Fosco glass standard approach in computer tomography as a differential diagnosis for COVID-19
INTRODUCTION: COVID-19 emerged in late 2019, in China, and showed exponential growth, being classified as a pandemic. The disease is caused by SARS-CoV-2, triggering clinical manifestations at different levels of severity. Most of those infected exhibit mild to moderate symptoms, while others require ICU bed hospitalization and intubation. Due to the magnitude reached by the disease, several studies have sought to unveil the pathophysiology, clinical manifestations, treatment methods, as well as to characterize clinical diagnostic patterns. AIM: Present the ground-glass pattern in Computed Tomography as a complementary diagnosis for COVID-19. MATERIAL AND METHODS: This is a systematic review based on articles indexed in the “Biblioteca Virtual em Saúde (BVS)” [Virtual Health Library (VHL)], using as descriptors: “Computed Tomography”, “Differential diagnosis” and “COVID-19”. Inclusion criteria were used: full text, in Portuguese, published between 2019 and 2020. The sample consisted of 11 articles. RESULTS: Computed Tomography (CT) plays an important role in the diagnosis and monitoring of patients with COVID-19 pneumonia, considering the variability of clinical manifestations and similarity of symptoms with other viral infections. Most cases of COVID-19 have presented similar tomographic findings, with a predominance of alveolar changes, such as ground-glass opacities, and, occasionally, consolidations, with predominantly peripheral distribution, sometimes associated with fine reticulate, vascular thickening and the inverted halo signal. The central involvement of the parenchyma or the presence of nodules, cavities, lymph node enlargement or pleural effusion are less frequent. However, some authors emphasize that the tomographic changes of the chest studied (ground-glass opacity, consolidation) are not specific for COVID-19, with the RT-PCR molecular technique being the gold standard for diagnosis. Thus, chest CT is complementary in the diagnosis of COVID-19, however, it cannot separately confirm or exclude it. When using RT-PCR as a reference, chest CT has high sensitivity (97%), but low specificity (25%), given the overlapping of findings with lung infections of different etiologies. CONCLUSION: CT is a complementary method of diagnosing COVID-19 and should be applied to hospitalized, symptomatic patients or in specific clinical situations. It is essential that radiologists and clinicians are familiar with the most common forms of image presentation of COVID-19. Considering that these tomographic findings of COVID-19 pneumonia vary according to the stage of the disease, it must be correlated with clinical and laboratory evidence. It is recommended that the final diagnosis of the disease be confirmed by RT-PCR or genetic sequencing.
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