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Review
. 2021 Nov;301(2):E383-E395.
doi: 10.1148/radiol.2021211396. Epub 2021 Aug 10.

CT of Post-Acute Lung Complications of COVID-19

Joshua J Solomon  1 , Brooke Heyman  1 , Jane P Ko  1 , Rany Condos  1 , David A Lynch  1
Affiliations
Review

CT of Post-Acute Lung Complications of COVID-19

Joshua J Solomon et al. Radiology. 2021 Nov.

Abstract

The acute course of COVID-19 is variable and ranges from asymptomatic infection to fulminant respiratory failure. Patients recovering from COVID-19 can have persistent symptoms and CT abnormalities of variable severity. At 3 months after acute infection, a subset of patients will have CT abnormalities that include ground-glass opacity (GGO) and subpleural bands with concomitant pulmonary function abnormalities. At 6 months after acute infection, some patients have persistent CT changes to include the resolution of GGOs seen in the early recovery phase and the persistence or development of changes suggestive of fibrosis, such as reticulation with or without parenchymal distortion. The etiology of lung disease after COVID-19 may be a sequela of prolonged mechanical ventilation, COVID-19-induced acute respiratory distress syndrome (ARDS), or direct injury from the virus. Predictors of lung disease after COVID-19 include need for intensive care unit admission, mechanical ventilation, higher inflammatory markers, longer hospital stay, and a diagnosis of ARDS. Treatments of lung disease after COVID-19 are being investigated, including the potential of antifibrotic agents for prevention of lung fibrosis after COVID-19. Future research is needed to determine the long-term persistence of lung disease after COVID-19, its impact on patients, and methods to either prevent or treat it. © RSNA, 2021.

