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COVID-19 is a zoonotic illness caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus was previously known as 2019 novel coronavirus. The first cases were seen in the city of Wuhan, China in December 2019, and have been linked to the Huanan Seafood Wholesale Market ^1,2,10. The imaging findings are of pneumonia, often bilateral ³². No effective treatment or vaccine currently exists ²⁰.

Terminology

The WHO had originally called this emerging zoonotic infectious illness "novel coronavirus-infected pneumonia (NCIP)" and the virus itself had been named 2019 novel coronavirus (2019-nCoV) ^1,2.

On 11 February 2020, the World Health Organisation (WHO) officially renamed the clinical condition COVID-19 (a shortening of COronaVIrus Disease-19), which was announced in a tweet ¹⁵. Coincidentally, on the same day, the Coronavirus Study Group (CSG) of the International Committee on Taxonomy of Viruses renamed the virus "severe acute respiratory syndrome coronavirus 2" (SARS-CoV-2) ^16,22.

The name of the disease and the virus should be fully capitalised, excerpt for the 'o' in the viral name which is in lower case ^16,22,41.

The WHO has expressed reservations about the official virus name in view of its closeness to the name SARS. It has publicly stated it will not be using it, instead using "COVID-19 virus" or the "virus that causes COVID-19". A group of Chinese virologists also stated in a letter published in The Lancet that the new name was likely to confuse the public due to its similarity to the disease SARS, and they suggested "human coronavirus 2019 (HCoV-19)" ³⁸. However, the scientific community is already using SARS-CoV-2 and it is likely that this will be gradually accepted by the wider world ²².

Epidemiology

As of 10 March 2020, over 116,000 cases of COVID-19 have been confirmed worldwide, with the majority (~70%) in China, according to an online virus tracker created by the medical journal, The Lancet, and hosted by Johns Hopkins University ⁵. Although the percentage of confirmed cases outside China is steadily increasing, the epidemic in China seems to be plateauing.

Six other countries have over 1,000 confirmed cases ⁵:

Italy: 9,172
Iran: 8,042
South Korea: 7,513
Spain: 1,622
France: 1,412
Germany: 1,281

In addition 717 cases were confirmed on two cruise ships, the Diamond Princess, moored off Japan with 696 cases, and 21 cases on the Grand Princess moored off the Californian coast in the United States ⁵.

On 13 January 2020, the first confirmed case outside China was diagnosed, a Chinese tourist in Thailand ¹⁰. On 20 January, the first infected person in the United States was confirmed to be a man in the State of Washington who had recently returned from a visit to Wuhan ⁹. The disease has now been diagnosed in over 115 territories, in six continents ^5,13.

The infection was declared a Public Health Emergency of International Concern (PHEIC) on 30 January 2020 by the WHO ⁷. On 28 February 2020, the WHO increased the global risk assessment of COVID-19 to “very high” which is the highest level.

The mortality rate is about 2-3% ^2,5 with currently 4,087 confirmed deaths (10 March 2020) ⁵. This includes 1,063 confirmed deaths in 24 territories outside mainland China, including 463 in Italy, 291 in Iran, and 54 in South Korea ⁵.

In the largest study to date, a paper published by the Chinese Center for Disease Control and Prevention (CCDC) analysed all the cases diagnosed up to 11 February 2020, which came to 44,672 cases. Of these 1.2% were asymptomatic and 80.9% were classed as "mild". The overall mortality rate was found to be 2.3% ²⁵.

In an article examining the first 425 infected cases in Wuhan, 56% of the infectees were male and the median age was 59 years ¹². In this early cohort, there were no children under 15 years old. Using this dataset, the group estimated that the R₀ (basic reproduction number) of the novel coronavirus was 2.2, that is each infected individual - on average - causes 2.2 new cases of the disease. The incubation period in this group has been calculated to be 5.2 days on average ¹².

