Non-Chest CT Scans Can Reveal COVID-19

May 15, 2020

Radiologists must continue to be aware that patients obtaining scans for non-respiratory symptoms could still present findings of COVID-19.

Lung CT scans are not the only images that can reveal the presence of COVID-19, new research has discovered.

In a study published this week in Radiology, investigators from the University of Maryland School of Medicine in Baltimore found that non-chest CT scans obtained for other, non-pulmonary reasons in the emergency department can also include findings that can point to COVID-19 infection. This includes patients who present to the hospital with neurological or gastrointestinal symptoms.

“Patients who present solely with gastrointestinal symptoms are more likely to be undiagnosed [for the virus] and remain in their community, posting a continued infectious risk,” wrote the team led by Rydhwana Hossain, M.D., assistant professor of diagnostic radiology and nuclear medicine.

The results, the team said, point to the need for radiologists to be mindful that not all patients who are positive for COVID-19 will initially show up with respiratory symptoms. Other symptoms are possible, and many of these patients will undergo CT imaging that includes portions for the lungs to determine a diagnosis.

To determine whether non-chest CT scans could reveal valuable information about potential COVID-19 infection, Hossain’s team collected data on 119 patients who had non-respiratory CT scans for gastrointestinal or neurological symptoms between March 10 and April 6. These patients were flagged for having findings that were suspicious for COVID-19.

The patients fell into two groups – 62 patients received RT-PCR before the CT scan because they presented to the emergency department with a fever and cough, and 57 had RT-PCR after the CT scan due to their incidental abnormal pulmonary findings. Of the entire group, 101 underwent abdomen or pelvic CTs, and 18 had cervical spine or neck CTs.

Based on those scans, the investigators made these findings:

  • Among patients who received RT-PCR before the CT, 52 percent showed evidence of COVID-19 pneumonia on a non-chest CT

  • Within the patient group who received RT-PCR post-CT, 77 percent had findings that pointed to COVID-19

  • Ground-glass opacity (96 percent) and consolidation (40 percent) were the most common findings

  • Of all the patients, 24 percent required intubation or vasopressor medication, and 23 percent died

  • Patients who had cervical spine or neck CTs experienced worse outcomes

Overall, the team cautioned, the results seen on non-chest CT scans serve as further evidence that radiologists and other providers should still consider COVID-19 as a possible diagnosis – even if a patient does not have the typical symptoms.

“Radiologists should maintain a high index of suspicion with respect to the lungs in patients with primary extrapulmonary clinical symptoms who undergo non-chest CT studies to facilitate earlier diagnosis of COVID-19-related pneumonia,” they wrote.