Differential Diagnosis of Lungs Lesions in a New Coronavirus Infection COVID-19 and Diseases of Non-Viral Etiology on the Clinical Cases by Computed Tomography Scans in Outpatient CT Centers

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Abstract

New coronavirus infection (COVID-19) viral pneumonia diagnosed by a complex assessment of the epidemiological history, clinical symptoms, radiological and laboratory tests. Radiologists often play a leading role in diagnosis of viral pneumonia, since they may encounter suspicious changes according to radiological studies before clinicians. However, in a number of diseases, including diseases of non-infectious non-viral etiology with a corresponding similar clinical symptoms, it may be difficult to correctly assess the changes detected by computed tomography. This study uses clinical cases to show the main differential diagnostic criteria for COVID-19 viral pneumonia and non-infectious lesions such as pulmonary edema, pulmonary embolism, acute hypersensitive pneumonitis, drug-induced pneumonitis, non-specific interstitial pneumonia, and adenocarcinoma. All patients were hospitalized based on the results of computed tomography, where a diagnosis of non-infectious non-viral lung injuries was established based on morphological and/or typical clinical symptoms, laboratory or radiological data. We examined clinical cases with radiological signs similar to viral pneumonia, such as areas of ground glass opacities with the presence or absence of areas of consolidation, as well as thickening of the lung interstitium with decreased lung attenuation (“crazy paving” symptom). In a difficult epidemiological situation, it is important for a radiologist to suspect the above-mentioned pathological conditions in patients who are urgently admitted to outpatient CT centers.

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About the authors

Mikhail N. Lobanov

State Budget-Funded Health Care Institution of the City of Moscow "Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies of Moscow Health Care Department"

Author for correspondence.
Email: m.lobanov@npcmr.ru
ORCID iD: 0000-0003-4748-7808
SPIN-code: 4898-1926

MD, PhD

Russian Federation, 28 bld. 1 Srednyaya Kalitnikovskaya str., 109029, Moscow

Oleg Y. Bronov

Federal State Budgetary Institution "National Medical and Surgical Center named after N.I. Pirogov" of the Ministry of Healthcare of the Russian Federation

Email: bronovou@pirogov-center.ru
ORCID iD: 0000-0002-2784-302X
SPIN-code: 7429-7993

MD, PhD, Associate Professor

Russian Federation, Moscow

Yuliya A. Abovich

Federal State Budgetary Institution "National Medical and Surgical Center named after N.I. Pirogov" of the Ministry of Healthcare of the Russian Federation; The Russian National Research Medical University named after N.I. Pirogov

Email: abovich@mail.ru
ORCID iD: 0000-0002-9446-2163
SPIN-code: 2344-8317

MD, PhD, Associate Professor

Russian Federation, Moscow; Moscow

Nataliya V. Ledikhova

State Budget-Funded Health Care Institution of the City of Moscow "Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies of Moscow Health Care Department"

Email: n.ledikhova@npcmr.ru
ORCID iD: 0000-0002-1446-424X
SPIN-code: 6907-5936

MD

Russian Federation, Moscow

Elena V. Turavilova

State Budget-Funded Health Care Institution of the City of Moscow "Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies of Moscow Health Care Department"

Email: e.turavilova@npcmr.ru
ORCID iD: 0000-0002-2403-8332
SPIN-code: 2770-1799

MD

Russian Federation, Moscow

Sergey P. Morozov

State Budget-Funded Health Care Institution of the City of Moscow "Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies of Moscow Health Care Department"

Email: morozov@npcmr.ru
ORCID iD: 0000-0001-6545-6170
SPIN-code: 8542-1720

MD, PhD, Professor

Russian Federation, Moscow

Natalya N. Kamynina

State-financed Institution of Moscow city "Scientific Research Institute of Healthcare Organization and Medical Management of Moscow Department of Healthcare"

Email: KamyninaNN@zdrav.mos.ru
ORCID iD: 0000-0002-0925-5822
SPIN-code: 2031-6825