A more recent study, for which researchers reviewed 12 studies of COVID-19, calculated the average R₀ to be higher at 3.28, with the authors estimating the likely R₀ to lie between 2 and 3 ³³.

Interestingly young children seem to be relatively unaffected by the virus to date. A Chinese study reviewing the first 31,211 cases in mainland China found that only nine children under one year of age were confirmed with COVID-19. All nine cases were admitted to hospital, and symptoms were mild or absent. None required intensive care or developed severe sequelae ³¹.

NB: it is important to appreciate that the known epidemiological parameters of any new disease are likely to change as larger cohorts of infected people are studied, although this will only to some extent reflect a true change in the underlying reality of disease activity (as a disease is studied and understood humans will be simultaneously changing their behaviours to alter transmission or prevalence patterns).

Clinical presentation

Initial cases of COVID-19 presented as pneumonia, however, it is now clear that some individuals, especially young children, remain asymptomatic, whilst others have mild upper respiratory tract symptoms only. Some also experience mild GI symptoms ¹⁸. However, its full spectrum of clinical effects remains to be determined ^1,2,13. Symptoms and signs are non-specific:

Diagnosis

The definitive test for SARS-CoV-2, the virus causing COVID-19, is the real-time reverse transcriptase-polymerase chain reaction (RT-PCR) test and is believed to be highly specific, but with a sensitivity as low as 60-70% ³². Thus false negatives are a real clinical problem and several negatives might be required in a single case to be confident about excluding the disease.

Therefore, in many cases, CT findings have been used as a surrogate diagnostic test ³². Indeed recent work supports the notion that CT is a more sensitive test for the virus than is the confirmatory RT-PCR test. In a cohort of 1,014 patients, with a positive PCR as the diagnostic test, the sensitivity of CT in reaching the same conclusion was 97%. In those patients in whom RT-PCR was negative - yet the CT chest was positive - clinical records were comprehensively re-reviewed and 48% of these cases were deemed to be "highly likely" to be COVID-19, with a further 33% as "probable" ³⁴.

Laboratory tests

The most common ancillary laboratory findings in a study of 138 hospitalised patients were ¹³:

Mild elevations of inflammatory markers (CRP and ESR) and D-dimer are also seen.

Complications

In a study of 138 patients who had been hospitalised, 26% were admitted to the intensive care unit (ICU). The ICU patients tended to be older with more comorbidities ¹³. Common sequelae were:

acute respiratory distress syndrome (ARDS)
acute cardiac injury
secondary infections
sepsis

Pathology

Aetiology

The WHO confirmed that SARS-CoV-2 was the cause of COVID-19 on 9 January 2020 (2019-nCoV was the name of the virus at that time) ^14,37. It is a member of the Betacoronavirus genus, one of the genera of the Coronaviridae family of viruses. Coronaviruses are enveloped single-stranded RNA viruses, that are found in humans, many other mammals and birds. These viruses are responsible for pulmonary, hepatic, CNS and intestinal disease.

The natural animal host of SARS-CoV-2 remains undetermined, and although the closest animal coronavirus by genetic sequence is a bat coronavirus, and this is the likely ultimate origin of the virus ^11,19,26, the disease can also be transmitted by snakes ²⁴.

Hitherto, six coronaviruses have been known to be responsible for human diseases, two are zoonoses, the severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV), both of which may sometimes be fatal. The remaining four viruses are widespread in human society, causing the common cold.

Transmission

COVID-19 is primarily transmitted person-to-person, in a similar way to the common cold, via droplets (not aerosols), by close contact with infected individuals' upper respiratory tract secretions, e.g. from sneezing or coughing ¹⁹. There is still uncertainty around as to if the virus can be transmitted through surface contamination.

Orofaecal spread was seen with the SARS epidemic, yet it remains unclear if SARS-CoV-2 can be transmitted in this way ¹⁹.

Vertical transmission

A recent retrospective study of nine pregnant patients infected by SARS-CoV-2 did not show any evidence of intrauterine infection ²¹.

