J Islamabad Med Dental Coll 2022 164
Open Access
High Resolution Computed Tomography Chest Findings Among
Post-COVID Patients
Rabia Shahid1, Muhammad Saleem Akhter2, Muhammad Waseem3, Maryam Rafiq3
1House officer, Department of Pulmonology ,Sahiwal Teaching hospital, Sahiwal.
2Assistant Professor and Head of Department, Radiology, Sahiwal Teaching Hospital, Sahiwal.
3Assistant Professor and Head of Department, Pulmonology, Sahiwal Teaching Hospital, Sahiwal.
4Assistant Professor, Department of Chemical Pathology, Sahiwal Teaching Hospital, Sahiwal.
A B S T R A C T
Background: High resolution computed tomography (HRCT) chest has proven to be a helpful radiological modality to
assess the course of disease. The main objective of the study was to analyze the pattern of lung involvement on HRCT
chest among post-Covid patients.
Methodology: This cross-sectional study was carried out in the post Covid patients (30 days after discharge) from Nov
2020 to July 2021 in Sahiwal Teaching Hospital, Pakistan. Total 180 patients were selected through non probability
consecutive sampling technique. Whole body Multi Slice CT scan, 128 Slices by GE discovery was used to get HRCT of
chest and to document various patterns and stages of pulmonary fibrosis in the post-COVID patients. The data was
analyzed using the IBM SPSS 28.0.0 2021. Various radiological findings were expressed in percentages.
Results: A total of 77.8% patients had bilateral lung involvement, while 22.2% had unilateral lung involvement after
one month of disease. Ground Glass Haze was the commonest radiological pattern, found in 140 (77.8%) cases. Other
radiological patterns were Air Space Opacification (47.2%), Septal Thickening (20%) and Fibrotic Bands (26.1%).
Traction Bronchiectasis (10%) and Honey Combing (7.8%) were among the lesser ones reported. About 62% patients
had mixed findings on HRCT Chest. Diagnosis of Organizing Pneumonia was made in 166 (92.22%) patients while 14
(7.78%) patients were labelled as Usual Interstitial Pneumonia (UIP) with honey-combing in HRCT chest. The
involvement of Right Lower Lobe was in 165 (91.7%) of cases. Right Middle Lobe remained fairly spared and was seen
in 120 (66.7%) cases.
Conclusion: Patchy ground glass haze seen bilaterally in lower lung lobes are the commonest abnormalities in HRCT
chest of post-COVID patients.
Keywords: Covid-19, Pneumonia, Radiology
Authors’ Contribution:
1Conception; Literature research;
manuscript design and drafting; 2,3 Critical
analysis and manuscript review; 4Data
analysis; Manuscript Editing.
Correspondence:
Maryam Rafiq
Email: mariamsheikh15@yahoo.com
Article info:
Received: September 21, 2021
Accepted: September 9, 2022
Cite this article. Shahid R, Akhter S M, Waseem M, Rafiq M. High Resolution Computed
Tomography (HRCT) Chest Findings Among Post-COVID Patients. J Islamabad Med Dental Coll.
2022;11(3): 164-168
DOI: https://doi.org/10.35787/jimdc.v11i3.789
Funding Source: Nil
Conflict of Interest: Nil
I n t r o d u c t i o n
The modern-day world is plagued by many disease
epidemics. Once every few decades, there comes a
microorganism that puts human life at halt. Arising
from Wuhan, China in December 2019, the disease
caused by Novel Coronavirus or SARS-CoV-2 was
declared as a Public Health Emergency of
International Concern on 30th January 2020. It was
O R I G I N A L A R T I C L E
J Islamabad Med Dental Coll 2022 165
labelled a Global Pandemic by the World Health
Organization on 11th March 2020. 1 While the leading
researchers and scientists took it upon themselves
to serve humanity by developing cure and
preventive vaccines within record time, the virus
had already wreaked havoc. As of August 2021,
there have been a total of more than 200 million
confirmed cases and over 4 million deaths
worldwide. 1
The disease presents itself as a respiratory tract
infection with symptoms such as fever, cough,
dyspnea, muscle pain and fatigue.2 With the newer
variants, such as, delta, the symptoms had
broadened to include diarrhea and flu.3 Diagnosis is
made chiefly, based on a combination of history of
exposure, symptoms and radiological and laboratory
findings. Chest X-rays are helpful in establishing
diagnosis; however, High Resolution Computed
Tomography chest has been employed as a useful
tool in observing the course of disease recovery
and/or fibrosis in post-COVID patients.4 A raised CRP
(C-Reactive Protein) and LDH (Lactate
Dehydrogenase) along with a low lymphocyte count
have been found to be associated with severe
disease and predict poor prognosis.5
Though the death rate of the disease is still around
2%, the after-effects of Covid continue to alarm the
world.6 Moving forward, more and more research is
being conducted and proving that this is deadlier
than the infectious diseases that normally prevail in
the community, with an increased propensity of
harming the old and the immunocompromised.
