Just finished an on call. Very different to the last on call I did with a clear change in the landscape and a sharp rise in number of COVID-19 cases. A few observations from the last two weeks:
1. The vast majority of proven PCR positive patients that required hospitalisation have shown bilateral consolidation on admitting CXR. Smaller number started as unilateral consolidation and progressed to bilateral. One started as normal CXR.
2. In some, swabs have needed to be repeated before becoming positive. When can you truly call a patient ‘negative’? Given long turnaround time for PCR results is there a role for a clinicoradiological scoring system involving CRP, lymphopenia, CXR +\- CT
3. Cases have gone home after initial admission before coming back and being admitted to ITU. Supports idea of adaptive immunity and cytokine storm
thelancet.com/journals/lance…
thelancet.com/journals/lance…
4. Reports of COVID-19 presenting as acute abdominal pain have been borne out - lymphopenia and CXR findings are clues. Difficult to say no to CT abdomen when clinician concerned, severe abdominal pain and CRP rise...
... Good clinical assessment and more experience of this may avoid need for CT in these cases and avoid contamination of scanner and staff. Have so far combined post contrast abdominopelvic CT with non contrast CT chest.
5. Clearly the threshold for performing non COVID inpatient CT will have to rise. Over the years the threshold in general has lowered but it’s time over cautious CTs took a back seat to avoid exposing patients to a potentially contaminated scanner and to free time for staff
6. Saying that unfortunately brain bleeds, PEs and acute surgical emergencies will continue to occur and don’t care that we are all focussed on COVID. Maybe we will see an increase in VTE in next few months with a more sedentary lifestyle during lockdown
7. CT in COVID-19 has been kept to a minimum so far. Doesn’t seem to have changed management strategy for clinicians but can see a classic COVID pattern on CT being helpful when repeated negative PCR and high clinical suspicion
8. COVID-19 will annoyingly rear its head on scans when you don’t want it to namely on any remaining outpatient CTs. Need to be prepared for this with robust SOPs. Posters for radiographers on expected COVID CT findings has helped identify cases
9. @BSTImaging templates for reporting have been invaluable and provided structure and clarity. In general @BSTImaging advice has been excellent in this time of need
10. Utmost respect to radiographers, reception staff and frontline healthcare workers. They will need all the support they can get. Speaking to frontline clinicians, hot reporting CXRs has helped them
