Volume 6, Issue 7, July – 2021 International Journal of Innovative Science and Research Technology

ISSN No:-2456-2165

Clinico-Radiological Profile in Covid – 19 Patients

Mohit Bhardwaj, Ayush Pandey, Sonali Saini, DPS Sudan, Prem Kumar Singhal, Adil Jokhi
Department of Pulmonary Medicine, SGT Medical College, Hospital & Research Institute, Gurugram-122505, India

Abstract:- The coronavirus-2 positive cases were paracetamol medication. Infection by the virus ranges from
enrolled retrospectively and specific data were collected asymptomatic to severe life-threatening course or eventually
on CT and imaging features. On admission, 45 patients death.
out of 50, were symptomatic and 5 were asymptomatic.
On admission, abnormalities in CT images were detected The severity of illness of COVID-19 patients varies
in 24 patients. The typical findings of chest CT images from asymptomatic, to mild, moderate, severe and critical.
were ground glass opacities with bilateral, multifocal, 1. Asymptomatic infection- Absence of clinical sign and
patchy peridermal lessions. Fever was the most common symptom of disease and normal chest x-ray or CT scan
complaint present in 74% patients. Based on COVID-19 associated with positive test for SARS-CoV-2.
severity illness grading, the patients were grouped as 2. Mild infection- Upper airway symptoms include fever,
asymptomatic, mild, moderate, severe or critical. fatigue, myalgia, cough, sore throat, sneezing, and
running nose. Some cases may not have fever and others
Keywords:- RT-PCR; CT Imaging; Classification. may show gastrointestinal (GIT) symptoms (e.g.,
nausea, vomiting, abdominal pain and diarrhea).
I. INTRODUCTION 3. Moderate infection- Clinical signs of pneumonia with
persistent fever, initially dry cough, which becomes
The coronavirus disease-2019 was first reported from productive, may have wheezing or crackles on
Wuhan, China. The rapid spread of the infection in different pulmonary auscultation but show no respiratory distress.
parts of the world resulted in an epidemic (1). World Health Some individual may not have any symptom or clinical
Organisation (WHO) declared the disease as an international sign but CT scan reveal typical pulmonary lesion.
public health emergency. The causal organism of the 4. Severe infection- Initial respiratory symptoms may be
disease is a corona virus named as severe acute respiratory associated with gastrointestinal complaints (GIS) such as
syndrome coronavirus-2 (SARS-CoV-2). The virus is now diarrhea. The clinical deterioration usually occurs in a
referred to as 2019-nCoV (2). week with development of dyspnea and hypoxemia
(blood oxygen saturation <94%).
Corona viruses belong to family Coronaviridae and are 5. Critical infection- There is fast deterioration of patients
grouped under the category of non-segmented positive sense leading to deterio to acute respiratory distress syndrome
RNA viruses (3). Although most human corona virus or respiratory failure. These may be present with shock,
infections are mild in nature but some viruses like Middle encephalopathy, myocardial injury or heart failure. In
East Respiratory Syndrome corona virus (MERS-CoV) are some critical pateints coagulopathy, acute kidney injury
considered virulent (4-9). The transmission of virus in and multiple organ dysfunction have also been observed.
human takes place either through droplets or contact with
fomites which is one of the major routes of the virus spread. The diagnostic criteria of COVID-19 is inclusive of
The virus causes mild infection in many patients but may history of exposure, clinical features and RT-PCR from
also cause serious illness leading to hospitalization and even specimens obtained by oro-pharyngeal or nasopharyngeal
death in elderly patients or those with comorbid conditions swab, assisted with work-up of ultrasound (US), digital
(10). Chest X-Ray (CXR) and (CT).
In India, the first COVID-19 positive patient was
diagnosed in Kerala on January 30, 2020. In Haryana, the II. METHODS
first COVID-19 positive case was diagnosed in on March 4,
2020 and subsequently the first positive case in Gurugram Present study was conducted on the patients admitted
was reported on March 16, 2020 (11). in the SGT Medical College, Hospital and Research
Institute, Gurugram, Haryana. It is a retrospective
The clinical symptoms of COVID-19 disease begins observational case series of demographic features and clinic
from mild to moderate fever, dry cough associated with radiological manifestations in patients suffering from
shortness of breath, sore throat, anosmia and loss of taste COVID-19. A total of 50 COVID-19 positive patients were
sensation with generalized weakness, later involvement of admitted in the hospital between May 2020 to September
gastrointestinal symptoms were reported in few positive 2020 during the outbreak of COVID-19 disease.
cases which included acute abdominal pain, nausea,
vomiting and diarrhea (12-14). Depending on the exposure Upon arrival, the suspected patients were isolated and
to viral load and immunity of individual, the symptoms admitted in isolation ward. The isolation facility was
varies from mild fever with malaise to breathlessness with established according to the standardized checklist
chest pain, high grade fever which is refractory to published by the Ministry of Health and Family Welfare

