Differential diagnosis of COVID-19 at the chest computed tomography scan: A review with special focus on cancer patients

Perrone, Fabiana; Balbi, Maurizio; Casartelli, Chiara; Buti, Sebastiano; Milanese, Gianluca; Sverzellati, Nicola; Bersanelli, Melissa

BACKGROUND: Given the several radiological features shared by coronavirus disease 2019 pneumonia and other infective or non-infective diseases with lung involvement, the differential diagnosis is often tricky, and no unequivocal tool exists to help the radiologist in the proper diagnosis. Computed tomography is considered the gold standard in detecting pulmonary illness caused by severe acute respiratory syndrome coronavirus 2. AIM: To conduct a systematic review including the available studies evaluating computed tomography similarities and discrepancies between coronavirus disease 2019 pneumonia and other pulmonary illness, then providing a discussion focus on cancer patients. METHODS: Using pertinent keywords, we performed a systematic review using PubMed to select relevant studies published until October 30, 2020. RESULTS: Of the identified 133 studies, 18 were eligible and included in this review. CONCLUSION: Ground-glass opacity and consolidations are the most common computed tomography lesions in coronavirus disease 2019 pneumonia and other respiratory diseases. Only two studies included cancer patients, and the differential diagnosis with early lung cancer and radiation pneumonitis was performed. A single lesion associated with pleural effusion and lymphadenopathies in lung cancer and the onset of the lesions in the radiation field in the case of radiation pneumonitis allowed the differential diagnosis. Nevertheless, the studies were heterogeneous, and the type and prevalence of lesions, distributions, morphology, evolution, and additional signs, together with epidemiological, clinical, and laboratory findings, are crucial to help in the differential diagnosis.