The burden on healthcare has been crippling for
even the most developed of nations. The most
worrisome part remains to be the fact that long after
the virus leaves the person’s body, its damaging
effects persist. Those with pre-existing
comorbidities are thought to be somewhat more
susceptible than those who have a perfectly healthy
immune system.7 The various stages of lung
parenchymal involvement in post COVID-19 patients
are documented in this study using HRCT chest, to
better visualize lung damage in affected individual
after hospital discharge. There are limited studies
which involve radiological follow up of COVID
patients so this study will add to the existing body of
knowledge by detecting post Covid changes in lung
parenchyma these may help health care providers to
detect those adverse changes timely and treat them
effectively.
M e t h o d o l o g y
This cross-sectional study was conducted in the
Pulmonology Department of Sahiwal Teaching
Hospital, Sahiwal, after approval from the
institutional ethical review board through letter no
155/DME/SLMC/SWL dated 08-10-2020. The study
was conducted from Nov 2020 to July 2021 in District
Sahiwal, Punjab, Pakistan. A sample size of 151 was
calculated through open epi website by taking
confidence level as 95%, level of precision as 5% and
prevalence of post covid HRCT changes in COVID
patients as 89 %. 8 In total 180 patients of both
genders were included by non-probability
consecutive sampling technique. Inclusion criteria
was COVID PCR Positive patients admitted in
hospital with follow up HRCT chest done 30 days
after discharge. Patients with active COVID-19 virus,
pregnant females and those with history of chronic
interstitial lung disease and preexisting lung
conditions like allergic alveolitis, tuberculosis or
other infections were excluded from the study.
Whole body Multi Slice CT scan 128 Slices by GE
discovery was used to get HRCT of chest and to
visualize and document various patterns and stages
of pulmonary fibrosis in the post-COVID patients.
The changes on HRCT chest were evaluated and
reported by three consultant radiologists, having
experience of more than five years in reporting HRCT
chest. The data was documented and analyzed using
the IBM SPSS 28.0.0 2021. Various radiological
findings were expressed in percentages.
J Islamabad Med Dental Coll 2022 166
R e s u l t s
Out of 180 post-Covid patients, 108(60%) were
males and 72(40%) females. The mean age of the
participants was found to be 54.1 ± 14.525 years. A
wide array of radiological findings was seen in the
HRCT chest of 1-month post-COVID patients. These
varied from slight ground glass haze or mild air space
opacification to traction bronchiectasis and
honeycombing. The frequency of these changes, as
seen in the HRCT chest of patients has been
tabulated below in Table 1.
Table I: Radiological Findings in HRCT Chest of
Post-COVID Patients. (n= 180)
RADIOLOGICAL FINDINGS NO. OF CASES
(Percentage)
Ground Glass Haze 140 (77.8)
Air Space Opacification 85 (47.2)
Fibrotic Bands 47 (26.1)
Septal Thickening 36 (20.0)
Mediastinal
Lymphadenopathy
23 (12.8)
Consolidation 22 (12.2)
Traction Bronchiectasis 18 (10.0)
Honeycombing 14 (7.8)
140 out of 180 patients (77.8%) had bilateral lung
involvement, while 40 (22.2%) had unilateral lung
involvement after one month of the disease.
Right Lower Lobe was found to be the most
commonly involved, with involvement in 165
(91.7%) cases. Right Middle Lobe was the least
commonly involved, with changes shown in only 120
(66.7%) out of 180 cases. Different patterns of
distribution were also observed, with patchy
distribution being the most common ( 85.3% ). The
different patterns of distribution, along with the
frequency of involvement of various lung lobes are
shown in table 2.
