Similarities and Differences of CT Features between COVID-19 Pneumonia and Heart Failure

Zhu, Z.; Tang, J.; Chai, X.; Fang, Z.; Liu, Q.; Hu, X.; Xu, D.; He, J.; Tang, L.; Tai, S.; Wu, Y.; Zhou, S.

Aims: During the COVID-19 epidemic, chest computed tomography (CT) has been highly recommended for screening of patients with suspected COVID-19 because of an unclear contact history, overlapping clinical features, and an overwhelmed health system. However, there has not been a full comparison of CT for diagnosis of heart failure or COVID-19 pneumonia. Methods: Patients with heart failure (n = 23) or COVID-19 pneumonia (n = 23) and one patient with both diseases were retrospectively enrolled. Clinical information and chest CT images were obtained and analyzed. Results: There was no difference in ground-glass opacity, consolidation, crazy paving pattern, the lobes affected, and septal thickening between heart failure and COVID-19 pneumonia. However, a less rounded morphology (4% vs. 70%, P = 0.00092), more peribronchovascular thickening (70% vs. 35%, P = 0.018) and fissural thickening (43% vs. 4%, P = 0.002), and less peripheral distribution (30% vs. 87%, P = 0.00085) were found in the heart failure group than in the COVID-19 group. Importantly, there were also more patients with upper pulmonary vein enlargement (61% vs. 4%, P = 0.00087), subpleural effusion (50% vs. 0%, P = 0.00058), and cardiac enlargement (61% vs. 4%, P = 0.00075) in the heart failure group than in the COVID-19 group. Besides, more fibrous lesions were found in the COVID-19 group, although there was no statistical difference (22% vs. 4%, P = 0.080). Conclusions: Although there is some overlap of CT features between heart failure and COVID-19, CT is still a useful tool for differentiating COVID-19 pneumonia.