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PURPOSE It has come to our attention that specific vascular changes (VCs) appear more frequently in chest computed tomography (CT) of patients with coronavirus disease 2019 (COVID-19). In this study, we aimed to investigate if these specific VCs in chest CT correlate with clinical severity of the disease. METHODS CT images of 102 patients who underwent low-dose noncontrast chest CT due to COVID-19 between 11 March 2020 and 11 April 2020 were evaluated retrospectively. The patients were divided into two groups based on the presence of VCs in CT images. VCs in chest CT of patients with COVID-19 were defined using the following descriptors: decreased lumen caliber, vascular wall irregularity, angulation in the course of the vessel, vascular disruption, and/or interruption. The relationship of these VCs with disease symptoms (fever, cough, shortness of breath), comorbid conditions (diabetes, hypertension, asthma), smoking habit, disease-specific laboratory changes (white blood cell-lymphocyte count, neutrophil/lymphocyte ratio, C-reactive protein [CRP], D-dimer, lactate dehydrogenase [LDH], ferritin, procalcitonin), lung parenchymal infiltration pattern (ground-glass opacity, crazy-paving pattern, consolidation) and its distribution (peripheral, central, mixed, upper lobes, lower lobes, right middle lobe) on CT were investigated by comparison of these variables between patients with and without VCs in chest CT. RESULTS VCs were observed in 18 out of 102 patients (18%) with typical parenchymal involvement for COVID-19. There was no significant difference in terms of age and sex. We found an irregularity in the wall of the vascular structures in the distal branches and decreased lumen caliber of the vessels related to ground-glass opacities in 15 patients, concentric luminal narrowing in annular form in 4 patients, angulation/traction or springiness in the vascular structures towards the active lesions in 3 patients, and interruptions along the vascular course in 1 patient. VCs were significantly correlated with fever (12/18, 66.7%) and shortness of breath (7/18, 39%). These changes were significantly more remarkable in common disease involving both upper and lower lobes (10/18, 56%). In these cases, there was a substantial increase in CRP (15/18, 83%; mean, 5.7 +/- 6.3 mg/dL) and LDH (8/18, 44%) values compared to those who did not have any VCs. CONCLUSION The results of this study suggest that specific VCs observed in chest CT may predict the disease severity in cases of COVID-19 pneumonia. These changes may be related to respiratory distress in the disease.

In this study, we aimed to reveal the relationship between initial lung parenchymal involvement patterns and the subsequent need for hospitalization and/or intensive care unit admission in coronavirus disease 2019 (COVID-19) positive cases. Overall, 231 patients diagnosed with COVID-19 as proven by PCR were included in this study. Based on the duration of hospitalization, patients were divided into three groups as follows: Group 1, patients receiving outpatient treatment or requiring hospitalization <7 days; Group 2, requiring hospitalization ≥7 days; Group 3, patients requiring at least 1 day of intensive care at any time. Chest CT findings at first admission were evaluated for the following features: typical/atypical involvement of the disease, infiltration patterns (ground-glass opacities, crazy-paving pattern, consolidation), distribution and the largest diameters of the lesions, total lesion numbers, number of affected lung lobes, and affected total lung parenchyma percentages. The variability of all these findings according to the groups was analyzed statistically. In this study, 172 patients were in Group 1, 39 patients in Group 2, and 20 patients in Group 3. The findings obtained in this study indicated that there was no statistically significant difference in ground-glass opacity rates among the groups (p = 0.344). The rates of crazy-paving and consolidation patterns were significantly higher in Groups 2 and 3 than in Group 1 (p = 0.001, p = 0.002, respectively). The rate of right upper, left upper lobe, and right middle lobe involvements as consolidation pattern was significantly higher in Group 3 than in Group 1 (p = 0.148, p = 0.935, p = 0.143, respectively). A statistically significant difference was also found between the affected lobe numbers, total lesion numbers, the diameter of the largest lesion, and the affected lung parenchyma percentages between the groups (p = 0.001). The average number of impacted lobes in Group 1 was 2; 4 in Group 2 and Group 3. The mean percentage of affected lung parenchyma percentage was 25% in Group 1 and Group 2, and 50% in Group 3. In case of infiltration dominated by right middle or upper lobe involvement with a consolidation pattern, there is a higher risk of future intensive care need. Also, the need for intensive care increases as the number of affected lobes and percentage of affected parenchymal involvement increase.