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Volume 6, Issue 7, July – 2021 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
(MoHFW). All the health-care workers deputed for taking of lung parenchyma [Fig. 1]. Pleural effusion was present in
care of the infected patients were given comprehensive only one patient (2%).
training about the contro practices and procedures. All
patients were treated by standardized protocol issued by At the time of admission, abnormalities in chest CT
government authorities from time to time. All the patients images were detected in 24 (48%) patients. Of the 20
were advised to contact a physician for any complication or patients, the typical findings of chest CT images were
to have a follow up checkup at regular intervals. ground glass opacities with bilateral, multifocal, patchy
peripheral lesions. The lower lobes were affected more than
The nasopharyngeal and oropharyngeal swabs were the upper lobes [Fig. 2]. Bilateral ground glass opacities
tested in the Mycobacteriology lab (NABL certified) of SGT involving multiple segments were also noted. Pure
Medical College, Hospital and Research Institute, consolidation picture in lung fields were present in 2 (4%)
Gurugram, Haryana for detection of COVID-19 using patients.
quantitative RT-PCR for confirmation.
Mixed pattern showing ground glass opacities with
The medical records of patients were analyzed in the consolidation were present in 2 (4%) patients. One patient
Department of Pulmonary Medicine of SGT Medical (2%) had pleural effusion tracing into fissures.
College, Hospital and Research Institute Gurugram,
Haryana. The clinical, laboratory and radiological All 50 COVID-19 positive patients became
characteristics data were obtained from medical records and asymptomatic and were discharged from the hospital after
history given by the patients. All data were reviewed by the RT-PCR report. All discharged patients were advised home
team. quarantine for 7 days as per latest guidelines issued on 8th
May, 2020 earlier it was 14 days. (guidelines issued on 21st
The recorded information included medical history, April, 2020)
exposure history, underlying co-morbidities, symptoms,
signs, and laboratory findings such as chest X-ray and CT IV. DISCUSSION
scan.
The COVID-19 infection spreads through human-to-
III. RESULTS human contact via respiratory route (15, 16). The clinical
manifestations of the disease range from mild symptoms to
In the present study, a total of 50 patents, all from severe illness and sometimes leading to death. It has been
Gurugram district of Haryana State, were incuded. The seen that the infected individual shows no sign and
average age of patients was 44 years (ranged 12-86 years). symptoms of the disease.
There was a male preponderance (76%). Out of 50 patients 4
were health care workers exposed from the SGT hospital, An analysis of chest CT revealed that 2 (4%)
remaining 46 patients were non-health care workers. asymptomatic cases were having abnormalilities in the
lungs. Similar findings have also been reported in
The common symptoms experienced by the patients asymptomatic cases that sowed a positive CT. Inui et al.
varied from fever, cough, sore throat, shortness of breath, to (17) observed that in Diamond Princess Cruise Ship case,
generalized weakness. Five patients (10%) were found to be 56% of asymptomatic COVID-19 cases were found to be
asymptomatic. Of the remaining 45 symptomatic patients with abnormal lungs. They made a comparison of total CT
(90%), fever was the most common complaint recorded in score (determined visually as the percentage of total lung
37 patients (74%). Nineteen patients (38%) suffered with involvement) and reported a significantly lower CT score in
cough, sixteen patients (32%) with shortness of breath, asymptomatic cases as compared to the symptomatic cases
seven patients (14%) with sore throat while six patients (p-value < 0.05). The consolidations were more common in
(12%) were having complaint of weakness. symptomatic cases (41%) as compared to asymptomatic
cases (17%), whereas GGOs (ground glass opacities)
Seven patients (14%) of total 50 had co-morbidities. predominated in asymptomatic cases (83% vs 59%).
Diabetes was the most common co- morbidity present in 5
patients followed by hypertension in 2 patients. The total Bandivali et al. (18) reported pulmonary parenchymal
leucocyte count on admission were normal (4000 – abnormalities in 59% (100/170) of asymptomatic or
11000/cmm) in 40 (80%) out of 50 patients and leukocytosis minimally symptomatic patients. Similarly several such
was seen in 8 (16%) patients while leucopenia was found in cases of asymptomatic COVID-19 patients with pulmonary
2 (4%) patients. Out of 50 patients, three (6%) showed findings have been reported (19). The converse has also
increased lymphocyte/neutrophil ratio. Eight (16%) patients been observed where symptomatic cases can have a negative
showed high ESR and CRP, and D-dimer level and IL-6 on CT (17, 20).
admission were found to be raised in 8 (16%) patients. In all
patients the serum creatinine was normal but blood urea was The distribution and type of pulmonary opacities in
raised in 2 (4%) patients. SGOT and SGPT were higher in asymptomatic cases may resemble the CT findings in
17 (34%) patients. Chest X-ray was found to be normal in symptomatic cases (20-23). However, asymptomatic and
26 patients (52%). 20 (40%) patients showed abnormality in mildly symptomatic cases have a lower percentage of lung
the form of infiltrates and haziness in mid and lower zones involvement with low CT severity score. It has been