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Figures

59-year-old woman with sequelae of COVID-related acute respiratory distress syndrome (ARDS). (A) CT on admission shows patchy consolidation and ground glass abnormality. This subsequently progressed to ARDS. (B) Two months later, the consolidation has resolved but there is moderate ground glass abnormality, multifocal linear abnormality and mild bronchiectasis. (C) Seven months after admission, these abnormalities had almost completely resolved, and restrictive pulmonary function also resolved.
Figure 1.
59-year-old woman with sequelae of COVID-related acute respiratory distress syndrome (ARDS). (A) CT on admission shows patchy consolidation and ground glass abnormality. This subsequently progressed to ARDS. (B) Two months later, the consolidation has resolved but there is moderate ground glass abnormality, multifocal linear abnormality and mild bronchiectasis. (C) Seven months after admission, these abnormalities had almost completely resolved, and restrictive pulmonary function also resolved.
59-year-old woman with sequelae of COVID-related acute respiratory distress syndrome (ARDS). (A) CT on admission shows patchy nodular consolidation. A halo of ground glass opacity is present around the largest left lower lobe nodule. The patient subsequently developed ARDS. (B) Two months later, the consolidation has resolved with moderate ground glass abnormality. (C) Three months after admission there is further improvement in ground glass. (D) Eleven months after admission there is still mild residual ground glass abnormality, but symptoms had resolved and pulmonary function was normal.
Figure 2.
59-year-old woman with sequelae of COVID-related acute respiratory distress syndrome (ARDS). (A) CT on admission shows patchy nodular consolidation. A halo of ground glass opacity is present around the largest left lower lobe nodule. The patient subsequently developed ARDS. (B) Two months later, the consolidation has resolved with moderate ground glass abnormality. (C) Three months after admission there is further improvement in ground glass. (D) Eleven months after admission there is still mild residual ground glass abnormality, but symptoms had resolved and pulmonary function was normal.
Progressive pulmonary fibrosis in a 67-year-old man with a history of relatively mild, stable fibrotic hypersensitivity pneumonitis. (A) Baseline CT shows mild ground glass and reticular abnormality. (B) CT angiogram obtained two months after infection shows substantially increased reticular abnormality with mild traction bronchiectasis. (C) CT obtained two months later shows increased traction bronchiectasis indicating progressive fibrosis.
Figure 3.
Progressive pulmonary fibrosis in a 67-year-old man with a history of relatively mild, stable fibrotic hypersensitivity pneumonitis. (A) Baseline CT shows mild ground glass and reticular abnormality. (B) CT angiogram obtained two months after infection shows substantially increased reticular abnormality with mild traction bronchiectasis. (C) CT obtained two months later shows increased traction bronchiectasis indicating progressive fibrosis.
Obstructive lung disease after COVID-19 in a 60-year-old woman. (A) Inspiratory CT with persistent shortness of breath and chest tightness eight months following COVID-19 infection shows subtle mosaic attenuation, best seen in the anterior left upper lobe. (B) Expiratory CT confirms lobular air trapping, which was present on multiple images, indicating small airway obstruction.
Figure 4.
Obstructive lung disease after COVID-19 in a 60-year-old woman. (A) Inspiratory CT with persistent shortness of breath and chest tightness eight months following COVID-19 infection shows subtle mosaic attenuation, best seen in the anterior left upper lobe. (B) Expiratory CT confirms lobular air trapping, which was present on multiple images, indicating small airway obstruction.
Pulmonary vascular disease after COVID-19 in a 63-year-old woman. (A) CT pulmonary arteriogram with persistent shortness of breath and elevated d-Dimer, seven weeks after onset of infection, shows obstructive thrombus in right interlobar pulmonary artery. (B) CT with lung windows at a lower level shows patchy ground glass opacity, and a focal wedge-shaped consolidative abnormality in the right middle lobe typical for pulmonary infarct. (C) Three months later, the large central thrombus had resolved, but nonocclusive linear webs were present in segmental vessels (arrows), typical for chronic thromboembolic disease.
Figure 5.
Pulmonary vascular disease after COVID-19 in a 63-year-old woman. (A) CT pulmonary arteriogram with persistent shortness of breath and elevated d-Dimer, seven weeks after onset of infection, shows obstructive thrombus in right interlobar pulmonary artery. (B) CT with lung windows at a lower level shows patchy ground glass opacity, and a focal wedge-shaped consolidative abnormality in the right middle lobe typical for pulmonary infarct. (C) Three months later, the large central thrombus had resolved, but nonocclusive linear webs were present in segmental vessels (arrows), typical for chronic thromboembolic disease.
Resolving reticular abnormality and subpleural bands following COVID-related acute respiratory distress syndrome (ARDS). (A) CT two months after infection shows ground glass abnormality with mild reticular abnormality and subpleural bands. No traction bronchiectasis or architectural distortion is visible. (B) CT six months after infection shows partial clearing. (C) CT eleven months after infection shows near complete resolution, with mild residual ground glass abnormality. Pulmonary function returned to normal.
Figure 6.
Resolving reticular abnormality and subpleural bands following COVID-related acute respiratory distress syndrome (ARDS). (A) CT two months after infection shows ground glass abnormality with mild reticular abnormality and subpleural bands. No traction bronchiectasis or architectural distortion is visible. (B) CT six months after infection shows partial clearing. (C) CT eleven months after infection shows near complete resolution, with mild residual ground glass abnormality. Pulmonary function returned to normal.
Organizing pneumonia pattern after COVID-19 infection in 64-year-old man. (A) CT obtained four months after infection onset shows patchy ground glass abnormality with bilateral peri-lobular thickening (arrows). (B) CT obtained three months later shows near complete resolution, with mild residual ground glass and linear abnormality. The patient had mild residual pulmonary symptoms.
Figure 7.
Organizing pneumonia pattern after COVID-19 infection in 64-year-old man. (A) CT obtained four months after infection onset shows patchy ground glass abnormality with bilateral peri-lobular thickening (arrows). (B) CT obtained three months later shows near complete resolution, with mild residual ground glass and linear abnormality. The patient had mild residual pulmonary symptoms.
Organizing pneumonia pattern with atoll sign following COVID-19. (A, B) Axial and coronal CT images show multiple areas of sharply demarcated ground glass abnormality with thin peripheral rim (arrows).
Figure 8.
Organizing pneumonia pattern with atoll sign following COVID-19. (A, B) Axial and coronal CT images show multiple areas of sharply demarcated ground glass abnormality with thin peripheral rim (arrows).
54-year-old man with COVID-related acute respiratory distress syndrome (ARDS) and subsequent fibrosis. (A) CT two weeks after admission shows diffuse ground glass abnormality with reticular abnormality and traction bronchiectasis in the right middle lobe indicating an organizing phase of lung injury. (B) CT six months after admission shows decreased ground glass abnormality but extensive traction bronchiectasis and architectural distortion suggesting fibrosis. The patient remained symptomatic with restricted pulmonary function.
Figure 9.
54-year-old man with COVID-related acute respiratory distress syndrome (ARDS) and subsequent fibrosis. (A) CT two weeks after admission shows diffuse ground glass abnormality with reticular abnormality and traction bronchiectasis in the right middle lobe indicating an organizing phase of lung injury. (B) CT six months after admission shows decreased ground glass abnormality but extensive traction bronchiectasis and architectural distortion suggesting fibrosis. The patient remained symptomatic with restricted pulmonary function.
Post-COVID fibrosis in a 79-year-old woman. CT obtained three months after acute infection with acute respiratory distress syndrome (ARDS) shows reticular abnormality with traction bronchiectasis. Mild patchy ground glass abnormality is also present. The findings were new from a pre-COVID-19 CT scan, and the patient had persistent exertional dyspnea.
Figure 10.
Post-COVID fibrosis in a 79-year-old woman. CT obtained three months after acute infection with acute respiratory distress syndrome (ARDS) shows reticular abnormality with traction bronchiectasis. Mild patchy ground glass abnormality is also present. The findings were new from a pre-COVID-19 CT scan, and the patient had persistent exertional dyspnea.
Progressive fibrosis following COVID-19 in 64-year-old man. The patient had a relatively mild COVID-19 infection which did not require intensive care unit (ICU) care, but subsequently developed progressive shortness of breath. (A) CT obtained six weeks after infection shows moderately extensive reticular abnormality with traction bronchiectasis. (B) CT obtained six months later shows progressive reticular abnormality and traction bronchiectasis. The patient had progressive shortness of breath and physiologic impairment.
Figure 11.
Progressive fibrosis following COVID-19 in 64-year-old man. The patient had a relatively mild COVID-19 infection which did not require intensive care unit (ICU) care, but subsequently developed progressive shortness of breath. (A) CT obtained six weeks after infection shows moderately extensive reticular abnormality with traction bronchiectasis. (B) CT obtained six months later shows progressive reticular abnormality and traction bronchiectasis. The patient had progressive shortness of breath and physiologic impairment.
Quantitative CT assessment of linear/reticular abnormality following COVID-19 acute respiratory distress syndrome (ARDS) in a 59-year-old woman. (A) Coronal CT obtained ten weeks after onset of infection shows ground glass abnormality with linear and reticular abnormality at both bases. (B) Corresponding quantitative CT image delineates the linear/reticular abnormality, quantified at 10.5% of the lung volume. (C) Four months later, the extent of ground glass and of linear/reticular abnormality has decreased substantially. Symptoms had resolved, and pulmonary function had returned to normal. (D) Corresponding quantitative CT indicates decrease in linear/reticular abnormality, now 4.6%.
Figure 12.
Quantitative CT assessment of linear/reticular abnormality following COVID-19 acute respiratory distress syndrome (ARDS) in a 59-year-old woman. (A) Coronal CT obtained ten weeks after onset of infection shows ground glass abnormality with linear and reticular abnormality at both bases. (B) Corresponding quantitative CT image delineates the linear/reticular abnormality, quantified at 10.5% of the lung volume. (C) Four months later, the extent of ground glass and of linear/reticular abnormality has decreased substantially. Symptoms had resolved, and pulmonary function had returned to normal. (D) Corresponding quantitative CT indicates decrease in linear/reticular abnormality, now 4.6%.
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References

