The atypical imaging findings of novel coronavirus pneumonia (COVID-19) and its evolution

This study aimed to explore the atypical imaging findings of the novel coronavirus pneumonia (COVID-19) and its evolution.

The atypical imaging data of ten patients in our hospital who tested positive for COVID-19 were analyzed retrospectively, and the distribution, morphology, and image evolution of the lesions were analyzed. High-resolution computed tomography (HRCT) was performed in all cases, and the imaging features were analyzed and summarized by two senior radiologists.

Of these ten patients, three were male, and seven were female. The age of these patients ranged from 21-53 years, with an average age of 36.3 ± 3.6. The first symptom was fever in nine cases and dry cough in one case. A total of 17 lesions were detected in these ten patients. Five patients had a single lesion, and five patients had multiple lesions, for a total of 12 lesions. Ten lesions (58.82%) were located in the inferior lobe of the right lung, four lesions (23.53%) in the left inferior lobe, two lesions (11.76%) in the left upper lobe, and one lesion (5.88%) in the right middle lobe. Among the five single lesions, two were solid lesions, two were mixed ground-glass lesions, and one was a pure ground-glass lesion. Among the 12 multiple lesions, eight were solid lesions, two were mixed ground-glass lesions, and two were pure ground-glass lesions. Atypical manifestations in image signs: five lesions (29.41%) had single solid and sub-solid nodules, and four lesions (23.53%) had cavitary nodules. Typical manifestation (the presence of "white lung"): three lesions (17.65%) had an air bronchogram, two lesions (11.76%) had crazy-paving signs, two lesions (11.76%) had vascular thickening, and one lesion (5.88%) had halo signs. At reexamination 2-6 days later, 15 lesions (88.24%) had enlarged or increased, and two lesions (11.76%) had decreased or absorbed.

Patients with COVID-19 may have atypical imaging findings. Radiologists should improve their understanding of the novel coronavirus pneumonia to avoid any missed diagnoses.