Mandatory medical device diagnostics.
- Radiograph of the chest (radiographic thorax/chest), in two planes [pulmonary infiltrates]Note: In patients with confirmed SARS-CoV-2 infection, radiologists classified 58% of radiographs as normal.
- Computed tomography of the thorax (chest CT) (gold standard)-if pneumonia is suspected.
- [primary findings: milk glass infiltrates (bilateral/bilateral milk glass opacities) and a consolidation of lung segments.
- secondary findings: reticular (“reticular”) patterns, milk glass opacities with a rounded morphology, and the “crazy-paving patterns” (patterns of a disordered pavement):
- “Crazy-paving pattern”: in the periphery, this shows a thickening of the interlobular septa (“located between different lobules” septa) and intralobular lines (“located within a lobule” septa)].
- If necessary, echocardiography (echo; cardiac ultrasound) – as a standard diagnostic for a new onset of heart failure symptoms (cardiac insufficiency)Note: mild courses of myocarditis (heart muscle inflammation) are accompanied by an unremarkable echocardiography.
Further notes
- COVID-19 infection is often detectable by computed tomography (CT) at a time when the polymerase chain reaction is still negative.
- A retrospective analysis of 21 symptomatic patients proven to be infected with COVID-19 revealed the following findings for this form of viral pneumonia.
- Infestation of more than one lobe (15 patients/71%),
- Ground glass opacities (12 patients/57%) (56.4%).
- Opacities with rounded morphology (7 patients/33%),
- Findings predominantly in the lung periphery (7 patients/33%),
- Consolidations with milk glass opacities (6 patients/29%),
- Crazy paving pattern (see above) (4 patients/19 %); see above for definition.
- Notice:
- No changes were found on CT in 2.9% of patients with severe disease and 17.9% with nonsevere disease.
- The imaging features of COVID-19 pneumonia (pneumonia) on CT are comparable to those of SARS and MERS, H1N1 influenza, cytomegalovirus (CMV) pneumonia, or atypical pneumonia. Therefore, it is important to note that the primary test for diagnosis of SARS-CoV-2 is polymerase chain reaction.
- It is possible that point-of-care ultrasound (POCUS) of the lung, that is, orienting sonographic examination with a short protocol, is an alternative to CT thorax because of its availability in intensive care units and the ease with which the transducer can be disinfected. The DEGUM (German Society for Ultrasound in Medicine) has provided a downloadable examination protocol for this purpose on its website.[Ground glass opacities, i.e. infiltrations, are also visible in ultrasound; reticular crazy paving patterns present themselves as B-lines in ultrasound, these are a reflection of interstitial water retention (in the interstitial spaces)]
- Online risk assessment for severe progression in COVID-19.
