby
Some of these comments suggest to me a lack of real experience seeing chest X-ray and CT cases of Covid-19.
This is a thread from 2/5/[u]2020[/u]. So yes, given that the virus had just arrived in the US, none of US had any real experience at that point. I am sure, by now most of us can glance at the thumbnails for the lung windows and diagnose a covid case.
Looking back, thankfully we never made it to the ‘buses full of patients’ stage. We did however get to the point where a positive CT in view of a negative PCR was used for a presumptive diagnosis. -
findings: “Patchy interstitial infiltrate is seen suggesting SARS-cov-2 (Covid) infection”
Impression: “Pulmonary findings consistent with SARS-cov-2 (Covid-19) infection.”
C’mon guys. It’s pretty much ubiquitous in our ER. If it looks like a duck…it could be an american coot, but it is most likely a duck. As far as I am concerned saying “consistent with” gives you just enough wiggle room if it turns out to be adult RSV or something goofy. -
Unknown Member
Deleted UserSeptember 2, 2021 at 5:13 pmCool retrospective thread!
-
Or be judicious with your words and just man up and say Impression: Covid pneumonia.
-
Unknown Member
Deleted UserSeptember 2, 2021 at 5:57 pmCovid pneumonia – winner
Lets speak like the natives, yo
-
Unknown Member
Deleted UserSeptember 2, 2021 at 6:29 pmRemoved due to GDPR request
-
Unknown Member
Deleted UserSeptember 2, 2021 at 6:31 pmRemoved due to GDPR request
-
Yes. I have seen one case that looked liked Covid that tested negativ. I think noone figured out what it was. And then I have also heard of cases that were repeatedly negative for Covid that did turn out to be Covid at autopsy.
-
Yeah at this point I just use the same generic descriptive line about the infiltrates and say its suggestive of or probable or likely COVID and then cut and paste it into the impression. But its funny to go back to a thread from Feb 2020.
Still though theres people that continue to list out huge list of Ddx with COVID included. Easy to drop in a macro I suppose. But its all the same at this point anyway. Will be funny if in the future COVID actually goes away to a great degree with little to no cases and you see what looks like COVID again though.
-
Quote from foton
Still though theres people that continue to list out huge list of Ddx with COVID included. Easy to drop in a macro I suppose. But its all the same at this point anyway. Will be funny if in the future COVID actually goes away to a great degree with little to no cases and you see what looks like COVID again though.
We had a very steep winter wave and the main challenge for both the ER docs and us was not to miss someone who just had acute CHF or CHF+covid among the deluge of covid patients. When I saw the first case of a plain bacterial pneumonia I was almost excited.
-
Oh. My bad. Didnt realize thread was from 2020.
But how does a thread from 2020 make it to the top of the messages list ?
-
-
-
-
-
-
-
-
-