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Volume 6, Issue 7, July – 2021 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
reported that the percentage of the total lung involvement The mean duration of conversion of the infection showed no
signifying the disease burden determines the severity of the relation with the symptoms of patients and history of
disease and the final clinical outcome (23-24). exposure.

The percentage of lung opacification is a surrogate of V. CONCLUSION

clinical outcome in COVID-19 pneumonia with a higher
percentage of lung involvement suggesting an adverse Based on COVID-19 severity illness grading, out of
outcome (23), a feature also reported by Tabatabaei et al. total 50 enrolled patients, 5 (10%) patients were
(24) asymptomatic, 21 (42%) patients had mild infection, and 24
(48%) patients had moderate infection. Of 50 patients, 24
Yu et al. (26) reported that age, presence of co- (48%) patients showed abnormal chest x-ray and CT chest
morbidities, low lymphocyte count, presence of findings.
consolidations, crazy paving pattern, larger size of
pulmonary opacities and pleural effusion were associated The various lung opacities observed on CT chest in
with severe illness. Older age has been found to be an COVID-19 patients were ground glass opacity (GGO), GGO
important risk factor for severe disease and adverse outcome with crazy paving pattern, pure consolidation, mixed pattern
(21, 23-25). Yang et al. (26) reported that asymptomatic (GGO with consolidation), segmental vessel enlargement,
patients were younger (median age of 37 years) as compared sub pleural linear/curvilinear lines, bronchial wall
to symptomatic patients (56 years) (p < .001). They had a thickening, bronchial dilatation, air bronchogram sign, and
higher CD4 +T lymphocyte count and showed a faster lung air bubble sign nodules, reticulations, and halo sign.
recovery on CT scans (9 vs 15 days) (p = .003) (25).
In our study, 20 (40%) patients, showed ground glass
Although CT has helped us in understanding the opacities which are bilateral, multifocal, patchy peripheral
disease but the repeat CTs are not recommended in lesions. The lower lobes were found to be affected more as
recovering patients. However, a repeat examination may be compared to upper lobes. Bilateral ground glass opacities
indicated in cases with suspected complications (e.g., super involving multiple segments were also noted. Pure
infection, pulmonary embolism) (26). According to consolidation picture in lung fields were present in 2 (4%)
American College of Radiology guidelines, CT should be patients. One patient (2%) had pleural effusion extending
reserved for hospitalized, symptomatic patients with specific into fissures. Mixed pattern showing ground glass opacities
clinical indications like deteriorating respiratory status (27, with consolidation were present in 2 (4%) patients. One
28). patient (2%) had pleural effusion extending into fissures and
two (4%) patients were asymptomatic. But CT chest
Present study included 50 COVID-19 affected patients examination revealed typical pulmonary lesions.
with the median age being 46 years. These patients were
around one decade younger than that reported by Wang et Seven patients (14%) of the total 50 showed co-
al. (15) (56.0 years), Chen et al. [9] (55.5 years) and three morbidities. The most common co-morbidity was diabetes
years younger than Huang et al. [29] (49.0 years). In our that was recorded in 5 patients. Hypertension was found in
study most of the patients infected with COVID-19 were two patients. The total leucocyte count of patients on
male (76%). Amost a similar observation was made by Chen admission were normal (4000 – 11000/cmm) in 40 (80%)
et al. (9) which showed 73.10% male predominance. On the patients and leukocytosis was seen in 8 (16%) patients and
other hand, a study conducted by Wang et al. (15) reported leucopenia was seen in 2 (4%) patients. Out of 50, Three
(54.3%) males. patients (6%) showed increased lymphocyte/neutrophil
ratio. ESR and CRP were high in 8 (16%) patients, and D-
Out of 50 patients, 8% were asymptomatic. In dimer level and IL-6 on admission were also found to be
symptomatic patients, in 74% pateints fever was the most raised in 8 (16%) patients. Serum creatinine was normal in
common symptom followed by cough (38%), and shortness all the patients but blood urea was raised in 2 (4%) patients.
of breath (32%). Our observations are similar to that SGOT and SGPT were raised in 17 (34%) patients.
reported by Wang et al. (15) and Huang et al. (29).
In our study, the mean age of participants was 44.
Of all the pateints, two patients (4%) showed There was a male preponderance (76%). Out of 50 patients,
lymphocytopenia which is very low when compared with 4 health care workers exposed from SGT hospital,
the study of Zhang et al. (30) (75.4%). In our study one remaining 46 patients were non-health care workers.
patient had lymphocytopenia with thrombocytopenia (2%).
The abnormal lung findings on CT were observed in
HRCT chest of patients demonstrated bilateral, asymptomatic cases with COVID-19 pneumonia. Clinically,
multifocal, patchy peripheral lesions. Bilateral ground glass some patients recovered without developing symptoms
opacities involving multiple segments were also noted. whereas some showed mild symptoms. In some other cases
These findings were similar with Guan et al. (10) and Young the condition of others deteriorated considerably. In such
et al. (31). cases imaging follow-up may reveal partial or complete
progression or there may not be any change.

