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Despite imaging not being a tool for novel coronavirus disease 2019 (COVID-19) diagnosis, there has been an increased number of chest computed tomography (CT) scans done worldwide. There are no pathognomonic CT features for COVID-19 pneumonia, as findings are also common in other infectious diseases and noninfectious aetiologies. Nonetheless, point-of-care physicians should be familiarized with the most common imaging presentations of the COVID-19. In this pictorial review, we have summarized the most reported imaging features of COVID-19 pneumonia, including possible differential diagnosis according to the CT finding.

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Chest imaging is often used as a complementary tool in the evaluation of coronavirus disease 2019 (COVID-19) patients, helping physicians to augment their clinical suspicion. Despite not being diagnostic for COVID-19, chest CT may help clinicians to isolate high suspicion patients with suggestive imaging findings. However, COVID-19 findings on CT are also common to other pulmonary infections and non-infectious diseases, and radiologists and point-of-care physicians should be aware of possible mimickers. This state-of-the-art review goal is to summarize and illustrate possible etiologies that may have a similar pattern on chest CT as COVID-19. The review encompasses both infectious etiologies, such as non-COVID viral pneumonia, Mycoplasma pneumoniae, Pneumocystis jiroveci, and pulmonary granulomatous infectious, and non-infectious disorders, such as pulmonary embolism, fat embolism, cryptogenic organizing pneumonia, non-specific interstitial pneumonia, desquamative interstitial pneumonia, and acute and chronic eosinophilic pneumonia.

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OBJECTIVES: To assess whether an additional chest ultra-low-dose CT scan to the coronary CT angiography protocol can be used for lung cancer screening among patients with suspected coronary artery disease. METHODS: 175 patients underwent coronary CT angiography for assessment of coronary artery disease, additionally undergoing ultra-low-dose CT screening to early diagnosis of lung cancer in the same scanner (80kVp and 15mAs). Patients presenting pulmonary nodules were followed-up for two years, repeating low-dose CTs in intervals of 3, 6, or 12 months based on nodule size and growth rate in accordance with National Comprehensive Cancer Network guidelines. RESULTS: Ultra-low-dose CT identified 71 patients with solitary pulmonary nodules (41%), with a mean diameter of 5.50±4.00mm. Twenty-eight were >6mm, and in 79% (n=22) of these cases they were false positive findings, further confirmed by follow-up (n=20), resection (n=1), or biopsy (n=1). Lung cancer was detected in six patients due to CT screening (diagnostic yield: 3%). Among these, four cases could not be detected in the cardiac field of view. Most patients were in early stages of the disease. Two patients diagnosed at advanced stages died due to cancer complications. The addition of the ultra-low-dose CT scan represented a radiation dose increment of 1.22±0.53% (effective dose, 0.11±0.03mSv). CONCLUSIONS: Lung cancer might be detected using additional ultra-low-dose protocols in coronary CT angiography scans among patients with suspected coronary artery disease.

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OBJECTIVE: The aim of this study was to analyze chest CT scans of patients with thoracic textiloma. METHODS: This was a retrospective study of 16 patients (11 men and 5 women) with surgically confirmed thoracic textiloma. The chest CT scans of those patients were evaluated by two independent observers, and discordant results were resolved by consensus. RESULTS: The majority (62.5%) of the textilomas were caused by previous heart surgery. The most common symptoms were chest pain (in 68.75%) and cough (in 56.25%). In all cases, the main tomographic finding was a mass with regular contours and borders that were well-defined or partially defined. Half of the textilomas occurred in the right hemithorax and half occurred in the left. The majority (56.25%) were located in the lower third of the lung. The diameter of the mass was ≤ 10 cm in 10 cases (62.5%) and > 10 cm in the remaining 6 cases (37.5%). Most (81.25%) of the textilomas were heterogeneous in density, with signs of calcification, gas, radiopaque marker, or sponge-like material. Peripheral expansion of the mass was observed in 12 (92.3%) of the 13 patients in whom a contrast agent was used. Intraoperatively, pleural involvement was observed in 14 cases (87.5%) and pericardial involvement was observed in 2 (12.5%). CONCLUSIONS: It is important to recognize the main tomographic aspects of thoracic textilomas in order to include this possibility in the differential diagnosis of chest pain and cough in patients with a history of heart or thoracic surgery, thus promoting the early identification and treatment of this postoperative complication.

