Objective: Various chest computed tomography (CT) manifestations of coronavirus disease-2019 (COVID-19) pneumonia have been reported in immunocompetent patients. In immunodeficient patients, the clinical manifestations and chest CT imaging findings may differ from usual patterns and may cause mistakes in the diagnosis and management. We evaluated the chest CT manifestations in patients with immunosuppression from various causes and to compare with those seen in immunocompetent patients.
Methods: Forty-four immunodeficient and 44 immunocompetent patients with positive real-time reverse transcriptase-polymerase chain reaction test for severe acute respiratory syndrome-coronavirus-2 having suspicious chest CT manifestations were included and the chest CT images were retrospectively evaluated. The making manifestations were divided as typical findings including ground-glass opacity (GGO)and/or consolidations, air bronchogram sign, crazy paving pattern, microvascular dilatation, halo sign&reverse halo signs and atypical findings including bronshiectasia, tree in bud appearance, pulmonary nodules, pleural effusion and cavitation.
Results: There were 28 males and 16 females in the immunodeficient group and 27 males and 17 females in the control group. A statistically significant difference was found in terms of the length of hospital stay and mortality. The most frequent symptom was fever in immunodeficient patients, while it was dyspnea in the control group. The most common underlying cause for immunosuppression was receiving chemo-radiotheraphy, and the lung&gastric cancers were the most common. In terms of CT features, GGO was the most common finding. A significant difference was found in crazy paving pattern and peripheral-subpleural distribution. Atypical findings were detected significantly higher in immunodeficient patients. When all patients considered together, there was a significant association between mortality and tree-in-bud appearance, pleural effusion, bronchiectasis.
Conclusion: In our study, there was an increased risk of more severe COVID-19 disease and a higher mortality rate in immunodeficient patients. Radiologists should consider COVID-19 pneumonia in cases of rare, atypical and vague CT findings in immunodeficient patients. Since the course of COVID-19 pneumonia may be more severe in immunodeficient patients, being aware of rare atypical findings will decrease morbidity and mortality rates.