Precautions

Given staff in the medical imaging department are some of the first parties to be in contract with COVID-19 patients, clear infection control guidelines are imperative. At the time of writing (8 March 2020) droplet-type precautions are in place for COVID-19 patients, that is, medical mask, gown, gloves, and eye protection (aerosol-generating procedures require N95 masks and aprons) ³⁹.

Patients requiring general radiography should receive it portably (to limit transporting patients) or in dedicated auxiliary units. Patients that require transport to departments must wear a mask to and from the unit. Machines, including ~~all the anything~~any ancillary equipment used during examinations, should be cleaned after examinations ⁴⁰. It is recommended that any imaging examinations ~~require~~have two radiographers in attendance using the 'one clean, one in contact with the patient' system to minimize cross-contamination.

Radiographic features

The primary findings of COVID-19 on chest radiograph and CT are those of pneumonia ^{3,6,13,17,27,28,32}. 75% of cases have presented with bilateral pneumonia ⁶.

CT

The primary findings on CT have been reported as ^{13,17,27,28,36}:

ground-glass opacities (GGO) in all hospitalised patients
crazy paving appearance (GGOs and inter-/intra-lobular septal thickening)
air space consolidation
vascular enlargement in the lesion
traction bronchiectasis

The ground-glass and/or consolidative opacities are usually bilateral, peripheral and basal ³².

Atypical CT findings

These are only seen in a small minority of patients, and should raise concern for superadded bacterial pneumonia or other diagnoses ³²:

mediastinal lymphadenopathy ¹⁷
pleural effusions
- may occur as a complication of COVID-19
multiple tiny pulmonary nodules
- unlike many other viral pneumonias

Temporal CT changes

In one study, 18 of 21 patients (86%) with non-complicated COVID-19 pneumonia, in whom the temporal progression of the CT appearances in COVID-19 were studied, the severity of lung abnormalities peaked at 10 days post symptom onset, with a gradual tail-off after this time ¹⁷. In another study of 36 patients, HRCT showed rapid changes over time with fibrous stripes appearing upon improvement in the disease course ²⁴.

Nuclear medicine

PET-CT

An initial small case series published on 22 February 2020 demonstrated that FDG uptake is increased in ground-glass opacities in those with presumed COVID-19 ⁴².

Treatment and prognosis

No specific treatment or vaccine exists for COVID-19 (as of March 2020). Therefore in the meantime, resources have been concentrated on public health measures, to prevent further interhuman transmission of the virus. This has required a multipronged approach and for individuals includes meticulous personal hygiene, fitted masks, and the avoidance of large crowds/crowded environments ¹¹.

In healthcare facilities, concerted efforts are required to effect rapid diagnosis, quarantine infected cases and provide effective supportive therapies. This will encompass empirical treatments with antibiotics, antivirals, steroids and supportive measures. Mechanical ventilation and extracorporeal membrane oxygenation (ECMO) have also been used where clinically necessary.

Whilst specific antiviral therapies for SARS-2-CoV do not currently exist, the combination of the protease inhibitors, ritonavir and lopinavir, or a triple combination of these antiviral agents with the addition of ribavirin, showed some success in the treatment of SARS ²⁰, and early reports suggest similar efficacy in the treatment of COVID-19 ²³. Remdesivir, a drug originally developed to treat Ebola virus and shown to be effective against MERS-CoV and SARS-CoV, showed promising in vitro results against SARS-CoV-2 ²⁹ and is being tested in humans ³⁰.

Vaccines for the coronaviruses have been under development since the SARS outbreak, but none are yet available for human patients ^11,26. A phase I trial in humans of a potential vaccine against MERS-CoV has already been performed in the UK ²⁶.

Prognosis

Progressive deterioration of imaging changes despite medical treatment is thought to be associated with poor prognosis ²⁷.