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Bronchioloalveolar carcinoma has various presentations and a wide spectrum of imaging patterns, as does adenocarcinoma with a bronchioloalveolar component. The objective of this essay was to describe and illustrate the CT findings that are most characteristic of these tumors. Three presentations are described: solitary pulmonary nodule, consolidation, and diffuse pattern. The last two should be included in the differential diagnosis, together with infectious diseases. Knowledge of the various presentations and the use of proper diagnostic procedures are crucial to early diagnosis and to improving survival.

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O carcinoma bronquíolo-alveolar e os adenocarcinomas mistos com componente bronquíolo-alveolar têm apresentações variadas e múltiplos padrões por imagem. O objetivo deste ensaio foi descrever e ilustrar os achados mais característicos desses tumores em TC. São descritas três apresentações: nódulo pulmonar solitário, consolidação e apresentação difusa, sendo que as duas últimas são importantes no diagnóstico diferencial com acometimento infeccioso. O conhecimento das diversas apresentações e a utilização de propedêutica diagnóstica adequada são definitivos para o diagnóstico precoce e o aumento na sobrevida.

Bronchioloalveolar carcinoma has various presentations and a wide spectrum of imaging patterns, as does adenocarcinoma with a bronchioloalveolar component. The objective of this essay was to describe and illustrate the CT findings that are most characteristic of these tumors. Three presentations are described: solitary pulmonary nodule, consolidation, and diffuse pattern. The last two should be included in the differential diagnosis, together with infectious diseases. Knowledge of the various presentations and the use of proper diagnostic procedures are crucial to early diagnosis and to improving survival.

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OBJECTIVE: The purpose of this article is to describe diseases that may present with the reversed halo sign on high-resolution CT. We emphasize the tomographic features most frequently associated with this sign and correlate them with histologic findings. CONCLUSION: A wide spectrum of infectious and noninfectious diseases may present with the reversed halo sign on chest CT. The nonspecific nature of this sign should not cloud an otherwise fairly straightforward diagnosis, especially when associated background findings are typical. Although a rigorous analysis of associated CT findings may help with the differential diagnosis, histologic assessment is often needed for a definitive determination of the cause.

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PURPOSE: Vascular 18F-2-fluoro-2-deoxy-D-glucose (18F-FDG) uptake has been suggested as a means of identifying metabolically active atheroma, whereas vascular calcification is accepted as an indicator of atherosclerosis. This investigation describes the frequency and stability of 18F-FDG uptake and vascular calcification in the thoracic aorta on serial 18F-FDG positron emission tomography/computed tomography (PET/CT) studies and correlates the findings with clinical data and risk factors for cardiovascular disease (CVD). MATERIALS AND METHODS: Serial 18F-FDG-PET/CT scans of 100 cancer patients who had at least 2 PET/CT studies were reviewed. Sites of aortic 18F-FDG uptake and calcifications were identified. Results were compared to assess the frequency and stability of the vascular findings and their correlation with clinical data. RESULTS: 18F-FDG aortic uptake was seen in 70% of the patients on the initial scan and changed on the second scan in 55% of the patients. Calcifications were often seen in patients with 18F-FDG uptake, but calcification and 18F-FDG uptake were present at the same site in only 2 cases. Both calcification and 18F-FDG uptake correlated with age. Patients with diabetes, hypertension, hyperlipidemia, or a history of CVD had significantly more calcifications. No correlation was seen between 18F-FDG uptake and calcification stability and the interval between scans, age, risk factors, or history of CVD. CONCLUSIONS: 18F-FDG vascular uptake was common on PET/CT and correlated with vascular calcifications, although the specific sites rarely overlapped. Calcifications were stable over time, but 18F-FDG uptake changed in more than half of the patients, supporting the postulate that inflammation in atheroma is a waxing and waning inflammatory process.

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OBJECTIVE: The aim of this study was to assess the high-resolution computed tomography (HRCT) findings at presentation in patients diagnosed with Influenza A (H1N1) virus-associated pneumonia. MATERIALS AND METHODS: We reviewed the HRCT findings from 20 patients diagnosed with Influenza A (H1N1) and compared their HRCT scans with chest radiographs, obtained on the same day. The imaging studies were obtained 4-9 days after the onset of symptoms. The patients included 11 men and 9 women (ages 24-62 years; mean 42.7 years). All patients had a body temperature greater than 100.4 degrees F (>38 degrees C), tachypnea, and cough. Other common symptoms included diarrhea (60%) and sore throat (30%). The radiographs and HRCT scans were reviewed independently by two observers who reached a consensus decision. RESULTS: The predominant HRCT findings consisted of bilateral ground-glass opacities (n=12), bilateral areas of consolidation (n=2), or a mixed bilateral pattern of ground-glass opacities and areas of consolidation (n=6). The abnormalities were bilateral in all of the 20 patients, had a predominantly sub-pleural distribution in 13 patients, and had a random distribution in the remaining 7 patients. The predominant radiographic findings were consolidations. Normal radiographs were found in 4 out of the 20 patients. CONCLUSION: HRCT may reveal parenchymal abnormalities in patients with Influenza A (H1N1) infection who have normal findings on radiographs. The predominant HRCT findings were bilateral, peripheral, ground-glass opacities and/or bilateral areas of consolidation. The patients who presented consolidations had more severe clinical course.

