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  Table of Contents    
RESEARCH LETTER
Year : 2020  |  Volume : 37  |  Issue : 4  |  Page : 349-350  

Chest computed tomography in recovered and discharged COVID-19 patients


1 Full Professor of Radiology, Department of Surgical and Biomedical Sciences, Chairman of Diagnostic Imaging Division, Santa Maria della Misericordia Hospital, Perugia, Italy
2 Department of Radiology, Budrio Hospital, Bologna, Italy

Date of Submission13-Apr-2020
Date of Acceptance15-Apr-2020
Date of Web Publication01-Jul-2020

Correspondence Address:
Michele Scialpi
Full Professor of Radiology, Department of Surgical and Biomedical Sciences, Chairman of Diagnostic Imaging Division, Santa Maria della Misericordia Hospital, Perugia
Italy
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/lungindia.lungindia_235_20

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How to cite this article:
Scialpi M, Piscioli I. Chest computed tomography in recovered and discharged COVID-19 patients. Lung India 2020;37:349-50

How to cite this URL:
Scialpi M, Piscioli I. Chest computed tomography in recovered and discharged COVID-19 patients. Lung India [serial online] 2020 [cited 2020 Aug 12];37:349-50. Available from: http://www.lungindia.com/text.asp?2020/37/4/349/288736



Dear Editor,

Pulmonary alterations are the most frequent manifestations of COVID-19 infection and an accurate assessment of pulmonary parenchyma is essential to prevent the “relapse” of some patients after discharge from the hospital.

The World Health Organization recommendations for the management of clinically recovered COVID-19 patients who are able to be discharged from isolation, published on 12 January 2020 (available on: https://apps.who.int/iris/bitstream/handle/10665/ 330374 / WHO-2019 -nCoV-laboratory-2020.1-eng.pdf), require two negative reverse-transcription polymerase chain and reaction (RT-PCR) results on sequential samples taken at least 24 hours apart. In recovered-discharged patients, the possibility of a reactivation of COVID-19 infection may be considered.

In a study by Zhou et al.,[1] among the factors determining the reactivation of COVID-19 infection such as re-fever and positive RT-PCR in discharged patients, the re-infection or secondary bacterial virus infection are considered. Zhou et al.[1] suggested that in view of this phenomenon, further stratified management of discharge from hospital should be carried out on the basis of guidelines, especially for elderly patients >60-year-old and patients with underlying diseases or severe or critical pulmonary lesions. Finally, different discharge evaluation criteria should be adopted to ensure the complete cure of patients and prevent recurrence after discharge from hospital.[1]

The role of chest computed tomography (CT) in detecting typical parenchymal patterns, their evolution over the time of COVID-19 infection,[2],[3] other additional findings such as enlarged subsegmental pulmonary vessels in 59%–89% of the cases [4],[5] related to pro-inflammatory factors or hyperemia [6],[7] and pulmonary thromboembolism [8],[9],[10] has been reported.

According to Zhou et al.,[1] we suggest that in recovered COVID-19 patients before discharge from hospital, chest CT in addition to normal blood oxygen saturation, absence of symptoms, normal body temperature for more than 1 week and at least two negative RT-PCR results, with sampling time at least 24 h apart, may be considered.

The discharge should be considered on the basis of chest CT results that can show a residual or complete resolution of the pulmonary lesions. A potential secondary infection should be prevented especially after discharge of COVID-19 patients with severe or underlying diseases, partly due to the presence of hypoxia in pulmonary interstitial fibrosis.[1]

In COVID-19 patients considered recovered, an individualized protocol, including chest CT is suggested to ensure complete recovery and to prevent “relapse” after discharge.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Zhou L, Liu K, Liu HG. Cause analysis and treatment strategies of “recurrence” with novel coronavirus pneumonia (COVID-19) patients after discharge from hospital. Zhonghua Jie He He Hu Xi Za Zhi 2020;43:E028.  Back to cited text no. 1
    
2.
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;295:202-7.  Back to cited text no. 2
    
3.
Pan F, Ye T, Sun P, Gui S, Liang B, Li L, et al. Time course of lung changes on chest CT during recovery from 2019 novel coronavirus (COVID-19) pneumonia. Radiology 2020;295:715-21.  Back to cited text no. 3
    
4.
Bai HX, Hsieh B, Xiong Z, Halsey K, Choi JW, Tran TM, et al. Performance of radiologists in differentiating COVID-19 from viral pneumonia on chest CT. Radiology 2020; Mar 10:200823.doi:10.1148/radiol.2020200823 Online ahead of print.  Back to cited text no. 4
    
5.
Caruso D, Zerunian M, Polici M, Pucciarelli F, Polidori T, Rucci C, et al. A Chest CT of COVID-19 in Rome, Italy Radiology 2020 Apr 3:201237.doi.10.1148/radiol.2020201237. Online ahead of print.  Back to cited text no. 5
    
6.
Ye Z, Zhang Y, Wang Y, Huang Z, Song B. Chest CT manifestations of new coronavirus disease 2019 (COVID-19): A pictorial review. Eur Radiol 2020; Mar 19:1-9.doi.10.1007/s00330-020-06801-0. Online ahead of print.  Back to cited text no. 6
    
7.
Li W, Moore MJ, Vasilieva N, Sui J, Wong SK, Berne MA, et al. Angiotensin-converting enzyme 2 is a functional receptor for the SARS coronavirus. Nature 2003;426:450-4.  Back to cited text no. 7
    
8.
Xie Y, Wang X Yang P, Zhang S. COVID-19 complicated by acute pulmonary embolism radiology: Cardiothoracic imaging. 2020 Apr 1;2(2):e200067.  Back to cited text no. 8
    
9.
Chen J, Wang X, Zhang S. Findings of acute pulmonary embolism in COVID-19 patients. The Lancet Infectious Diseases. 3/1/2020. doi: 10.2139/ssrn.3548771. https://ssrn.com/abstract=3548771 (preprint. Available at SSRN).  Back to cited text no. 9
    
10.
Danzi GB, Loffi M, Galeazzi G, Gherbesi E. Acute pulmonary embolism and COVID-19 pneumonia: A random association? Eur Heart J 2020 May 14,41(19):1858.doi:10.1093/eurheartj/ehaa254.  Back to cited text no. 10
    




 

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