PERAN RADIOLOGI DALAM PENEGAKAN DIAGNOSIS COVID
Transcript of PERAN RADIOLOGI DALAM PENEGAKAN DIAGNOSIS COVID
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PERAN RADIOLOGI DALAM PENEGAKAN DIAGNOSIS COVID
OLEH :
DR. NOVIA ANDANSARI PUTRI R., SP.RAD
FAKULTAS KEDOKTERAN UNIVERSITAS MATARAM WEBINAR PENGABDIAN MASYARAKAT
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• Diagnosis Covid 19 • Patogenesis
• Gejala klinis
• Gambaran radiologi
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DIAGNOSIS
COVID 19
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EPIDEMIOLOGI
• Secara global, terdapat sekitar 190 juta kasus terkonfirmasi COVID-19 per 16 Juli 2021.
Kasus baru per 1 Juli 2021 adalah sekitar 418.784 kasus terkonfirmasi COVID-19. Angka
kematian di Indonesia sekitar 71.397 kasus. Angka kematian secara global adalah sekitar
4,08 juta kasus.
• Di Indonesia, terdapat sekitar 2,78 juta kasus terkonfirmasi COVID-19 per 16 Juli 2021.
Kasus baru per 1 Juli 2021 adalah sekitar 54.000 kasus terkonfirmasi COVID-19. Angka
kematian di Indonesia sekitar 71.397 kasus.
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PATOGENESIS
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GEJALA KLINIS COVID-19
Pasien COVID 19 paling sering mengeluhkan batuk, demam disertai nafas yang pendek
serta gejala non spesifik lainnya seperti sakit kepala, dyspnea, fatigue, dan nyeri otot
Manifestasi pasien yang dirawat terbagi 2 kategori :
Kategori 1 : penurunan gejala respiratorik (batuk, nafas pendek, nyeri dada) setelah
tatalaksana dan suhu yang normal selama 3 hari tanpa penggunaan kortikosteroid
ataupun antipiretik, penurunan abnormalitas dalam radiologi dan lama perawatan
<10 hari
Kategori 2 : COVID-19 refrakter dan dianggap berat apabila ada 1 kondisi dari yang
disebutkan berikut: Laju pernafasan > 30x/menit, SpO2 < 93 saat beristirahat,
PaO2/FiO2 < 300 mmHg
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• Berdasarkan WHO therapeutics and COVID-19 : Living Guideline (Juli, 2021),
keparahan infeksi SARS-CoV-2 dapat dibagi menjadi berikut:
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LABORATORIUM ???
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Foto Polos CT Scan
MODALITAS PEMERIKSAAN RADIOLOGI”
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3. CHEST X RAY OF COVID
PNEUMONIA-19
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CHEST X RAY IN COVID-19 PNEUMONI • CXR typically shows patchy or diffuse asymmetric airspace opacities
• Similar to other causes of corona virus pneumonias.
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BILATERAL GGO
Soon Ho Yoon, KJR 2020
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BILATERAL GGO AND CONSOLIDATION
Soon Ho Yoon, KJR 2020
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NODUL REVERSE HALO
Soon Ho Yoon, KJR 2020
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RADIOLOGICAL FINDINGS WITH INCREASED TIME
BETWEEN SYMPTOM ONSET AND IMAGING
• Focal unilateral abnormality to diffuse bilateral opacities with evolution to consolidation, reticulation, and mixed pattern disease involving more lung segments.
• Consolidation being reported in nearly all patients requiring intensive care unit (ICU) support and GGO in those not requiring ICU.
• Crazy-paving pattern is also reported with greater time from symptom onset.
• In recovered, late-stage CT findings (14 days or longer) showed varying degrees of clearing but signs may persist for more than 1 month after initial detection
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Guan W-J, Ni Z-Y, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020 Feb 28,
• INITIAL IMAGING WITH CHEST RADIOGRAPH (CXR) AND COMPUTED TOMOGRAPHY (CT) MAY BE NORMAL IN COVID-19.
• Disease severity and timing of imaging appear to impact on the rates of normal baseline imaging.
