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Journal of Radiological Review 2021 September;8(3):195-205

DOI: 10.23736/S2723-9284.21.00147-2


language: English

Pitfalls in radiological diagnosis of the new Coronavirus disease 2019

Federica FLAMMIA , Eleonora BICCI, Diletta COZZI, Chiara MORONI, Alessandra BINDI, Silvia PRADELLA, Vittorio MIELE

Department of Medicine and Emergency Radiodiagnostics, Careggi University Hospital, Florence, Italy

In 2019, novel Coronavirus disease (COVID-19) was first reported in China and has quickly swept the world. The most common manifestation is pneumonia, up to the more aggressive acute respiratory distress syndrome (ARDS), which is associated with high mortality. Real-time reverse transcription polymerase chain reaction (RT-PCR) of viral nucleic acid is regarded as the reference standard in COVID-19 diagnosis; however, recent studies confirmed the importance of radiological imaging. Early recognition and isolation of COVID-19 patients is crucial for the outbreak control, and positive chest X-ray and CT can be obtained before the initial positive RT-PCR. Coronavirus 2019 disease has different imaging manifestations at different stages, which may mimic those of other several diseases. In the current context of Coronavirus 2019 pandemic, the imaging findings may be indicative, but they are not specific of 2019 Coronavirus infection. The radiological features are not exclusive of COVID-19 pneumonia and a certain diagnosis is sometimes difficult. Even in areas of high disease prevalence, a number of both infectious and non-infectious diseases, with similar features, should be considered in the differential diagnosis. Chest imaging plays a crucial role in speeding up the diagnosis of Coronavirus pneumonia 2019 and aiding patient management. In this review, we investigated the diagnostic pitfalls by evaluating the radiological features of COVID-19 pneumonia that differentiate it from viral pneumonia and other respiratory diseases, intending to facilitate the differential diagnosis and increase the diagnostic awareness of radiologists.

KEY WORDS: COVID-19; Tomography, X-ray computed; Diagnosis, differential

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