Table II: Distribution of Histological Changes in HRCT
Chest of Post-COVID patients.
Pattern
Distribution
No. of cases
(Percentage)
Patchy 151(85.3%)
Diffuse 15(8.5%)
Sub-Pleural 75(42.4%)
Peripheral 76(42.9%)
Lobes
Involved
Right Upper
Lobe
159(88.3%)
Right Middle
Lobe
120(66.7%)
Right Lower
Lobe
165(91.7%)
Left Upper
Lobe
137(76.1%)
Left Lower
Lobe
145(80.6%)
Radiological diagnosis of 166 (92.22%) patients
was,made to be Organizing Pneumonia while 14
(7.78%) patients were labelled as Usual Interstitial
Pneumonia (UIP) with honey-combing depicted in
their HRCT chest.
J Islamabad Med Dental Coll 2022 167
Figure 1: Radiological Diagnosis on the basis of HRCT Chest in Post-COVD patients.
D i s c u s s i o n
COVID-19 has trapped the world in a frenzy, where
scientific knowledge is limited and our resources are
being exhausted at an alarming rate. It is imperative
to play our part in these trying times and gather
enough reliable information for the betterment of
humanity. This study is one of few conducted in
Pakistani Patients. COVID-19 is posing enormous
threat to our healthcare system because of the
continued damage that might lead to lung fibrosis in
the absence of timely intervention. 9,10
As shown by previous research data, males are at an
increased risk of developing COVID and resultantly
post-COVID interstitial lung disease (ILD)/fibrosis.11
60% of the cases were males while 40% were
females, which is consistent with similar studies
conducted worldwide.
Increased age has been shown to be a significant
risk-factor via different studies.12 The mean age of
affected patients was 54.1 + 14.52 years consistent
with study reported by Shi in which mean age of
infected individuals was reported to be 49 years.13
Role of repeat CT scan in follow up of Lung Disease
has been well-established now and HRCT chest is far
superior to the conventional CXR.14,15 HRCT chest
was repeated at a one-month interval post-COVID.
Individuals with known ILD such as Hypersensitivity
Pneumonitis (HP) were excluded from this study to
allow a clear deduction of results. Various
histological changes were apparent in the HRCT
Chest. The most common finding was a Ground Glass
Haze (seen in 77.8% of cases), which is consistent
with the findings of previously conducted similar
studies.16
Few other studies revealed similar results with
ground glass opacites being the commonest
finding.17,18 A spectrum of radiological changes was
reported, from Air Space Opacification (47.2%) to
Septal Thickening (20%) and Fibrotic Bands (26.1%).
Traction Bronchiectasis (10%) and Honey Combing
(7.8%) were relatively rare and can be considered to
be more late/severe changes on the path to Lung
Fibrosis. The criteria used for various radiological
findings such as Ground Glass Haze and Air Space
Opacification was according to Fleischner society
glossary of terms for thoracic imaging.19
Bilateral Lower Lobe involvement was seen most
commonly, while the Right Middle Lobe remained
relatively spared. There is a lot of room for further
key variables to be explored in future studies. There
might be a correlation in the lobes being involved
and gender, occupation or smoking status of an
individual.
We can save the crippling healthcare infrastructure
by adequately treating and dealing with all the
complications associated with this deadly pandemic.
HRCT Chest can be used as a very helpful radiological
tool for close follow-up of improvement or
deterioration in a post-COVID patient. The goal is to
predict, investigate and then intervene timely to
J Islamabad Med Dental Coll 2022 168
reduce morbidity and mortality. Furthermore, the
small number of patients recruited at a single facility
limit any definitive conclusions, although they do
indicate the necessity for a more thorough follow-up
of COVID-19 patients.
C o n c l u s i o n
Patchy ground glass haze seen bilaterally in
Lower Lung Lobes are the commonest
radiological abnormalities in HRCT chest of
post-COVID patients.
Timely identification of post-COVID
interstitial lung disease can help in prompt
interventions in the form of drugs like
corticosteroids to save a patient from
complications like lung fibrosis.
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