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Volume 6, Issue 7, July – 2021 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
The conditions which were commonly associated with Severity of illness of COVID-19 patients:
clinic radiological progression include older age, higher Asymptomatic 5
lymphocyte count, higher D dimer and presence of co- Mild 21
morbidities. Moderate 24
Severe 0
The containment of spread of disease is the most Critical 0
important determinant of the final morbidity due to COVID-
19 pandemic. In India, there is need to follow-up pattern of CECT THORAX OF COVID19 PATIENTS
disease spread involving clinical presentation in the larger
population. In order to prevent widespread transmission
within the communities, a close monitoring and large-scale
control strategies are urgently needed.

TABLE I. DEMOGRAPHIC, CLINICAL FEATURES OF

COVID-19 PATIENTS
Age Group:
Criteria Male Female
0-19 years 0 (0%) 3 (6%)
20-39 years 11 (22%) 2 (4%)
40-59 years 25 (50%) 4 (8%)
>60 years 3 (6%) 2 (4%)
Total 39 (78%) 11 (22%)

Asymptomatic Symptomatic
05 45
FIGURE 1: CHEST X-RAY OF STUDY PATIENTS
Health Care Workers Non-Health Care Workers SHOWING BILATERAL LUNG OPACITIES
(HCW) (NHCW)
04 46

Subsequent Symptoms:
Symptoms Male Female
Fever 27 (54%) 10 (20%)
Cough 15 (30%) 04 (8%)
Sore throat 05 (10%) 02 (4%)
Shortness of breath 11 (22%) 05 (10%)
Generalized 03 (6%) 03 (6%)
weakness
Loose stools 01 (2%) 01 (2%)

Co morbid Illness:
Male Female
Diabetes 03 (6%) 02 (4%)
Hypertension 01 (2%) 01 (2%)

Death:
Male Female
0 0

Types of Lung opacities on Chest CT: Figure. 2. A. Areas of consolidation in right lung field. B.
Lung opacity Number of patients (%) Diffuse ground glass opacities in bilateral lower lobes. C.
Multifocal ground glass opacities in bilateral lower lobes in
Ground glass opacity 20 (40%)
peripheral and subpleural region. D. Diffuse areas of ground
Pure consolidation 2 (4%) glass opacities in bilateral lower lobes in peripheral region.
Mixed pattern 2 (4%) E. Diffuse area of ground glass opacities in bilateral lung
fields.

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ISSN No:-2456-2165
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