    1. Stadler K , Masignani V , Eickmann M , Becker S , Abrignani S , Klenk HD , et al. . SARS--beginning to understand a new virus . Nat Rev Microbiol . 2003. ; 1 ( 3 ): 209 – 18 . 10.1038/nrmicro775 - DOI - PMC - PubMed
    1. Mackay IM , Arden KE . MERS coronavirus: diagnostics, epidemiology and transmission . Virol J . 2015. ; 12 : 222 . 10.1186/s12985-015-0439-5 - DOI - PMC - PubMed
    1. Jin Y , Yang H , Ji W , Wu W , Chen S , Zhang W , et al. . Virology, Epidemiology, Pathogenesis, and Control of COVID-19 . Viruses . 2020. ; 12 ( 4 . 10.3390/v12040372 - DOI - PMC - PubMed
    1. Wang C , Horby PW , Hayden FG , Gao GF . A novel coronavirus outbreak of global health concern . Lancet . 2020. ; 395 ( 10223 ): 470 – 3 . 10.1016/S0140-6736(20)30185-9 - DOI - PMC - PubMed
    1. Wu F , Zhao S , Yu B , Chen YM , Wang W , Song ZG , et al. . A new coronavirus associated with human respiratory disease in China . Nature . 2020. ; 579 ( 7798 ): 265 – 9 . 10.1038/s41586-020-2008-3 - DOI - PMC - PubMed
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