In the earliest studies, the mortality rate was estimated at 3%, although later data, suggests it as being slightly closer to 2% ^2,5. In a study of the first 44,672 diagnosed cases in mainland China, the fatality rate was found to be 2.3% ²⁵.

In a Chinese study looking at 138 hospitalised patients only, in-hospital mortality was higher at 4.3% ¹³.

Early reports show that in some patients the RT-PCR test remains positive despite the apparent clinical recovery. This raises the concern that asymptomatic carriage may occur ³⁵.

Resources

-</ul><h4>Pathology</h4><h5>Aetiology</h5><p>The WHO confirmed that SARS-CoV-2 was the cause of COVID-19 on 9 January 2020 (2019-nCoV was the name of the virus at that time) <sup>14,37</sup>. It is a member of the <em>Betacoronavirus</em> genus, one of the genera of the <em>Coronaviridae</em> family of viruses. <a href="/articles/human-coronavirus-1">Coronaviruses</a> are enveloped single-stranded RNA viruses, that are found in humans, many other mammals and birds. These viruses are responsible for pulmonary, hepatic, CNS and intestinal disease. </p><p>The natural animal <a href="/articles/host-infectious-disease">host</a> of SARS-CoV-2 remains undetermined, and although the closest animal coronavirus by genetic sequence is a bat coronavirus, and this is the likely ultimate origin of the virus <sup>11,19,26</sup>, the disease can also be transmitted by snakes <sup>24</sup>. </p><p>Hitherto, six coronaviruses have been known to be responsible for human diseases, two are zoonoses, the <a href="/articles/sars">severe acute respiratory syndrome coronavirus (SARS-CoV)</a> and <a href="/articles/middle-east-respiratory-syndrome-coronavirus-mers-cov-infection">Middle East respiratory syndrome coronavirus (MERS-CoV)</a>, both of which may sometimes be fatal. The remaining four viruses are widespread in human society, causing the <a href="/articles/common-cold">common cold</a>. </p><h5>Transmission</h5><p>COVID-19 is primarily transmitted person-to-person, in a similar way to the common cold, via droplets (not aerosols), by close contact with infected individuals' upper respiratory tract secretions, e.g. from sneezing or coughing <sup>19</sup>. There is still uncertainty around as to if the virus can be transmitted through surface contamination. </p><p>Orofaecal spread was seen with the <a href="/articles/severe-acute-respiratory-syndrome-1">SARS</a> epidemic, yet it remains unclear if SARS-CoV-2 can be transmitted in this way <sup>19</sup>. </p><h6>Vertical transmission</h6><p>A recent retrospective study of nine pregnant patients infected by SARS-CoV-2 did not show any evidence of intrauterine infection <sup>21</sup>.</p><h6>Precautions </h6><p>Given staff in the medical imaging department are some of the first parties to be in contract with COVID-19 patients, clear infection control guidelines are imperative. At the time of writing (8 March 2020) droplet-type precautions are in place for COVID-19 patients, that is, medical mask, gown, gloves, and eye protection (aerosol-generating procedures require N95 masks and aprons) <sup>39</sup>.</p><p>Patients requiring general radiography should receive it portably (to limit transporting patients) or in dedicated auxiliary units. Patients that require transport to departments must wear a mask to and from the unit. Machines, including all the anything used during examinations, should be cleaned after examinations <sup>40</sup>. It is recommended that examinations require two radiographers using the 'one clean, one in contact with the patient' system to minimize cross-contamination.</p><h4>Radiographic features</h4><p>The primary findings of COVID-19 on <a href="/articles/chest-radiograph">chest radiograph</a> and <a href="/articles/ct-chest-summary">CT</a> are those of pneumonia <sup>3,6,13,17,27,28,32</sup>. 75% of cases have presented with bilateral pneumonia <sup>6</sup>.</p><h5>CT</h5><p>The primary findings on CT have been reported as <sup>13,17,27,28,36</sup>:</p><ul>
