Spectrum of HRCT findings among asymptomatic and recovered COVID-19 patients: how did they impact the clinical decision?

Abstract

Background: Decisions about asymptomatic COVID-19 patients are always critical, either during initial screening or during recovery. Spread of infection will be inevitable if those patients were left non-isolated. This study aimed not only to survey spectrum of HRCT findings of COVID-19 among asymptomatic and recovered patients but also to record unexpected results and document their impact upon the clinical decision. Results: The study was retrospectively conducted, during June and July 2020, on 120 patients proved with COVID-19, during initial HRCT screening or delayed following announcement of recovery. All patients were completely asymptomatic. They included 72 males and 48 females (60%:40%). Their age ranged from 10 to 58 years (mean 35.95 ± 12.25 SD). HRCT was analyzed by three expert consultant radiologists in consensus. Among asymptomatic initially screened COVID-19 patients, additional to GGOs, bilateral consolidative changes were unexpectedly found together with secondary fibrosis (23.3% and 10%). HRCT results significantly impacted the clinical decision (P < 0.0001); PCR had to be repeated with home isolation (43.3%). Infected health care providers had to stop their duty immediately (20%). Isolated hospitalization replaced routine ward admission (25%). Cautious surgical interference was performed using full personal protective equipment (PPE) (8.3%). Among asymptomatic recovered COVID-19 patients, unexpected large lesions (> 3 cm) were found (70%). Near 50% of lung volume was persistently affected (10%). Secondary fibrosis was striking (33%). Encysted hydro-pneumothorax persisted for a whole month (1.7%). “No-isolation” decision remained unchanged because of clinical and laboratory stability; however, steroids were prescribed to speed lung recovery. Conclusion: HRCT findings among asymptomatic and recovered COVID-19 patients can be unexpected and can definitely impact the clinical decision.