Chest Imaging in Patients With COVID-19

Imaging is advised for patients with risk factors for COVID-19 progression and either positive COVID-19 testing or moderate-to-high pre-test probability in the absence of COVID-19 testing.

APRIL 29, 2020 -- An multinational consensus statement from the Fleischner Society on the role of chest imaging in the management of patients with COVID-19 was published in April 2020 (FDA).[1]

Patients with mild features of COVID-19

Imaging is advised for patients with risk factors for COVID-19 progression and either positive COVID-19 testing or moderate-to-high pre-test probability in the absence of COVID-19 testing.

Imaging is not indicated in asymptomatic patients or those with suspected COVID-19 and mild clinical features unless they are at risk for disease progression.

Imaging is indicated in COVID-19 patients with worsening respiratory status.

Patients with moderate-to-severe features of COVID-19

Imaging is advised regardless of the results or availability of COVID-19 testing for patients who present with moderate-to-severe features consistent with COVID-19 infection and a pre-test probability of infection.

For patients with COVID-19, imaging establishes baseline pulmonary status and identifies underlying cardiopulmonary abnormalities that may facilitate risk stratification for clinical worsening.

Patients with moderate-to severe-features of COVID-19 in a resource-constrained environment

Imaging is advised when point-of-care COVID-19 testing is available and positive.

Imaging is indicated for medical triage in resource-constrained environments for patients with suspected COVID-19 with moderate-to-severe clinical features and high pretest probability of the virus.

There is no role for imaging of patients with mild features of COVID-19 if there are significant constraints on resources.

Patients recovered from COVID-19

Imaging is appropriate in patients with functional impairment and/or hypoxemia after recovery from COVID-19.

Other scenarios

Daily chest radiographs are not indicated in stable intubated patients with COVID-19.

COVID-19 testing is indicated in patients who are found incidentally to have typical findings of the virus on a CT scan.

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References
Sources: Fleischner Society. The Role of Chest Imaging in Patient Management during the COVID-19 Pandemic: A Multinational Consensus Statement from the Fleischner Society. https://pubs.rsna.org/doi/10.1148/radiol.2020201365

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