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Severe Acute Respiratory Syndrome: Spectrum of High-Resolution CT Findings and Temporal Progression of the Disease

¹ Department of Diagnostic Radiology and Organ Imaging, United Christian Hospital, 130 Hip Wo St., Kwun Tong, Hong Kong.
² Department of Medicine, Respiratory Division, United Christian Hospital, Kwun Tong, Hong Kong.

View larger version (151K): [in a new window]   Fig. 1A. —42-year-old woman with severe acute respiratory syndrome coronavirus pneumonia who presented with fever, chills, and myalgia. High-resolution CT scan obtained on day 3 from onset of symptoms shows well-defined lobular ground-glass opacity (arrow) in subpleural area of anteromedial basal segment of lower lobe. She developed fever and diarrhea on day 8.

View larger version (135K): [in a new window]   Fig. 1B. —42-year-old woman with severe acute respiratory syndrome coronavirus pneumonia who presented with fever, chills, and myalgia. High-resolution CT scan obtained on day 12 shows that original lesion has resolved (arrow). Patchy ill-defined areas of peribronchial and subpleural consolidations are found in adjacent lung (not shown). Bronchial wall thickening (arrowheads) is also observed.

View larger version (104K): [in a new window]   Fig. 1C. —42-year-old woman with severe acute respiratory syndrome coronavirus pneumonia who presented with fever, chills, and myalgia. High-resolution CT scans obtained on day 15 show ill-defined nodular areas of ground-glass opacities in upper lobes (arrows) and consolidations in lower lobes.

View larger version (106K): [in a new window]   Fig. 1D. —42-year-old woman with severe acute respiratory syndrome coronavirus pneumonia who presented with fever, chills, and myalgia. Progressive resolution of parenchymal changes is seen in follow-up high-resolution CT scans obtained on day 19 showing residual parenchymal bands that may represent atelectasis or scarring. Patient was discharged on day 33.

View larger version (149K): [in a new window]   Fig. 2A. —36-year-old woman with severe acute respiratory syndrome coronavirus pneumonia who presented early on day 1 with fever, malaise, and diarrhea. High-resolution CT scan obtained on same day shows small consolidation in anterobasal segment of right lower lobe (arrow).

View larger version (143K): [in a new window]   Fig. 2B. —36-year-old woman with severe acute respiratory syndrome coronavirus pneumonia who presented early on day 1 with fever, malaise, and diarrhea. Repeated high-resolution CT scan obtained on day 2 shows that lesion has enlarged slightly (arrow). Patient's symptoms improved in first week, but she developed fever again on day 10.

View larger version (151K): [in a new window]   Fig. 2C. —36-year-old woman with severe acute respiratory syndrome coronavirus pneumonia who presented early on day 1 with fever, malaise, and diarrhea. High-resolution CT scan obtained on day 13 shows that original lesion has resolved (arrow). Pleural-based consolidation and air bronchograms are observed in adjacent pulmonary parenchyma. Changes were confined to right lower lobe throughout course of her illness. Remains of the lungs are clear.

View larger version (131K): [in a new window]   Fig. 2D. —36-year-old woman with severe acute respiratory syndrome coronavirus pneumonia who presented early on day 1 with fever, malaise, and diarrhea. Parenchyma bands (arrows) are seen in subpleural area of right lower lobe on day 21. Follow-up high-resolution CT scan (not shown) obtained on day 27 showed completely normal findings. The patient was discharged on day 31.

View larger version (150K): [in a new window]   Fig. 3A. —30-year-old woman with severe acute respiratory syndrome coronavirus pneumonia who presented with fever and throat discomfort. High-resolution CT scan obtained on day 3 from onset of symptoms shows small lobular consolidations (arrow) in anterior segment of right upper lobe.

View larger version (136K): [in a new window]   Fig. 3B. —30-year-old woman with severe acute respiratory syndrome coronavirus pneumonia who presented with fever and throat discomfort. High-resolution CT scan obtained on same day as A at different level shows another consolidation (arrow) in posterobasal segment of right lower lobe. She developed fever again on day 11 with progressively worsening chest radiography findings (not shown).

View larger version (157K): [in a new window]   Fig. 3C. —30-year-old woman with severe acute respiratory syndrome coronavirus pneumonia who presented with fever and throat discomfort. High-resolution CT scan obtained on day 12 shows consolidation in right lower lobe in predominantly peribronchial distribution. Ground-glass opacification and thickening of interlobular septa and intralobular interstitium (arrow) are seen anteriorly. Small pleural effusion is also observed. Patient's condition deteriorated, with arterial oxygen saturation of 96% in room air.