MD, PhD, Professor

Russian Federation, Moscow

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Supplementary files

Supplementary Files
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1. Fig. 1. Computed tomography of the chest organs: A - axial projection; B - enlarged image of the focus zheniya. On both sides in the lungs, seals of the pulmonary parenchyma are determined by the type of "ground glass" of various lengths in the posterior segments of the lungs

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2. Fig. 2. Computed tomography of the chest organs, axial projection. In the posterior segments of the lower lobe of the right lung the zone of "frosted glass" is determined, against which the thickening of the intralobular interstitium is clearly traced - compaction cobblestone pulmonary parenchyma (arrows)

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3. Fig. 3. Computed tomography of the chest organs in axial (A) and coronal (B) projections. On both sides in the lungs characteristic areas of consolidation of polygonal and heavy configuration, small local zones of "matte glass "(arrows). Symptom "reverse halo" - rounded areas of low-intensity "frosted glass" surrounded by a strip of consolidation (arrows)

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4. Fig. 4. Computed tomography of the chest organs, axial projection; A - "pulmonary" window; B - "mediastinal" window. On both sides in the lungs, there is a thickening of the interlobular septa in both lungs, zones of reduced transparency by type “Ground glass” and small areas of consolidation within the secondary lobules (arrows) (A). Fluid in the pericardial cavity, mainly in the right pleural cavity, an increase in the size of the heart (B)

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5. Fig. 5. Fragments of computed tomograms of the chest organs, native examination, axial projection: A - infiltrative changes in the lower lobe of the right lung, surrounded by a "frosted glass" zone; B - section of airiness decrease by the type of "frosted glass"

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6. Fig. 6. Fragment of CT angiopulmonography, axial projection. Multiple contrasting defects of the pulmonary trunk, the main pulmonary arteries, as well as the right and left lobar arteries, massive PE, “rider” thrombus located on the bifurcation of the pulmonary artery trunk

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7. Fig. 7. Computed tomography of the chest organs, axial projection. In the upper parts of both lungs, subpleural and centrally located areas of reduced airiness of the "ground glass" type are noted and the presence of an increased interstitial pattern - a symptom of "cobblestone", the presence of fluid in both pleural cavities

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8. Fig. 8. Computed tomography of the chest organs, axial projection: A - "pulmonary" window; B - "mediastinal" window. Study 14 days after treatment with glucocorticosteroids, complete regression of changes in the lungs, residual fluid in the pleural cavities

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9. Fig. 9. Computed tomography of the chest organs, axial projection. Low intensity frosted glass areas in S2 (A) and S3 (B) of the right lung (arrows), unilateral lesion of the right lung

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10. Fig. 10. Computed tomography of the chest organs, axial projection. Consolidation zone elongated, heterogeneous structure located in the subpleural parts of the upper lobe on the right. In addition, in the right and left lungs, local areas of "frosted glass", against the background of some areas of "frosted glass" - the central consolidation zone (arrows) (AND). The zone of consolidation of the pulmonary parenchyma of heterogeneous density in the posterior upper sections of the right lung, a symptom of "reverse halo "- zones of" frosted glass "surrounded on the periphery by a rim of consolidation (arrows) (B)

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11. Fig. 11. Computed tomography of the chest organs, axial projection in the position of the patient on the back (A) and on the stomach (B). In the middle lobe on the right and in the basal parts of both lungs there are reticular changes, extensive zones of "ground glass", pronounced traction broncho- and bronchioectasis (arrows), signs of esophageal achalasia

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12. Fig. 12. Computed tomography of the chest organs, axial projection, in the upper lobe of the left lung is determined by the formation of an inhomogeneous density with the presence of a solid component and "frosted glass" along the periphery and a strand to the pleura (A), also in the upper lobe of the left lung (arrow) - an additional focus of "frosted glass", which can be regarded as a primary dropout tumors (B)

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