PERAN RADIOLOGI DALAM PENEGAKAN DIAGNOSIS COVID

OLEH :

DR. NOVIA ANDANSARI PUTRI R., SP.RAD

FAKULTAS KEDOKTERAN UNIVERSITAS MATARAM WEBINAR PENGABDIAN MASYARAKAT

• Diagnosis Covid 19 • Patogenesis

• Gejala klinis

• Gambaran radiologi

DIAGNOSIS

COVID 19

EPIDEMIOLOGI

• Secara global, terdapat sekitar 190 juta kasus terkonfirmasi COVID-19 per 16 Juli 2021.

Kasus baru per 1 Juli 2021 adalah sekitar 418.784 kasus terkonfirmasi COVID-19. Angka

kematian di Indonesia sekitar 71.397 kasus. Angka kematian secara global adalah sekitar

4,08 juta kasus.

• Di Indonesia, terdapat sekitar 2,78 juta kasus terkonfirmasi COVID-19 per 16 Juli 2021.

Kasus baru per 1 Juli 2021 adalah sekitar 54.000 kasus terkonfirmasi COVID-19. Angka

kematian di Indonesia sekitar 71.397 kasus.

PATOGENESIS

GEJALA KLINIS COVID-19

Pasien COVID 19 paling sering mengeluhkan batuk, demam disertai nafas yang pendek

serta gejala non spesifik lainnya seperti sakit kepala, dyspnea, fatigue, dan nyeri otot

Manifestasi pasien yang dirawat terbagi 2 kategori :

Kategori 1 : penurunan gejala respiratorik (batuk, nafas pendek, nyeri dada) setelah

tatalaksana dan suhu yang normal selama 3 hari tanpa penggunaan kortikosteroid

ataupun antipiretik, penurunan abnormalitas dalam radiologi dan lama perawatan

<10 hari

Kategori 2 : COVID-19 refrakter dan dianggap berat apabila ada 1 kondisi dari yang

disebutkan berikut: Laju pernafasan > 30x/menit, SpO2 < 93 saat beristirahat,

PaO2/FiO2 < 300 mmHg

• Berdasarkan WHO therapeutics and COVID-19 : Living Guideline (Juli, 2021),

keparahan infeksi SARS-CoV-2 dapat dibagi menjadi berikut:

LABORATORIUM ???

Foto Polos CT Scan

MODALITAS PEMERIKSAAN RADIOLOGI”

3. CHEST X RAY OF COVID

PNEUMONIA-19

CHEST X RAY IN COVID-19 PNEUMONI • CXR typically shows patchy or diffuse asymmetric airspace opacities

• Similar to other causes of corona virus pneumonias.

BILATERAL GGO

Soon Ho Yoon, KJR 2020

BILATERAL GGO AND CONSOLIDATION

Soon Ho Yoon, KJR 2020

NODUL REVERSE HALO

Soon Ho Yoon, KJR 2020

RADIOLOGICAL FINDINGS WITH INCREASED TIME

BETWEEN SYMPTOM ONSET AND IMAGING

• Focal unilateral abnormality to diffuse bilateral opacities with evolution to consolidation, reticulation, and mixed pattern disease involving more lung segments.

• Consolidation being reported in nearly all patients requiring intensive care unit (ICU) support and GGO in those not requiring ICU.

• Crazy-paving pattern is also reported with greater time from symptom onset.

• In recovered, late-stage CT findings (14 days or longer) showed varying degrees of clearing but signs may persist for more than 1 month after initial detection

Guan W-J, Ni Z-Y, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020 Feb 28,

• INITIAL IMAGING WITH CHEST RADIOGRAPH (CXR) AND COMPUTED TOMOGRAPHY (CT) MAY BE NORMAL IN COVID-19.

• Disease severity and timing of imaging appear to impact on the rates of normal baseline imaging.

