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So what are a few things I want you

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to remember about COVID-19, as if you could forget, but let's go through it.

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So, in terms of the epidemiology,

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this has been a global pandemic.

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It has affected all populations,

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but the elderly and the immunocompromised were most at risk.

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A lot of variation in terms of where

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it showed up, in terms of location, association with vaccination status,

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the variants that were are moving through the areas.

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As of May of this year, almost 84 million documented cases in the US alone.

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Signs and symptoms, this may be what you get on the requisition, varies greatly

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and it can be things that are very mild or patients can be asymptomatic.

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But the most commonly described signs and symptoms: fevers,

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chills, cough, shortness of breath, body aches, loss of taste and smell, fatigue,

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headache. In terms of diagnosis, while it is tempting to want to order

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a study, an imaging study, to get a diagnosis, not really appropriate.

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And so we have serologic testing, which is recommended for the diagnosis of COVID-19.

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It's not necessarily recommended for the diagnosis of an active infection,

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but is useful in determining prior infection.

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In terms of the American College of Radiology,

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they have very consistently said CT should not be used as a screening

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for a first line test to diagnose COVID-19.

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However, the role of CT,

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which should be used sparingly and should be reserved for hospitalized patients

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who are symptomatic, there is a role for those patients. And when patients were

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coming down to the CT, appropriate infection protocols should be used

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so that subsequent patients aren't necessarily cross-infected.

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On the CT, you may see bilateral, subpleural,

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peripheral ground glass opacities, like we saw in the case.

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Crazy paving appearance is not uncommon.

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Traction, bronchiectasis, and airspace consolidation are what you see.

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On the chest x-ray,

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again, you're going to look for airspace

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opacities, either ground glass or focal dense consolidation.

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It's usually bilateral,

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it tends to be peripheral, and then the findings tend to be most

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apparent at imaging, ten to twelve days after symptoms of onset.

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However, that's not to say that you can't see it sooner, but certainly at the first

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sign of a symptom, if someone's coming in and getting imaged,

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just because you're getting a negative x-ray doesn't mean that there's not COVID

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and that there won't be findings that will develop later.

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In terms of some of the pearls

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and pitfalls, you want to make sure that as you're appropriately protocoling

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these patients, you keep in mind that giving contrast

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could be helpful, but could also be distracting.

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So, helpful in the sense that oftentimes, patients who have COVID also can have

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a higher likelihood of developing pulmonary emboli.

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And so giving that contrast for CTPA

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obviously makes sense. In patients where that may not be a risk factor,

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holding back on the contrast, particularly now that we're having

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a global shortage of IV contrast, is not necessarily a bad thing.

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In terms of some things to consider,

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pearl wise, CT is very helpful for patients who are

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known to have COVID-19, but their respiratory status is worsening.

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So being able to stage and grade at the degree of pulmonary consolidation or

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the degree of aeration that's going on, is helpful from a CT perspective.

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And then keep in mind that if we're

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looking at radiographs, this is one time where a portable chest

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x-ray is actually preferred because of its ease of having to move patients.

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Really the source is going to the patient and the ease of decontamination and being

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able to reuse that resource without necessarily increasing the spread.

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So those are some things to keep in mind,

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and here are some references.