• In non-severe disease, up to 18% of patients have a normal initial CXR or CT, but only 3% in severe disease
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CHEST X RAY NOT SENSITIVE
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FOLLOW UP : PERBURUKAN
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HOW TO READ CHEST X RAY OF COVID
PNEUMONIA-19
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HOW TO READ CHEST X RAY IN SUSPECTED COVID • Focus to lower lobe and peripher
• Inverse and Adjust window (Low WW WL)
• Compare to previous chest x ray
• Follow up
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HOW TO READ CHEST X RAY IN SUSPECTED COVID • Focus to lower lobe and peripher
• Inverse and Adjust window (Low WW WL)
• Compare to previous chest x ray
• Follow up
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HOW TO READ CHEST X RAY IN SUSPECTED COVID • Focus to lower lobe and peripher
• Inverse and Adjust window (Low WW WL)
• Compare to previous chest x ray
• Follow up
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HOW TO READ CHEST X RAY IN SUSPECTED COVID • Focus to lower lobe and peripher
• Inverse and Adjust window (Low WW WL)
• Compare to previous chest x ray
• Follow up
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FOLLOW UP FOR DIAGNOSIS
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CHEST X RAY OF COVID PNEUMONIA-19
REPORTING
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REPORTING FORMAT FOR COVID-19 SUSPECT
Ø Pattern of reporting - same as shown in above slide.
Ø Final conclusion of findings should be labelled as :
§ Normal : No findings on CXR ; COVID-19 not excluded.
§ Classic/Probable COVID-19 : Lower lobe predominant, peripheral predominant, multiple,
bilateral, areas of GGOs ± peripheral consolidation
§ Indeterminate for COVID-19 : Does not fit classic/ non –COVID descriptors
§ Non-COVID-19 : Pneumothorax, Lobar pneumonia, pleural effusion , pulmonary edema.
Disclaimer: CXR is not a diagnostic modality for novel COVID-19 infection. This report should be
taken in conjunction with other clinical parameters, travel/exposure history and virus isolation in
swab/BAL.
Thoracic Imaging in COVID-19 Infection. Guidance for the reporting radiologist. British Society of Thoracic Imaging. Version 2. 16th March 2020.
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Peripheral predominant,
multiple, bilateral, areas of
GGOs and consolidations
CLASSIC/PROB
ABLE COVID-
19
COVID-19 positive case
(AIIMS, New Delhi)
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CLASSIC VS INDETERMINATE VS NON COVID
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2. CT SCAN IMAGING
FEATURES
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• Up to approximately 50% of patients with COVID-19 infection may have normal CT scans 0–2 days aEer onset of flu-like symptoms from COVID-19
• Lung abnormalities during the early course of COVID-19 infection usually are peripheral focal or multifocal ground-glass opacities affecting both lungs in approximately 50%–75% of patients.
• As the disease progresses, crazy paving and consolidation become the dominant CT findings, peaking around 9–13 days followed by slow clearing at approximately 1 month and beyond.
CT SCAN IMAGING FEATURES
Jeffrey P. Kanne, MD, Radiology 2020
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Figure 4: Frequency of selected chest CT findings as a function of time course from symptom onset.
Bernheim A. Published Online: February 20, 2020
https://doi.org/10.1148/radiol.2020200463
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NORMAL SCAN WAS FOUND • 56% of patients scanned within 2 days of symptom onset
• 9% of patients within 3-5 days
• 4% of patients within 6-12 days from symptoms
• Radiographic abnormalities are almost certain to be present on CT
following 6 days of symptoms.
Guan W-J, Ni Z-Y, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020 Feb 28,
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THE HALLMARKS OF COVID-19 INFECTION ON CT IMAGING
- bilateral
- peripheral ground-glass opacity
- consolidative pulmonary opacities.
- slight predominance in the right lower lobe
.
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SPECTRUM OF CT
Shuchang Zhou et al, AJR 2020
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LESI JARANG
Halo sign
Reverse Halo sign
Small nodule
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LESI YANG SERING DIJUMPAI
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ABSORPTION STAGE
Pneumatocele and dilated vessel
Bronchiolectasi, curvilinear band
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PITFALLS
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CASE
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CASE
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CASE 3
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CASE 3
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CASE 4
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CASE 4
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Case . Corona virus Pneumonia vs
Bacterial Pneumoni
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ARDS VS CARDIOGENIC EDEMA ?
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SOURCE : 1. BUKU IMEJING PNEUMONIA COVID 19 DR. DR. AZIZAH,SPRAD DAN DR. DR. RUSLI MULJADI,SPRAD
2. PPT COVID WEBINAR DR. DR. RUSLI MULJADI,SPRAD
3. FOTO KOLEKSI PRIBADI NOVIA