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Letter to the Editor: “Pneumonia in COVID-19: Time to change the paradigm for chest CT”

by Michele Scialpi (michelescialpi1@gmail.com)

Dear Editor,

From the first cases of Coronavirus-19 (COVID-19) pneumonia with clinical presentations greatly resembling viral pneumonia, identified in Wuhan, Hubei province, in China in late 2019 [1, 2], the most of the available studies, case series, and case reports, mainly from the Chinese literature, report parenchymal changes by chest CT attributable to COVID-19 pneumonia. None of the plethora of COVID-19 pneumonia studies are related to histopathology.

Several pathological lesions in addition to pneumonia occur in the lung of COVID-19 patients which may explain the high mortality rate up to 26% [3].

In a detailed autoptic analysis of 21 patients who died from COVID-19 by Menter et al [4] emerge that the pneumonia is not the primary cause of death. COVID-19 is a multi-organ disease that can lead to pathologies in other organ systems, mainly attributable to shock [4]. Superimposed pneumonia occur in 48% of cases (focal in 19%, and diffuse 29%) and the death is due to respiratory failure with massive capillary congestion in 100% of cases often accompanied by microthrombi despite anticoagulation and with exudative diffuse alveolar damage in 76% of cases [4].

In COVID-19 patients with sudden-onset clinical deterioration with worsening dyspnea, a careful evaluation of COVID-19-related lung injury and of other organs, after an evaluation of the patient’s comorbidities is needed. In these patients, a proper diagnosis and management may result from contrast-enhanced CT to assess parenchymal and vascular lung and other organs lesions.