Chest computed tomography (CT) is frequently used in diagnosing coronavirus disease 2019 (COVID-19) for detecting abnormal changes in the lungs and monitoring disease progression during the treatment process. Furthermore, CT imaging appearances are correlated with patients presenting with different clinical scenarios, such as early versus advanced stages, asymptomatic versus symptomatic patients, and severe versus nonsevere situations. However, its role as a screening and diagnostic tool in COVID-19 remains to be clarified. This article provides a systematic review and meta-analysis of the current literature on chest CT imaging findings with the aim of highlighting the contribution and judicious use of CT in the diagnosis of COVID-19. A search of PubMed/Medline, Web of Science, ScienceDirect, Google Scholar and Scopus was performed to identify studies reporting chest imaging findings in COVID-19. Chest imaging abnormalities associated with COVID-19 were extracted from the eligible studies and diagnostic value of CT in detecting these abnormal changes was compared between studies consisting of both COVID-19 and non-COVID-19 patients. A random-effects model was used to perform meta-analysis for calculation of pooled mean values and 95% confidence intervals (95% CI) of abnormal imaging findings. Fifty-five studies met the selection criteria and were included in the analysis. Pulmonary lesions more often involved bilateral lungs (78%, 95% CI: 45–100%) and were more likely to have a peripheral (65.35%, 95% CI: 25.93–100%) and peripheral plus central distribution (31.12%, 95% CI: 1.96–74.07%), but less likely to have a central distribution (3.57%, 95% CI: 0.99–9.80%). Ground glass opacities (GGO) (58.05%, 95% CI: 16.67–100%), consolidation (44.18%, 95% CI: 1.61–71.46%) and GGO plus consolidation (52.99%, 95% CI: 19.05–76.79%) were the most common findings reported in 94.5% (52/55) of the studies, followed by air bronchogram (42.50%, 95% CI: 7.78–80.39%), linear opacities (41.29%, 95% CI: 7.44–65.06%), crazy-paving pattern (23.57%, 95% CI: 3.13–91.67%) and interlobular septal thickening (22.91%, 95% CI: 0.90–80.49%). CT has low specificity in differentiating pneumonia-related lung changes due to significant overlap between COVID-19 and non-COVID-19 patients with no significant differences in most of the imaging findings between these two groups (P>0.05). Furthermore, normal CT (13.31%, 95% CI: 0.74–38.36%) was reported in 26 (47.3%) studies. Despite widespread use of CT in the diagnosis of COVID-19 patients based on the current literature, CT findings are not pathognomonic as it lacks specificity in differentiating imaging appearances caused by different types of pneumonia. Further, there is a relatively high percentage of normal CT scans. Use of CT as a first-line diagnostic or screening tool in COVID-19 is not recommended.

Infectious aortitis (IA) is a rare and life-threatening cardiovascular disease. Early diagnosis and timely intervention are crucial for reducing mortality associated with mycotic aortic aneurysms (MAAs); however, early diagnosis is challenging due to the nonspecific symptoms. Some cases are diagnosed at an advanced stage or after developing complications, such as rupture or aortic fistula. Current state-of-the-art imaging modalities—including computed tomography (CT), magnetic resonance imaging (MRI), and 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT—can detect infected aneurysms in clinically suspicious cases. MAA features on imaging include lobulated pseudoaneurysm, indistinct irregular arterial wall, perianeurysmal gas, perianeurysmal edema, perianeurysmal soft tissue mass, aneurysmal thrombosis, and high metabolic activity with increased uptake of FDG. Enlarged lymph nodes are often found adjacent to the aneurysm, while iliopsoas abscess (IPA), spondylitis, and aortic fistulas are commonly associated complications. After surgery or endovascular repair, radiological features—including ectopic gas, peri-graft fluid, thickening of adjacent bowel, pseudoaneurysm formed at the graft anastomosis, and increased uptake of FDG—may indicate an infection of aortic graft. This article provides an overview of the clinical and imaging features of MAAs. Thus, familiarity with the imaging appearances of MAAs may assist radiologists in the diagnosis and facilitation of timely treatment.

Spontaneous interventricular septum dissecting hematoma with endocardial fibroelastosis: imaging, diagnosis, surgical therapy and 6-year follow-up outcomes

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Tubercular aortic aneurysm is a rare complication of tuberculosis but associated with very high mortality. Early diagnosis is critical, however, it is challenging due to nonspecific symptoms. This study summarized the CT features of tubercular aortic aneurysm in order to assist timely clinical diagnosis. Seventeen patients with confirmed tubercular aortic aneurysm between 2016 and 2020 were included in this study. The clinical manifestations, past medical history, laboratory and imaging examinations, treatments and other data were collected. CT angiography was routinely performed in all patients. Clinical and CT imaging data was collected and analyzed. All tuberculous aneurysms were pseudoaneurysms, which were located in the thoracic aorta, abdominal aorta, junction of thoracic and abdominal aorta or iliac aorta. The shapes of aneurysms were saccular or lobular. The diameter of aneurysm ranged from 30 to 120 mm. Thirteen patients had atherosclerosis. Mural thrombus was shown in 14 patients. Twelve patients showed enlarged lymph nodes which were found closely related to the aneurysm. Nine patients had tuberculous spondylitis including tuberculosis of thoracic lumbar and lumbosacral spine. Psoas abscess was showed in four patients and iliopsoas abscess was in one patient. Compared with other infectious aneurysms, tuberculous aneurysms typically show more cystic and lobulated shapes on CT scan, which are imaged as poured and unstressed. Another point of differential diagnosis is that the surrounding tissues and adjacent organs of tubercular aneurysms are usually infected with tuberculosis and most of them are accompanied by other sites of tuberculosis.