Podcast 560: Imaging in a COVID world

<p><strong>Contributor: Don Stader, MD</strong></p> <p><strong>Educational Pearls:</strong></p> <ul> <li style="font-weight: 400;"><span style= "font-weight: 400;">COVID-19 commonly appears as a bilateral patchy infiltrate on chest radiograph, but this is a non-specific finding </span></li> <li style="list-style: none; display: inline;"> <ul> <li style="font-weight: 400;"><span style= "font-weight: 400;">Sensitivities range from 17-70% for COVID-19</span></li> <li style="font-weight: 400;"><span style="font-weight: 400;">Many other viral pneumonias such as RSV and influenza can have similar findings</span></li> </ul> </li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Point-of-care ultrasound (POCUS) demonstrates B-lines,</span> <a href= "https://www.atsjournals.org/doi/abs/10.1164/ajrccm-conference.2016.193.1_MeetingAbstracts.A1806"> <span style="font-weight: 400;">water-fall sign</span></a><span style="font-weight: 400;">, or hepatization of the lung, but these are also non-specific</span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Computerized tomography (CT)  appears to be one of the more sensitive tests for detecting COVID-19, demonstrating ground-glass opacities - often before or without the patient having symptoms</span></li> <li style="list-style: none; display: inline;"> <ul> <li style="font-weight: 400;"><span style= "font-weight: 400;">However, routine use of CT for diagnosis COVID-19 is strongly discouraged by many medical societies and the CDC</span></li> </ul> </li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Imaging may not be necessary in most patients presenting with suspected COVID-19 for multiple reasons:</span></li> <li style="list-style: none; display: inline;"> <ul> <li style="font-weight: 400;"><span style= "font-weight: 400;">Diagnosis is often clinical suspicion, with or without confirmatory PCR testing (if available)</span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Imaging does little to change the man