X-Ray Images Show What Coronavirus Does to Lungs

Credit: Coronavirus Disease 2019 (COVID-19): A Perspective from China

What does a coronavirus infection look like in the lungs? How does a coronavirus infection progress to pneumonia in the lungs? Scientists are starting to share images with one another, and the public, in hopes of gaining information rapidly about the pandemic.

All of the x-ray images in this article are courtesy of the Radiological Society of North America, which continues to compile peer-reviewed cases of COVID-9 as a “free diagnostic resource to help prevent the spread of this outbreak.”

In the caption for each image, is the summary of what’s going on in the given image, as it was submitted to the RSNA by a researcher.

Here’s what you need to know:


LOOK: X-Ray Images of Coronavirus-Infected Lungs Show How the Virus Damages the Respiratory System

“Chest radiography of confirmed Coronavirus Disease 2019 (COVID-19) pneumonia A 53-year-old female had fever and cough for 5 days. Multifocal patchy opacities can be seen in both lungs (arrows).” -Coronavirus Disease 2019 (COVID-19): A Perspective from China

According to the Centers for Disease Control and Prevention, the main symptoms for coronavirus are fever, coughing, and shortness of breath. But that doesn’t fully explain how the virus manifests inside of your body, if it does infect you.

COVID-9 enters the body through respiratory droplets shared through coughing or sneezing, as explained by The New York TimesOnce inside the body, the virus travels down bronchial tubes and into the lungs.

When the virus reaches the lungs, the mucus membrane of the lungs becomes inflamed, and it becomes harder for them to supply oxygen to the blood (thus the increased shortness of breath).

 

“CT findings of confirmed Coronavirus Disease 2019 (COVID-19) pneumonia Solitary rounded ground-glass opacity (GGO) pattern. A 51-year-old woman presenting without fever had close contact with patients with lab-confirmed COVID-19. a, Baseline axial unenhanced chest CT acquired 6 days before the first positive RT-PCR test showed a rounded GGO in the left lung upper lobe (arrow). b. Follow-up chest CT 4 days later showed the size increase of the lesion (arrow).” -Coronavirus Disease 2019 (COVID-19): A Perspective from China

Pneumonia, an infection in the lung, can occur as the result of this swelling and impaired oxygen flow. In the worst case scenario, an infected patient can eventually have Acute Respiratory Distress Syndrome, where the lungs become so filled with fluid that the patient can’t breathe, even with support, and dies.

Though many people who become infected with coronavirus barely even experience symptoms, others who suffer from the virus have been found to come out on the other side of the virus with a reduced lung capacity, according to a new report by the Hong Kong Hospital Authority.

 

“CT findings of confirmed Coronavirus Disease 2019 (COVID-19) pneumonia Patchy GGO pattern. A 58-old-year man with close contact history presenting without fever. Axial unenhanced chest CT showed patchy pure GGO (arrow).” — -Coronavirus Disease 2019 (COVID-19): A Perspective from China

In a report by the China Morning Post on March 13, the Authority released its findings after observing the first wave of discharged coronavirus patients in China. These findings included the following results: some people still had trouble breathing while walking quickly, and others were believed to have a drop of up to 30% of lung function as a result of the virus.

Zi Yue Zu*, Meng Di Jiang*“CT findings of confirmed Coronavirus Disease 2019 (COVID-19) pneumonia Crazy paving pattern. A 69-old-year woman presenting with fever, cough, and muscle soreness with Wuhan exposure history. a, Axial unenhanced chest CT acquired on January 26, 2020 showed patchy GGO with typical crazy paving pattern (arrow). b, Axial unenhanced chest CT acquired on January 31, 2020 showed multiple subpleural distributed GGOs (arrows).” –Coronavirus Disease 2019 (COVID-19): A Perspective from China

Dr. Owen Tsang Tak-yin, medical director of the authority’s Infectious Disease Centre at Princess Margaret Hospital in Kwai Chung, said to the Chinese publication of these findings, “Some patients might have around a drop of 20 to 30 per cent in lung function [after recovery].” Tsang said more testing had to be done on these patients before any of these findings were proven to be final.

As of March 13, WHO says that approximately 80% of people who are infected with COVID-9 recover without needing any special treatment.

“Typical evolution of CT findings in a47-year-old female patient presenting with persistent fever (38.8°C) for three days. (a) At presentation (day 3), a small region of subpleural GGO with partial consolidation was demonstrated in the right lower lobe; (b) day 7, there was an enlarged region of GGO with superimposed inter-and intralobular septal thickening (crazy-paving pattern) with partial consolidation; (c) day 11, partial resolution of the initial GGO, with a new area of subpleural consolidation; (d) day 20, continued resolution with minimal residual GGO and parenchymal bands were observed. All images have the same window level of -600 and window width of 1600.” – Time Course of Lung Changes On Chest CT During Recovery From 2019 Novel Coronavirus (COVID-19) Pneumonia

To The Guardian, Prof John Wilson, president-elect of the Royal Australasian College of Physicians, explained that almost all serious cases of coronavirus include pneumonia. There are four broad cases of infection, he explained: in the most mild cases, the person is infected with the virus but shows no symptoms.

In the second most mild case, Wilson explained, a person gets an infection in the upper respiratory tract, which “a person has a fever and a cough and maybe milder symptoms like headache or conjunctivitis”.

“Images in a 44-year-old man who presented with fever and suspected COVID-19 pneumonia. A-C, Thin-slice (1-mm) axial CT images showed multiple patchy ground-glass opacity along the peribronchial and subpleural lungs. Some reticular opacities were also found within areas of ground glass (crazy-paving pattern). Lymphadenopathy was absent. D-F, Multiplanar reconstruction showed diffuse distribution of lesions.” – Severe Acute Respiratory Disease in a Huanan Seafood Market Worker: Images of an Early Casualty

The third most severe case represents the largest group of infections, Wilson said, and is comprised of flu-like symptoms that keep people from work, but don’t necessarily become severe.

The most severe case tends to lead to severe symptoms, which might lead to pneumonia. “The lining of the respiratory tree becomes injured, causing inflammation,” Wilson said. “This in turn irritates the nerves in the lining of the airway. Just a speck of dust can stimulate a cough. But if this gets worse, it goes past just the lining of the airway and goes to the gas exchange units, which are at the end of the air passages.”

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