View larger version (103K): [in a new window]   Fig. 3D. —30-year-old woman with severe acute respiratory syndrome coronavirus pneumonia who presented with fever and throat discomfort. High-resolution CT scans obtained on day 15 show patchy ground-glass changes and consolidations involving both lungs.

View larger version (106K): [in a new window]   Fig. 3E. —30-year-old woman with severe acute respiratory syndrome coronavirus pneumonia who presented with fever and throat discomfort. Small pneumomediastinum is shown on high-resolution CT scan in prevertebral (arrow), retrosternal, and paratracheal spaces on day 20. Patient's condition improved gradually, and she was sent home on day 27.

View larger version (101K): [in a new window]   Fig. 3F. —30-year-old woman with severe acute respiratory syndrome coronavirus pneumonia who presented with fever and throat discomfort. Follow-up high-resolution CT scans obtained on day 31 reveal minimal subtle ground-glass opacities (arrows).

View larger version (97K): [in a new window]   Fig. 4A. —36-year-old man with severe acute respiratory syndrome coronavirus pneumonia who presented with fever, chills, rigors, myalgia, and cough. High-resolution CT scans obtained on day 4 from onset of symptoms show multiple nodular ground-glass opacities in both lungs distributed peripherally. He developed recurrent fever, diarrhea, and shortness of breath on day 7.

View larger version (107K): [in a new window]   Fig. 4B. —36-year-old man with severe acute respiratory syndrome coronavirus pneumonia who presented with fever, chills, rigors, myalgia, and cough. Follow-up high-resolution CT scans obtained on day 34 show ground-glass changes, consolidations in peribronchial distribution in both lungs, and extensive pneumomediastinum and subcutaneous emphysema. Patient's condition was stabilized, but he was still in hospital at time of writing (day 71).

View larger version (138K): [in a new window]   Fig. 5A. —23-year-old woman with severe acute respiratory syndrome coronavirus pneumonia who presented with fever, chills, rigors, myalgia, and sore throat. Her fever subsided on day 3. High-resolution CT scan obtained on day 4 from onset of symptoms shows ground-glass opacity with superimposed reticular pattern producing crazy paving appearance (arrow) in anterior segment of left upper lobe.

View larger version (119K): [in a new window]   Fig. 5B. —23-year-old woman with severe acute respiratory syndrome coronavirus pneumonia who presented with fever, chills, rigors, myalgia, and sore throat. Her fever subsided on day 3. Follow-up high-resolution CT scan obtained on day 12 shows that previously seen lesion (not shown) has resolved. Subtle ill-defined ground-glass changes are seen involving entire left upper lobe. Patient was discharged on day 25.

View larger version (142K): [in a new window]   Fig. 6A. —32-year-old man with severe acute respiratory syndrome coronavirus pneumonia who is also hepatitis B carrier. He presented with fever and myalgia. Chest radiograph with apparently normal findings was obtained on admission (day 5 from onset of symptoms). High-resolution CT scan obtained on day 5 shows consolidation in posterobasal segment of left lower lobe with air bronchograms. His condition was stable during first week, but he developed fever and desaturation on day 9 and was admitted to intensive care unit for close monitoring.

View larger version (103K): [in a new window]   Fig. 6B. —32-year-old man with severe acute respiratory syndrome coronavirus pneumonia who is also hepatitis B carrier. He presented with fever and myalgia. Chest radiograph with apparently normal findings was obtained on admission (day 5 from onset of symptoms). Follow-up high-resolution CT scans obtained on day 21 show extensive ground-glass opacities and consolidations in both lungs. Air-space consolidations with air bronchograms (solid arrow) are seen predominantly in posterior location in lower lungs and areas of ground-glass attenuation are found anteriorly in upper lungs. Extensive pneumomediastinum with trapping of air along bronchovascular sheath (open arrow) is noted. There is also small right pleural effusion (arrowhead). He was recieving intubation on day 24 but ventilation was successfully discontinued 4 days later.

View larger version (103K): [in a new window]   Fig. 6C. —32-year-old man with severe acute respiratory syndrome coronavirus pneumonia who is also hepatitis B carrier. He presented with fever and myalgia. Chest radiograph with apparently normal findings was obtained on admission (day 5 from onset of symptoms). High-resolution CT scans obtained on day 45 show progressive resolution of pneumomediastinum, ground-glass changes, and consolidations. Ground-glass opacities in centrilobular distribution (arrows) are seen in upper lobes. Intralobular honeycombing and bronchiolectasis with septal lines (arrowheads) are found in lung bases. Patient was discharged on day 52.

