Özlem AKDOĞAN, Derya YAPAR, Hülya TOPÇU, Sertaç ARSLAN, Hilal BOYACI, Yasemin ARI YILMAZ, Aysel KOCAGÜL ÇELİKBAŞ, Nurcan BAYKAL

Traumatic lung pathologies confused with COVID-19

While the COVID-19 pandemic affected the whole world, lung radiologic imaging has become widely used for diagnosis. Ground glass opacity is the most detected radiologic findings in pulmonary tomography. However, in the first 6-8 hours of CT scans of patients admitted to the hospital with injuries affecting the chest cavity, single or multiple patchy and/or diffuse ground-glass parenchymal infiltrates can be seen usually. Due to these appearances, it is necessary to eliminate COVID-19 in cases with a lung contusion. This study aims to evaluate the clinical and laboratory characteristics of patients who presented with pulmonary trauma and were suspected of COVID-19 due to lung images. Between the March 2020 and December 2020 pandemic period, patients who applied to our hospital in emergency services due to trauma and who were discharged or hospitalized in COVID services or followed in intensive care units because COVID-19 could not be excluded due to lung tomography findings were included in the study. It was evaluated retrospectively with laboratory tests and thoracic CTs in patients over 18 years old. Fourteen cases were included in the study, seven of them were males (50%), with a mean age of 45 (19-74). The COVID-19 PCR result was negative for all patients except one patient (case 11) with lymphopenia. Peripherally located ground-glass opacity (GGO) (92.9%), subpleural line (85.7%), air bronchogram (64.3%), pleural thickening (64.3%), atelectasis (% 64.3), consolidation (50%), ground glass mixed consolidation (42.9%) was detected in chest CT cases. Eleven cases (78.6%) were hospitalized to the COVID service or intensive care unit. Thoracic CT images of patients with lung trauma may be confused with COVID-19. It is appropriate to evaluate the cases together with epidemiological data, clinical and laboratory findings. Lymphopenia may help physicians to consider the diagnosis of COVID-19 in trauma patients.

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1. Ai T, Yang Z, Hou H, et al. Correlation of chest CT and RT-PCR testing for coronavirus disease 2019 (COVID-19) in China: A Report of 1014 Cases. Radiology. 2020;296:32-40.
2. Rouhezamin MR, Paydar S, Haseli S. COVID-19 or pulmonary contusion? A diagnostic dilemma. Academic Radiol. 2020;27:894-5.
3. Rothan HA, Byrareddy SN. The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak. J Autoimmunity. 2020;109:102433.
4. Magu S, Yadav A, Agarwal S. Computed tomography in blunt chest trauma. Indian J Chest Diseases Allied Sci. 2009;51:75-81.
5. Chen LR, Chen ZX, Liu YC, et al. Pulmonary contusion mimicking COVID-19: A case report. World J Clin Cases. 2020;8:1554-60.
6. Jamil S, Mark N, Carlos G. Diagnosis and Management of COVID-19 Disease. Am J Respiratory Critical Care Med. 2020;201:19-20.
7. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet (London, England). 2020;395:497-506.
8. Wang Y, Zeng C, Dong L, et al. Pulmonary contusion during the COVID-19 pandemic: challenges in diagnosis and treatment. Surgery today. 2020;50:1113-6.
9. Long C, Xu H, Shen Q, et al. Diagnosis of the coronavirus disease (COVID-19): rRT-PCR or CT? Eur J Radiol. 2020;126:108961.
10. Zu ZY, Jiang MD, Xu PP, et al. Coronavirus disease 2019 (COVID-19): A perspective from china. Radiology. 2020;296:15-25.
11. Ye Z, Zhang Y, Wang Y, et. all. Chest CT manifestations of new coronavirus disease 2019 (COVID-19): a pictorial review. Eur Radiol. 2020;30:4381-9.
12. Pan F, Ye T, Sun P, et al. Time course of lung changes at chest ct during recovery from coronavirus disease 2019 (COVID-19). Radiology. 2020;295:715-21.
13. Rendeki S, Molnár TF. Pulmonary contusion. J Thoracic Disease. 2019;11:141-51.
14. Huang P, Liu T, Huang L, et al. Use of chest CT in combination with negative RT-PCR assay for the 2019 novel coronavirus but high clinical suspicion. Radiology. 2020;295:22-3.