Can the CT-scan help differentiate which COVID-19 patients get severe pneumonia?

Daily thoughts & numbers on the COVID-19 pandemic from a M.D. working in the front lines at the Emergency Department in a hospital in Stockholm, Sweden. 

Eur Radiol 2020-04-11 article by Zhang et al, ‘CT features of SARS-CoV-2 pneumonia according to clinical presentation: a retrospective analysis of 120 consecutive patients from Wuhan city‘: *

Discussion:

In line with other studies [12,13,14,15,16,17,18,19], the predominant patterns of abnormalities on CT for our 120 patients were GGOs with a peripheral distribution and bilateral, multifocal lower lung involvement. Compared with those of common cases, some CT features were more common in severe cases, such as crazy-paving patterns, bronchiectasis, hilar or mediastinal lymph node enlargement, white lung, air bronchogram, and pleural effusion. We also found that severe cases usually presented as consolidation larger than segmental consolidation, and only severe cases showed an overall lobar or diffuse pneumonia distribution pattern, which indicated that the affected area or volume could also be an important determinant for the disease severity of SARS-CoV-2 pneumonia. However, these patterns also often overlap because CT manifestations are dynamic [15, 16], and depend on various factors, such as disease severity, the evolution of the disease course [14, 15, 20], treatment [12], comorbidity, and complications. Usually, as the disease progressed, the range of GGO patches and consolidation increased. Afterwards, condition would improve, GGO and consolidation disappeared, and fibrous stripes (reticulation) may appear [20]. *

So, in other words, while bilateral GGOs [ground-glass opacities] are a common find in COVID-19 patients, those that get critically ill might also show features such as bronchiectasis, hilar/mediastinal node enlargements, white lung, air bronchograms, pleural effusions, and crazy-paving patterns * *.

Crazy-paving patterns look like this:

Images from: thoracic.org – The American Thoracic Society: “Crazy-paving on CT refers to the findings of ground-glass opacities (patchy or diffuse) with thickened interlobular septae and intralobular lines. It gets its name from the similar appearance to a pathway made up of disorganized paving-stones.” *

COVID-19 Numbers Sweden 2020-04-13 *

• 919 deaths nationally
  • 543 of them in Stockholm
• 10 948 confirmed cases nationally
  DEATHS [SWE]
  
  New confirmed deaths daily in Sweden. 
  (Number of COVID-19 cases over time in Sweden, updates during mornings at 14:00 so todays numbers are not yet complete until the next day).
  ICU [SWE]
  
  New Covid-19 patients Being Treated at the ICU in Sweden. 
  (Number of COVID-19 cases over time in Sweden, updates during mornings at 14:00 so todays numbers are not yet complete until the next day).
  NEW CONFIRMED CASES [SWE]  
  
  New confirmed cases daily in Sweden.
  (Number of COVID-19 cases over time in Sweden, updates during mornings at 14:00 so todays numbers are not yet complete until the next day).
  TOTAL CONFIRMED CASES [SWE]  
  
  New confirmed cases accumulated over time in Sweden. 
  (Number of COVID-19 cases over time in Sweden, updates during mornings at 14:00 so todays numbers are not yet complete until the next day).
  
• Intensive care Sweden: *
  • 857 COVID-19 confirmed patients treated in the ICU in total so far
  • 10,5 days from symptoms to ICU
  • 24,5 % women
    
    Total number of recorded of COVID-19 patients needing ICU care each week. From Week 10 it seems to more than triple each week for the first 4 weeks. From week ten: 5 →  24  → 129 → 425 → 760 → 1068 (1087 this week up until now, however since it’s only monday this weeks numbers are yet incomplete)

COVID-19 Numbers Globally (updated today 2020-04-13 at 19:00 CET) *

• 111 652 confirmed deaths
• 1 773 084 confirmed cases
• 6 250 new deaths, daily change: -10,02%

That’s it until tomorrow, keep calm and stay safe!