Diagnostic utility of additional whole-chest CT as part of an acute abdominal pain CT imaging pathway during the COVID-19 pandemic

• Published in: Clinical radiology 2020-08, Vol.75 (8), p.592-598
• Main Authors: Hamilton, N.E., Adam, G.H., Ifan, D.L., Lam, S.S., Johnson, K., Vedwan, K.A.G., Shambrook, J.S., Peebles, C.R., Harden, S.P., Abbas, A.
• Format: Article
• Language: English
• Subjects: Abdominal Pain - etiology; Acute Disease; Betacoronavirus; Coronavirus Infections - complications; Coronavirus Infections - diagnostic imaging; COVID-19; Female; Humans; Male; Middle Aged; Pandemics; Pneumonia, Viral - complications; Pneumonia, Viral - diagnostic imaging; Radiography, Thoracic - methods; Retrospective Studies; SARS-CoV-2; Tomography, X-Ray Computed - methods
• ISSN: 0009-9260; 1365-229X
• DOI: 10.1016/j.crad.2020.06.002

To evaluate the diagnostic utility of additional whole-chest computed tomography (CT) in identifying otherwise unheralded COVID-19 lung disease as part of an acute abdominal pain CT imaging pathway in response to the COVID-19 pandemic. Consecutive patients (n=172) who underwent additional whole-chest CT via a COVID-19 acute abdominal pain CT imaging pathway between 27 March and 3 May 2020 were evaluated in this retrospective single-centre study. Chest CT examinations were graded as non-COVID-19, indeterminate for, or classic/probable for COVID-19. CT examinations in the latter two categories were further divided into one of three anatomical distributions (lung base, limited chest [below carina], whole chest [above carina]) based on location of findings. Reverse transcriptase-polymerase chain reaction (RT-PCR) results and clinical features of COVID-19 were assessed to determine if COVID-19 was clinically suspected at the time of CT referral. Twenty-seven of the 172 (15.7%) patients had CT features potentially indicative of COVID-19 pneumonia, 6/27 (3.5%) demonstrating a classic/probable pattern and 21/27 (12.2%) demonstrating an indeterminate pattern. After correlation with clinical features and RT-PCR 8/172 (4.7%) were defined as COVID-19 positive, of which only 1/172 (0.6%) was clinically unsuspected of COVID-19 at the time of CT referral. All COVID-19 positive cases could be identified on review of the lung base alone. Whole-chest CT as part of an acute abdominal pain CT imaging pathway has a very low diagnostic yield for our cohort of patients. All COVID-19-positive patients in our cohort were identified on review of the lung bases on the abdominal CT and this offers an alternative imaging approach in this patient group. •Low unheralded COVID-19 diagnostic rate for whole chest CT for acute abdominal pain•Alternative CT strategies for COVID-19 diagnosis in acute abdominal pain are viable•Mean radiation dose burden of 3.4mSv for additional whole chest CT for COVID-19