Podcast 560: Imaging in a COVID world

COVID-19 commonly appears as a bilateral patchy infiltrate on chest radiograph, but this is a non-specific finding

Sensitivities range from 17-70% for COVID-19
Many other viral pneumonias such as RSV and influenza can have similar findings

Point-of-care ultrasound (POCUS) demonstrates B-lines, water-fall sign, or hepatization of the lung, but these are also non-specific

Computerized tomography (CT) appears to be one of the more sensitive tests for detecting COVID-19, demonstrating ground-glass opacities - often before or without the patient having symptoms

However, routine use of CT for diagnosis COVID-19 is strongly discouraged by many medical societies and the CDC

Imaging may not be necessary in most patients presenting with suspected COVID-19 for multiple reasons:

Diagnosis is often clinical suspicion, with or without confirmatory PCR testing (if available)
Imaging does little to change the management in the majority of patients with COVID-19
Obtaining imaging exposes additional healthcare workers
Cleaning protocols for units (especially CT) can be extensive and require significant downtime of the machine, thereby leading to delays in care