Clinical diagnostic value of CT imaging in COVID-19 with multiple negative RT-PCR testing

Abstract

Dear Editor, At the end of December 2019, an outbreak of unexplained pneumonia in Wuhan [1,2] was caused by Severe Acute Respiratory Syndrome Coronavirus −2 (SARS-CoV-2) infection named Coronavirus Disease-19 (COVID-19). As of February 22, 2020, widespread human-to-human transmission has resulted in 76,396 cases with 2,348 deaths in 26 countries. Clinically, we have found that some patients had initial negative RT-PCR results, but chest CT had typical imaging findings, including ground-glass opacification (GGO) and/or mixed consolidation. Early detection, early diagnosis, early isolation, and early treatment of these cases can effectively control the spread of the epidemic and the emergence of large outbreaks. A 56-year old patient who traveled to Wuhan, China 5 days ago was admitted to the emergency department for an hyperthermia (39.1 °C) evolving for 1 day. Laboratory studies showed white blood cell count, lymphocyte cell count and serum procalcitonin were normal. Several additional laboratory tests were abnormal, including C-reactive protein (48.65mg/L; normal range, 0–10 mg/L), erythrocyte sedimentation rate (23 mm/h; normal range, 0–20 mm/h) and alanine aminotransferase (57 U/L; normal range, 5–40 U/L). On admission, chest CT scan revealed multiple ground-glass opacities in both lungs, especially the extrapulmonary bands and subpleural distribution (Fig. 1 A). Three RT-PCR assay of the oropharyngeal swab samples were negative for the SARS-CoV-2 nucleic acid. After antiviral (ribavirin) and symptomatic treatment, repeat chest CT showed significant progression of multi-focal ground-glass opacification and mixed consolidation that most appeared at peripheral area of both lungs (Fig. 1 B). Therefore, we performed the fourth SARS-CoV-2 nucleic acid test and the result was positive. In the end, the patient was diagnosed with COVID-19 pneumonia...