Common respiratory findings seen in follow-up chest imaging of patients who were hospitalized and diagnosed with COVID-19

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the coronavirus disease 2019 (COVID-19) pandemic. It is an airborne, respiratory infection with multi-systemic involvement, notably in the upper and lower airways. Clinical manifestations range from asymptomatic to respiratory failure requiring advanced airway placement with mechanical ventilation, and mortality risk is significant. Although this is a multisystemic disease process, chest imaging has been used to assess patients during and after hospitalization. The objective of this study was to assess common findings seen in follow-up chest imaging studies of patients who were diagnosed and treated with COVID-19 at our local tertiary center.

Methods: We performed an institutional review board (IRB) approved retrospective chart review of patients who were hospitalized and discharged with COVID-19 from our local tertiary center. Our institution’s electronic medical record (EMR) was accessed, and a list was generated in Microsoft Excel of COVID-19 patients diagnosed by reverse transcriptase polymerase chain reaction (RT-PCR). Patient data was collected for those who were admitted from March to August 2020. Chest X-ray and chest computed tomography (CT) findings were reviewed anywhere up to >200 days after initial admission. Imaging studies were obtained during initial hospitalization, subsequent hospitalization, or emergency room (ER) visits within the health system that occurred after discharge. The imaging studies were reviewed, specifically those pertaining to respiratory status, and the findings were compared. Commonly reported imaging findings obtained from chest X-ray and chest CT from the chart review included coarsening pulmonary vasculature, cardiomegaly, focal consolidations, atelectasis, effusions, and low lung volume.

Results: Average age at diagnosis of the patients from the generated list was 74.8 years. Of the list of 232 individuals generated from our health system’s EMR, 48 patients had follow-up imaging reviewed, including chest X-ray or chest CT. The majority of studies were obtained within 150 days after initial hospitalization. Of those 48 patients for which follow-up imaging had been obtained, 39 had chest X-ray findings available, and 9 had chest CT findings available for review. As for the more common findings seen in the follow-up chest X-ray or chest CT studies, coarsening pulmonary vasculature was seen most commonly (52.1%), followed by atelectasis (27.1%), and then cardiomegaly (22.9%).

Conclusion: This study demonstrates the more common chest X-ray and chest CT findings obtained in follow-up assessments of COVID-19 patients who were hospitalized at our tertiary center. Chest imaging studies are one of the available ways to assess follow-up in patients hospitalized with a diagnosis of COVID-19. Following chest imaging studies provides one way to assess recovery and complications from COVID-19, although the disease includes multisystemic involvement. Coarsening pulmonary vasculature was most commonly seen in the follow-up imaging studies’ results that were available in our patient population. Although studies are needed to assess lasting effect on pulmonary function, follow-up chest imaging studies may provide prognostic value in assessing disease outcomes in COVID-19 patients.