• In non-severe disease, up to 18% of patients have a normal initial CXR or CT, but only 3% in severe disease

CHEST X RAY NOT SENSITIVE

FOLLOW UP : PERBURUKAN

HOW TO READ CHEST X RAY OF COVID

PNEUMONIA-19

HOW TO READ CHEST X RAY IN SUSPECTED COVID • Focus to lower lobe and peripher

• Inverse and Adjust window (Low WW WL)

• Compare to previous chest x ray

• Follow up

HOW TO READ CHEST X RAY IN SUSPECTED COVID • Focus to lower lobe and peripher

• Inverse and Adjust window (Low WW WL)

• Compare to previous chest x ray

• Follow up

HOW TO READ CHEST X RAY IN SUSPECTED COVID • Focus to lower lobe and peripher

• Inverse and Adjust window (Low WW WL)

• Compare to previous chest x ray

• Follow up

HOW TO READ CHEST X RAY IN SUSPECTED COVID • Focus to lower lobe and peripher

• Inverse and Adjust window (Low WW WL)

• Compare to previous chest x ray

• Follow up

FOLLOW UP FOR DIAGNOSIS

CHEST X RAY OF COVID PNEUMONIA-19

REPORTING

REPORTING FORMAT FOR COVID-19 SUSPECT

Ø Pattern of reporting - same as shown in above slide.

Ø Final conclusion of findings should be labelled as :

§ Normal : No findings on CXR ; COVID-19 not excluded.

§ Classic/Probable COVID-19 : Lower lobe predominant, peripheral predominant, multiple,

bilateral, areas of GGOs ± peripheral consolidation

§ Indeterminate for COVID-19 : Does not fit classic/ non –COVID descriptors

§ Non-COVID-19 : Pneumothorax, Lobar pneumonia, pleural effusion , pulmonary edema.

Disclaimer: CXR is not a diagnostic modality for novel COVID-19 infection. This report should be

taken in conjunction with other clinical parameters, travel/exposure history and virus isolation in

swab/BAL.

Thoracic Imaging in COVID-19 Infection. Guidance for the reporting radiologist. British Society of Thoracic Imaging. Version 2. 16th March 2020.

Peripheral predominant,

multiple, bilateral, areas of

GGOs and consolidations

CLASSIC/PROB

ABLE COVID-

19

COVID-19 positive case

(AIIMS, New Delhi)

CLASSIC VS INDETERMINATE VS NON COVID

2. CT SCAN IMAGING

FEATURES

• Up to approximately 50% of patients with COVID-19 infection may have normal CT scans 0–2 days aEer onset of flu-like symptoms from COVID-19

• Lung abnormalities during the early course of COVID-19 infection usually are peripheral focal or multifocal ground-glass opacities affecting both lungs in approximately 50%–75% of patients.

• As the disease progresses, crazy paving and consolidation become the dominant CT findings, peaking around 9–13 days followed by slow clearing at approximately 1 month and beyond.

CT SCAN IMAGING FEATURES

Jeffrey P. Kanne, MD, Radiology 2020

Figure 4: Frequency of selected chest CT findings as a function of time course from symptom onset.

Bernheim A. Published Online: February 20, 2020

https://doi.org/10.1148/radiol.2020200463

NORMAL SCAN WAS FOUND • 56% of patients scanned within 2 days of symptom onset

• 9% of patients within 3-5 days

• 4% of patients within 6-12 days from symptoms

• Radiographic abnormalities are almost certain to be present on CT

following 6 days of symptoms.

Guan W-J, Ni Z-Y, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020 Feb 28,

THE HALLMARKS OF COVID-19 INFECTION ON CT IMAGING

- bilateral

- peripheral ground-glass opacity

- consolidative pulmonary opacities.

- slight predominance in the right lower lobe

.

SPECTRUM OF CT

Shuchang Zhou et al, AJR 2020

LESI JARANG

Halo sign

Reverse Halo sign

Small nodule

LESI YANG SERING DIJUMPAI

ABSORPTION STAGE

Pneumatocele and dilated vessel

Bronchiolectasi, curvilinear band

PITFALLS

CASE

CASE

CASE 3

CASE 3

CASE 4

CASE 4

Case . Corona virus Pneumonia vs

Bacterial Pneumoni

ARDS VS CARDIOGENIC EDEMA ?

SOURCE : 1. BUKU IMEJING PNEUMONIA COVID 19 DR. DR. AZIZAH,SPRAD DAN DR. DR. RUSLI MULJADI,SPRAD

2. PPT COVID WEBINAR DR. DR. RUSLI MULJADI,SPRAD

3. FOTO KOLEKSI PRIBADI NOVIA