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OBJETIVO: Apresentar os achados em tomografia computadorizada (TC) de tórax em pacientes com papilomatose laringotraqueobrônquica. MÉTODOS: Foram estudadas, retrospectivamente, as TCs de oito pacientes, cinco masculinos e três femininos, com idades variando de 5 a 18 anos, com média de 10,5 anos. Os exames foram analisados por dois radiologistas, de forma independente, e as decisões finais foram obtidas por consenso. RESULTADOS: Os achados mais comuns nas TCs foram as lesões nodulares da traquéia e os nódulos pulmonares, muitos com escavação. CONCLUSÕES: O aspecto tomográfico mais freqüentemente observado nos casos de papilomatose laringotraqueobrônquica foi a associação de lesões polipóides de traquéia com múltiplos nódulos pulmonares, vários deles escavados.

OBJECTIVE: To present the findings of computed tomography (CT) scans of the chest in patients with laryngotracheobronchial papillomatosis. METHODS: We retrospectively analyzed CT scans of eight patients, five males and three females, ranging from 5 to 18 years of age with a mean age of 10.5 years. Images were independently reviewed by two radiologists. In discrepant cases, a consensus was reached. RESULTS: The most common CT findings were intratracheal polypoid lesions and pulmonary nodules, many of which were cavitated. CONCLUSIONS: In patients with laryngotracheobronchial papillomatosis, the most common tomographic finding was the combination of intratracheal polypoid lesions and multiple pulmonary nodules, many of which were cavitated.

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OBJECTIVE: To present the findings of computed tomography (CT) scans of the chest in patients with laryngotracheobronchial papillomatosis. METHODS: We retrospectively analyzed CT scans of eight patients, five males and three females, ranging from 5 to 18 years of age with a mean age of 10.5 years. Images were independently reviewed by two radiologists. In discrepant cases, a consensus was reached. RESULTS: The most common CT findings were intratracheal polypoid lesions and pulmonary nodules, many of which were cavitated. CONCLUSIONS: In patients with laryngotracheobronchial papillomatosis, the most common tomographic finding was the combination of intratracheal polypoid lesions and multiple pulmonary nodules, many of which were cavitated.

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Primary pulmonary meningioma is very rare, with about 30 cases reported in the English literature. These lesions are usually benign, grow slowly, and have an excellent prognosis. However, they can mimic any other pulmonary tumor, as the most common presentation is as a solitary pulmonary nodule. We report a case of a primary pulmonary meningioma manifesting as a solitary lung nodule with a very high metabolic activity on the positron emission tomography, mimicking a primary lung cancer.

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OBJECTIVE: To assess the reproducibility of a new high-resolution computed tomography (CT) visual semiquantitative method for pleural plaques in asbestos-exposed workers. MATERIAL AND METHODS: We performed thin-section CT in 752 chrysotile asbestos mining workers and ex-workers. Institutional review board approval and signed written informed consent from subjects were obtained. Two readers independently evaluated the 752 CT scans and identified 57 workers (mean age +/- SD, 61.8 years +/- 8.1; range, 37 to 81 years) who had pleural plaques and no other pleural or parenchymal abnormality. Three independent radiologists then quantified the plaque burden in these 57 workers using a scoring system based on the evaluation of the maximum thickness of parietal pleural plaques and percentage of parietal pleural surface involvement. We also calculated the proportion between the number of CT slices with diaphragmatic plaques and the total number of slices in which the diaphragm was seen (pdiaph). The intraobserver and interobserver agreements were analyzed using weighted Kappa coefficient. RESULTS: Interobserver agreements were good for the pleural plaque score (k = 0.61, 0.75, and 0.79) and ranged from good (k = 0.61) to excellent (k = 0.86) for the pdiaph. Intraobserver agreements ranged from good to excellent for the pleural plaque score (k = 0.79 and 1.00) and for the pdiaph (k = 0.79 and 0.93). CONCLUSION: The method proposed for high-resolution CT pleural plaque quantification in asbestos-exposed workers has a high reproducibility.

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