146 CMAAO
CORONA FACTS and MYTH BUSTER Managing COVID 19 Imaging
Dr K Aggarwal
President CMAAO
968: Update on Covid-19
IMA-CMAAO Webinar on
“Imaging and Covid-19”
4th
July, 2020, 4-5pm
Participants
Dr
KK Aggarwal, President CMAAO
Dr
RV Asokan, Hony Secretary General IMA
Dr
Ramesh K Datta, Hony Finance Secretary IMA
Dr
Jayakrishnan Alapet
Dr
Tulsi
Dr
Brahm Prakash
Dr
VK Venugopal
Dr
Rajan
Dr
Manish Jha
Dr
DS Chadha
Dr
Promila Pankaj
Dr
VK Goel
Dr
LC Jain
Dr
Arpita Joshi
Kabir
Mahajan
Jacob
Ninan
Dr
Divakar Rana
Mr
HK Gohil
Mr
Vijay Khanna
Ravi
Bindra
Dr
S Sharma
Faculty
Dr Harsh Mahajan
Chief
Radiologist, Mahajan Imaging
Chairman,
Centre for Advanced Research in Imaging, Neuroscience and Genomics (CARING)
New
Delhi
Key points
·
Chest
x-ray
(CXR) is typically the first line imaging modality for patients with suspected
Covid-19, although less sensitive than chest CT. It may be normal in early or
mild disease. Even with serious disease, about 31% had normal CXR at the time
of admission. Findings are most extensive about 10-12 days after onset of
symptoms.
·
Findings
on CXR:
most frequent are airspace opacities (described as consolidation or ground
glass opacities), which are often bilateral, peripheral and mainly in the lower
zone. Pleural effusion is very rare (if patient has pleural effusion, chances
are that it may not be Covid).
·
Oblique
CXR
is done when lesion (subpleural or close to chest cavity) is not seen on
routine AP view but there may be some data on CT.
·
Point of
care ultrasound: It is useful to monitor disease progression in patients
who have hypoxemia and hemodynamic failure. It is not a sensitive and specific
modality, but its advantages are inexpensive, ease of use, repeatability and no
exposure to radiation. However,
there is high risk of exposure to the operator, so used less.
·
Findings
on USG:
Multiple B-lines, subpleural consolidation, irregular thickened pleural line
with scattered discontinuities, alveolar consolidation, reappearance of
bilateral A-lines; return of normal A-lines from B-lines suggest that the patient
is improving.
·
CT chest: A
systematic meta-analysis of 49 studies of CT features of Covid-19 by CARING showed
that the commonest finding at all stages of the disease was diffuse bilateral ground
glass opacity. The next common findings were consolidations and mixed density
lesions. Around 78% of patients with RT-PCR positive had either ground-glass
opacities or consolidation or both.
·
There is a significant overlap of CT scan
findings between Covid and non-Covid patients, who present as SARI or ILI.
·
Common CT
findings:
Ground glass opacities, consolidation, mixed lesions, crazy paving pattern,
reticulations, septal thickening (can be inter- or intra-lobular; commonly seen
in advanced disease)
·
Specific
CT findings: Halo sign, reverse Halo sign (focal rounded area of GGO
surrounded by a complete ring of consolidation; one of the typical findings of
Covid-19 as per RSNA), spider web sign, pulmonary vessel engorgement (prominent
pulmonary vessels in relation to the lesions; it is a potential early predictor
of lung impairment), vacuolar sign (vacuole-like transparent shadow <5mm in
length observed in the lesion)
·
Infrequent
CT findings: Architectural distortion, lymph node enlargement and
pleural effusion
·
In initial stages, GGOs can be unilateral and
patchy progressing to multifocal confluent lesions with advancing disease.
·
If crazy paving pattern and vascular
engorgement, the patient needs to be treated more aggressively.
·
Pulmonary embolism is emerging as main
pathogenesis in Covid-19, which can lead to pulmonary infarction. A
contrast-enhanced CT pulmonary angiography is done when PE is suspected.
·
CT severity score: it scores lung opacities
in all 6 lung zones (3 on each side), the sum of scores from all 6 is the
overall CT score (maximum score 24). The severity of lung involvement on CT
correlates with disease severity.
·
Extra-thoracic
Covid manifestations: Covid-19-associated acute hemorrhagic
necrotizing encephalopathy, multisystem inflammatory syndrome (airway
inflammation and rapid development of pulmonary edema on thoracic imaging,
coronary artery aneurysms and extensive right iliac fossa inflammatory changes
on abdominal imaging)
·
CT should not be used as initial screening or
diagnostic tool. It can be used to identify early markers for lung impairment
in symptomatic patient with RTPCR positive for Covid-19 or for patients with non-resolving symptoms to evaluate disease
progression.
·
The role of CT in stable pediatric patients
is limited.
·
X-ray should not be used as initial screening
tool for Covid-19. In suspected patients with history of fever, dry cough, do a
RT PCR first instead of chest x-ray.
·
All patients coming to
Radiology with any respiratory symptoms should be considered a potential
Covid-19 patient. Accordingly, all precautions should be taken. No mixing with
other patients, maintain social distancing, sanitize equipment before using it
for the next patient.
·
Portable x-rays are used for temporal
progression and resolution and also for serial follow-ups. Use a dedicated
machine wherever logistically possible.
There are some natural remedies that can be used in the prevention and eliminate diabetes totally. However, the single most important aspect of a diabetes control plan is adopting a wholesome life style Inner Peace, Nutritious and Healthy Diet, and Regular Physical Exercise. A state of inner peace and self-contentment is essential to enjoying a good physical health and over all well-being. The inner peace and self contentment is a just a state of mind.People with diabetes diseases often use complementary and alternative medicine. I diagnosed diabetes in 2010. Was at work feeling unusually tired and sleepy. I borrowed a cyclometer from a co-worker and tested at 760. Went immediately to my doctor and he gave me prescription like: Insulin ,Sulfonamides,Thiazolidinediones but Could not get the cure rather to reduce the pain but brink back the pain again. i found a woman testimony name Comfort online how Dr Akhigbe cure her HIV and I also contacted the doctor and after I took his medication as instructed, I am now completely free from diabetes by doctor Akhigbe herbal medicine.So diabetes patients reading this testimony to contact his email drrealakhigbe@gmail.com or his Number +2348142454860 He also use his herbal herbs to diseases like:SPIDER BITE, SCHIZOPHRENIA, LUPUS,EXTERNAL INFECTION, COMMON COLD, JOINT PAIN, EPILEPSY,STROKE,TUBERCULOSIS ,STOMACH DISEASE. ECZEMA, PROGENITOR, EATING DISORDER, LOWER RESPIRATORY INFECTION, DIABETICS,HERPES,HIV/AIDS, ;ALS, CANCER , MENINGITIS,HEPATITIS A AND B,ASTHMA, HEART DISEASE, CHRONIC DISEASE. NAUSEA VOMITING OR DIARRHEA,KIDNEY DISEASE. HEARING LOSSDr Akhigbe is a good man and he heal any body that come to him. here is email drrealakhigbe@gmail.com and his Number +2349010754824
ReplyDelete