+</ul><h4>Pathology</h4><h5>Aetiology</h5><p>The WHO confirmed that SARS-CoV-2 was the cause of COVID-19 on 9 January 2020 (2019-nCoV was the name of the virus at that time) <sup>14,37</sup>. It is a member of the <em>Betacoronavirus</em> genus, one of the genera of the <em>Coronaviridae</em> family of viruses. <a href="/articles/human-coronavirus-1">Coronaviruses</a> are enveloped single-stranded RNA viruses, that are found in humans, many other mammals and birds. These viruses are responsible for pulmonary, hepatic, CNS and intestinal disease. </p><p>The natural animal <a href="/articles/host-infectious-disease">host</a> of SARS-CoV-2 remains undetermined, and although the closest animal coronavirus by genetic sequence is a bat coronavirus, and this is the likely ultimate origin of the virus <sup>11,19,26</sup>, the disease can also be transmitted by snakes <sup>24</sup>. </p><p>Hitherto, six coronaviruses have been known to be responsible for human diseases, two are zoonoses, the <a href="/articles/sars">severe acute respiratory syndrome coronavirus (SARS-CoV)</a> and <a href="/articles/middle-east-respiratory-syndrome-coronavirus-mers-cov-infection">Middle East respiratory syndrome coronavirus (MERS-CoV)</a>, both of which may sometimes be fatal. The remaining four viruses are widespread in human society, causing the <a href="/articles/common-cold">common cold</a>. </p><h5>Transmission</h5><p>COVID-19 is primarily transmitted person-to-person, in a similar way to the common cold, via droplets (not aerosols), by close contact with infected individuals' upper respiratory tract secretions, e.g. from sneezing or coughing <sup>19</sup>. There is still uncertainty around as to if the virus can be transmitted through surface contamination. </p><p>Orofaecal spread was seen with the <a href="/articles/severe-acute-respiratory-syndrome-1">SARS</a> epidemic, yet it remains unclear if SARS-CoV-2 can be transmitted in this way <sup>19</sup>. </p><h6>Vertical transmission</h6><p>A recent retrospective study of nine pregnant patients infected by SARS-CoV-2 did not show any evidence of intrauterine infection <sup>21</sup>.</p><h6>Precautions </h6><p>Given staff in the medical imaging department are some of the first parties to be in contract with COVID-19 patients, clear infection control guidelines are imperative. At the time of writing (8 March 2020) droplet-type precautions are in place for COVID-19 patients, that is, medical mask, gown, gloves, and eye protection (aerosol-generating procedures require N95 masks and aprons) <sup>39</sup>.</p><p>Patients requiring general radiography should receive it portably (to limit transporting patients) or in dedicated auxiliary units. Patients that require transport to departments must wear a mask to and from the unit. Machines, including any ancillary equipment used during examinations, should be cleaned after examinations <sup>40</sup>. It is recommended that any imaging examinations have two radiographers in attendance using the 'one clean, one in contact with the patient' system to minimize cross-contamination.</p><h4>Radiographic features</h4><p>The primary findings of COVID-19 on <a href="/articles/chest-radiograph">chest radiograph</a> and <a href="/articles/ct-chest-summary">CT</a> are those of pneumonia <sup>3,6,13,17,27,28,32</sup>. 75% of cases have presented with bilateral pneumonia <sup>6</sup>.</p><h5>CT</h5><p>The primary findings on CT have been reported as <sup>13,17,27,28,36</sup>:</p><ul>
~~-<li>traction bronchiectasis</li>~~
+<li><a title="Traction bronchiectasis" href="/articles/traction-bronchiectasis">traction bronchiectasis</a></li>
~~-<li><a href="/articles/pleural-effusion">pleural effusions</a></li>~~
+<li>
+<a href="/articles/pleural-effusion">pleural effusions</a><ul><li>may occur as a complication of COVID-19</li></ul>
+</li>
~~-<li><a href="https://www.cdc.gov/coronavirus/2019-ncov/index.html">United States of America (Centers for Disease Control and Prevention </a></li>~~
+<li><a href="https://www.cdc.gov/coronavirus/2019-ncov/index.html">United States of America (Centers for Disease Control and Prevention)</a></li>

