Computed tomography after severe COVID-19 pneumonia: findings at 6 months and beyond

Poitevineau, Thibaud; Chassagnon, Guillaume; Bouam, Samir; Jaubert, Paul; Cheurfa, Chérifa; Regard, Lucile; Canniff, Emma; Dinh-Xuan, Anh Tuan; Revel, Marie-Pierre

SARS-Cov-2 infects the alveolar epithelial cells causing COVID-19 pneumonia of varying severity [1, 2]. Fifteen to 30% of patients develop acute respiratory distress syndrome (ARDS) requiring hospitalisation in intensive care units (ICU) and mechanical ventilation [2, 3]. At 3 months, there are persisting CT abnormalities in 17 to 91% of discharged COVID-19 patients [4–8], mainly consistent with an organising pneumonia pattern. These anomalies are more frequently reported in patients who were admitted to ICU [9]. Pulmonary fibrosis has been reported at autopsy of patients deceased from COVID-19 pneumonia, along with pulmonary microvascular thrombosis [10]. Fibrotic-like changes have also been reported at 6-month CT follow-up in COVID-19 survivors [11]. A proportion of survivors from the first SARS-Cov outbreak of 2003 had residual impairment of lung function and abnormal chest radiograph (CXR) findings at 6 months [12]. However, little is known about long-term changes on CT following severe SARS-Cov-2 pneumonia, or after ARDS in general, most descriptions being limited to CXR.