View larger version (147K): [in a new window]   Fig. 7A. —31-year-old woman with severe acute respiratory syndrome coronavirus pneumonia. She presented with fever, myalgia, cough, and malaise. On admission (day 3), posteroanterior chest radiograph shows air-space opacity in right lower zone. Initial high-resolution CT was not performed. Patient's fever subsided soon after admission, but she developed recurrent fever with shortness of breath on day 11.

View larger version (106K): [in a new window]   Fig. 7B. —31-year-old woman with severe acute respiratory syndrome coronavirus pneumonia. She presented with fever, myalgia, cough, and malaise. High-resolution CT scans obtained on day 21 show extensive consolidations and ground-glass opacities that are denser in dependent, posterior lung zone with relative sparing of anterior and upper lung fields. Thickened interlobular septa and intralobular interstitium are also seen. Patient was admitted to intensive care unit on day 26 because of persistent desaturation despite 100% oxygen therapy.

View larger version (97K): [in a new window]   Fig. 7C. —31-year-old woman with severe acute respiratory syndrome coronavirus pneumonia. She presented with fever, myalgia, cough, and malaise. Follow-up high-resolution CT scans obtained on day 31 reveal extensive pneumomediastinum with secondary subcutaneous emphysema and left pneumothorax. Chest drain (arrow) has been inserted into left pleural cavity. There is partial resolution of ground-glass changes and consolidations. Patient's condition further deteriorated on day 32 with development of large right pneumothorax. Patient was intubated but died on day 55 as result of uncontrolled sepsis and respiratory failure.

View larger version (126K): [in a new window]   Fig. 8A. —47-year-old man with severe acute respiratory syndrome coronavirus pneumonia. He was admitted on day 4 with fever, chills, rigors, and myalgia. Posteroanterior chest radiograph shows air-space opacifications (arrows) in right middle and lower zones. Initial high-resolution CT was not performed. Patient developed fever again with shortness of breath on day 8 and had been admitted to intensive care unit on day 11 for close monitoring because of persistent desaturation.

View larger version (108K): [in a new window]   Fig. 8B. —47-year-old man with severe acute respiratory syndrome coronavirus pneumonia. He was admitted on day 4 with fever, chills, rigors, and myalgia. High-resolution CT scans obtained on day 23 show patchy ground-glass opacities in upper lobes and consolidations in upper and lower lobes. There is extensive pneumomediastinum.

View larger version (109K): [in a new window]   Fig. 8C. —47-year-old man with severe acute respiratory syndrome coronavirus pneumonia. He was admitted on day 4 with fever, chills, rigors, and myalgia. Follow-up high-resolution CT scans obtained on day 51 show persistent pneumomediastinum. Partial resolution of ground-glass opacities and consolidations is observed. Traction bronchiectasis (arrows) is seen in subsegmental airways. Intralobular honeycombing and bronchiolectasis with septal lines are found in both lung bases. Note small right pleural effusion. Patient's condition improved gradually, and he was discharged on day 56.

View larger version (122K): [in a new window]   Fig. 9A. —34-year-old man with severe acute respiratory syndrome coronavirus pneumonia. He presented with fever, cough, and malaise. Posteroanterior chest radiograph on admission (day 3 from onset of symptoms) shows air-space opacification (arrow) in left middle zone. Initial high-resolution CT was therefore not performed. Patient developed high fever and desaturation on day 7 and was admitted to intensive care unit.

View larger version (113K): [in a new window]   Fig. 9B. —34-year-old man with severe acute respiratory syndrome coronavirus pneumonia. He presented with fever, cough, and malaise. High-resolution CT scans obtained on day 20 show diffuse ground-glass attenuation and consolidations (arrows) associated with traction bronchiectasis and bronchiolectasis. Honeycomb changes (arrowheads) are found in subpleural area of left and right lower lobes posteriorly. Architectural distortion is observed from displacement of bronchi and pulling back of major fissures. There is no pneumomediastinum. Patient also had cardiomegaly with pulmonary arterial hypertension. Pulmonary trunk measured 33.6 mm in diameter. Follow-up high-resolution CT scans obtained on days 28 and 32 (not shown) did not show much change in extent of disease. He was intubated on day 42 because of respiratory failure and died on day 56 because of uncontrolled sepsis.

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