Letter to the Editor: “Pneumonia in COVID-19: Time to change the paradigm for chest CT”

by Michele Scialpi (michelescialpi1@gmail.com)

Dear Editor,

Since the beginning of Coronavirus-19 (COVID-19) pneumonia outbreak in Wuhan, Hubei province of China, in late 2019 [1, 2], greatly resembling viral pneumonia, most of the available studies, case series, and case report, mainly from the Chinese literature, reported parenchymal changes on chest CT, attributable to SARS-CoV-2 infection. studies are related to histopathology.

In addition to pneumonia, several pathological lesions occur in the lung of COVID-19 patients, which may explain the high mortality rate, up to 26% [3].

In a detailed autoptic analysis by Menter et al [4], in which 21 patients who died from COVID-19, it emerges that pneumonia is not the primary cause of death. COVID-19 is a multi-organ disease that can lead to pathologies in other organ systems, mainly attributable to shock [4]. Superimposed pneumonia occurs in 48% of cases (19% focal, 29% diffuse) and death is due to respiratory failure with massive capillary congestion in 100% of the cases, often accompanied by microthrombi despite anticoagulation and with exudative, diffuse alveolar damage in 76% of cases [4].

In COVID-19 patients with sudden-onset clinical deterioration with worsening dyspnoea, a careful evaluation of COVID-19-related lung injury as well as other organs is needed, after a full evaluation of the patient’s comorbidities. In these patients, a proper diagnosis and management may result from contrast-enhanced CT to assess parenchymal and vascular damage to the lung and lesions to the other organs.