Radiology of COVID: Dealing With Diagnostic Ambiguity

Sharyn Katz, MD, MTR, Associate Professor at the University of Pennsylvania Perelman School of Medicine, provides an overview on the potential for diagnostic ambiguity in the radiology of Covid-19, a topic she presented at the virtual 2022 Great Debates & Updates in Lung Cancers meeting.

In her presentation, Dr Katz discussed the radiology of COVID pneumonia, particularly in the lung cancer population, with a focus on chest radiographs and chest CT, and touched on some of the atypical presentations and common mimics of COVID-19 pneumonia.

Transcript:

Hello, my name is Sharyn Katz. I am a thoracic radiologist and associate professor in the Department of Radiology at the University of Pennsylvania Perelman School of Medicine. I gave a talk this August for Great Debates & Updates in Lung Cancers on radiology of COVID pneumonia, with a focus on chest radiographs and chest computed tomography (CT). In this discussion, we talked about the typical and atypical appearances of COVID-19 pneumonia and looked at those over time: the imaging at presentation, which is often negative, and the evolution over time with ground glass opacity and consolidation that usually begins to peak around 2 to 3 weeks of disease and can progress further to adult respiratory distress syndrome or superimposed pneumonias and other complications. However, it has a predictable course of development over time, with a peripheral basal predominant distribution of disease.

In addition to the typical findings, there are also atypical presentations of COVID-19 pneumonia. We talked about those and discussed the Radiological Society of North America (RSNA) CT reporting criteria recommendations for COVID-19 produced early in the pandemic. Here they classified typical appearance and determinate appearance, atypical appearance, at which time you should really seek another diagnosis, and what negative looks like for disease. While we are 2-and-a-half years into this pandemic, and resources are no longer stressed, to make these criteria useful for that purpose, there's still a utility in understanding what the typical and atypical appearances of COVID-19 pneumonia are, and when you should really be seeking another diagnosis for your patient, even in the setting of a positive test.

We discussed not only the different presentations of COVID-19 pneumonia, but we also looked at the common mimics of COVID-19 pneumonia, particularly in the lung cancer population: superimposed infections such as influenza, and other sources of inflammation such as radiation-induced lung injury and drug toxicities that can really look quite a lot like COVID-19 pneumonia. It is important to take those into consideration when interpreting these images. And we concluded our discussion with take-home points for the clinicians on how best to utilize imaging in the setting of this pandemic and specifically in the lung cancer population.

Source:

Katz, S. Radiology of COVID: Dealing With Diagnostic Ambiguity. Presented at: Great Debates & Updates in Lung Cancers. Aug 24-26, 2022. Virtual.