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. 2020 Oct;17(10):1231-1237.
doi: 10.1513/AnnalsATS.202004-324OC.

Chest Computed Tomography and Clinical Follow-Up of Discharged Patients with COVID-19 in Wenzhou City, Zhejiang, China

Chenbin Liu  1 , Ling Ye  2 , Ruike Xia  3 , Xudong Zheng  4 , Cuiyun Yuan  1 , Zhenguo Wang  1 , Ruiwu Lin  5 , Deen Shi  3 , Yuantong Gao  3 , Junpu Yao  6 , Qingfeng Sun  7 , Xiaoyang Wang  3 , Meiling Jin  2
Affiliations

Chest Computed Tomography and Clinical Follow-Up of Discharged Patients with COVID-19 in Wenzhou City, Zhejiang, China

Chenbin Liu et al. Ann Am Thorac Soc. 2020 Oct.

Abstract

Rationale: Many clinical studies have focused on the epidemiological and clinical characteristics of inpatients with coronavirus disease (COVID-19). However, there are few reports about the clinical follow-up of discharged patients.Objectives: To describe the follow-up of patients with COVID-19 in Wenzhou City, Zhejiang, China.Methods: We retrospectively reviewed 4-week follow-ups in patients with COVID-19, including computed tomographic (CT) chest scanning, blood testing, and oropharyngeal-swab testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ribonucleic acid. The chest CT scans and blood tests were performed on the last day before discharge and 2 weeks and 4 weeks after discharge. The oropharyngeal-swab tests were performed at both 1 week and 2 weeks after discharge. Fifty-one patients with common COVID-19 were enrolled in the study. All the CT and clinical data were collected between January 23 and March 28, 2020.Results: Compared with the abnormalities found on the the last CT scans before discharge, the abnormalities in the lungs at the first and second follow-ups after discharge had been gradually absorbed. The cases with focal ground-glass opacity were reduced from 17.7% to 9.8% of cases. The cases with multiple ground-glass opacities decreased from 80.4% to 23.5%. The cases with consolidation were reduced from 49.0% to 2.0%. The cases with interlobular septal thickening were reduced from 80.4% to 35.3%. The cases with subpleural lines were reduced from 29.4% to 7.8%. The cases with irregular lines were reduced from 41.2% to 15.7%. The lung lesions of 25.5% patients were shown to be fully absorbed on the first CT scans after discharge, and the rate of lung recovery increased to 64.7% after the second follow-up. Nucleic-acid test results became recurrently positive in 17.6% of discharged patients, of whom only 33.3% complained of clinical symptoms. There were no differences in the characteristics of the last CT scans before discharge between the patients with recurrently positive test results and the patients with negative test results. The lung damage was fully absorbed in 55.6% of discharged patients with recurrence of positive test results for SARS-CoV-2 ribonucleic acid.Conclusions: The lung damage due to COVID-19 could be reversible for patients with common COVID-19. A few cases showed recurring positive results of nucleic-acid tests after discharge.

Keywords: COVID-19; SARS-CoV-2; computed tomographic imaging; follow-up; recurrently positive.

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Figures

Figure 1.
Figure 1.
Chest computed tomographic (CT) features of patients with COVID-19. (A) Chest CT scan of a 48-year-old male patient. Multiple ground-glass opacities (GGOs) are shown in the lower lobes. (B) Chest CT scan of a 34-year-old female patient after 3 days of treatment. Multiple patchy GGOs are shown in the lower lobes. (C) Chest CT scan of a 51-year-old male patient at admission. Consolidation in the right middle lobe and air bronchogram signs are shown. (D) Chest CT scan of a 36-year-old male patient after 8 days of treatment. Multiple consolidations are shown in both lungs. (E) The last chest CT scan before discharge of a 65-year-old male patient. Subpleural lines and interlobular septal thickening are shown in the right lung, and irregular lines were present in left lung. (F) Chest CT scan of a 70-year-old male patient after 3 days of treatment. Multiple reticular patterns are shown in the right lung, and small consolidations are shown in the left lung.
Figure 2.
Figure 2.
The chest computed tomographic (CT) scans from a 34-year-old female patient with coronavirus disease (COVID-19). (A–D) The chest CT scans at admission. (E–H) The chest CT scans 4 weeks after discharge show near recovery from multiple patchy ground-glass opacities in the lower lobes, consolidations, and bronchiectasis.
Figure 3.
Figure 3.
The chest computed tomographic (CT) scans from a 35-year-old male patient with coronavirus disease (COVID-19). (A and E) The chest CT scans at admission. Chest CT scans demonstrated multiple consolidation in the upper and lower lobes, ground-glass opacity (GGO) in the peripheral lung, and a small cavity in the lower lobe of the left lung. (B and F) The last chest CT scans before discharge. The consolidations are mostly absorbed and have transformed into small, patchy GGOs. (C and G) The chest CT scans 2 weeks after discharge. The GGO was absorbed completely. (D and H) The chest CT scans 4 weeks after discharge shows no recurrence.
Figure 4.
Figure 4.
The chest computed tomographic (CT) scans from a 48-year-old male patient with coronavirus disease (COVID-19). (A and E) The chest CT scans at admission. Multiple patchy ground-glass opacities (GGOs), consolidation, and interlobular septal thickening were shown in the lower lobes. (B and F) The last chest CT scans before discharge. Most of the subpleural consolidations were absorbed. Small patchy consolidation in the lower right lung was present. GGOs transformed into irregular lines and subpleural lines. The density of the interlobular septal thickening decreased. (C and G) The chest CT scans 2 weeks after discharge. The consolidation in the right lower lobe transformed into GGO. The density of subpleural GGO in both lungs was gradually absorbed. (D and H) The chest CT scans 4 weeks after discharge show that the damage was partly absorbed. The consolidation in the left upper lobe transformed into GGO, and the subpleural GGO was further absorbed.
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