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29","thumbnail":"https://prod-images-static.radiopaedia.org/images/52232380/da8b9198cc02641aaf0f9307e0603d_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52233109,"studyId":86494,"caseSlug":"covid-19-pneumonia-30","caption":"Case 30","thumbnail":"https://prod-images-static.radiopaedia.org/images/52233109/9cd3c1fcd0a55edaf256e4f6ab72af_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52254733,"studyId":86625,"caseSlug":"covid-19-pneumonia-40","caption":"Case 31 ","thumbnail":"https://prod-images-static.radiopaedia.org/images/52254733/b2b57d9a37b3583569176b8a011955_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52240880,"studyId":86561,"caseSlug":"covid-19-pneumonia-49","caption":"Case 32 ","thumbnail":"https://prod-images-static.radiopaedia.org/images/52240880/9451607643d1cd9c4570cdb1c48593_big_gallery.jpeg","isStack":false,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52252311,"studyId":86708,"caseSlug":"covid-19-pneumonia-43","caption":"Case 33 ","thumbnail":"https://prod-images-static.radiopaedia.org/images/52252311/221a595119abcd1cc91b930f34060e_big_gallery.jpeg","isStack":false,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52252310,"studyId":86631,"caseSlug":"covid-19-pneumonia-43","caption":"Case 34 ","thumbnail":"https://prod-images-static.radiopaedia.org/images/52252310/d7b08174f3f6151654408d34fb8593_big_gallery.jpeg","isStack":false,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52286551,"studyId":86789,"caseSlug":"covid-19-pneumonia-52","caption":"Case 35","thumbnail":"https://prod-images-static.radiopaedia.org/images/52286551/6b87133a40a8a4532adf09cacd4657_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52298708,"studyId":86914,"caseSlug":"covid-19-pneumonia-56","caption":"Case 36","thumbnail":"https://prod-images-static.radiopaedia.org/images/52298708/3f71d082fe2b5a944b74890b6d0f2f_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52298472,"studyId":86913,"caseSlug":"covid-19-pneumonia-55","caption":"Case 37","thumbnail":"https://prod-images-static.radiopaedia.org/images/52298472/9a015368b7df8a8fdf1b94ce57d4ac_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52144300,"studyId":85903,"caseSlug":"covid-19-pneumonia-11","caption":"Case 38","thumbnail":"https://prod-images-static.radiopaedia.org/images/52144300/59da2d56def0e71162e58297487fad_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52298341,"studyId":86912,"caseSlug":"covid-19-pneumonia-54","caption":"Case 39 ","thumbnail":"https://prod-images-static.radiopaedia.org/images/52298341/7508066ca6d477788bff6cc3718cc3_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52296787,"studyId":86884,"caseSlug":"covid-19-pneumonia-53","caption":"Case 40 ","thumbnail":"https://prod-images-static.radiopaedia.org/images/52296787/9382428c49dcd870d705e87fdb97ac_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52289131,"studyId":86811,"caseSlug":"post-intubation-pneumomediastinum-and-pneumothorax-background-covid-19-pneumonia","caption":"Case 41: post-intubation pneumomediastinum and pneumothorax with COVID-19 pneumonia","thumbnail":"https://prod-images-static.radiopaedia.org/images/52289131/81af553601a1bc1fdf81c99436a50b_big_gallery.jpeg","isStack":false,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52196997,"studyId":86262,"caseSlug":"covid-19-rapidly-progressive-acute-respiratory-distress-syndrome-ards","caption":"Case 42: rapidly progressive ARDS","thumbnail":"https://prod-images-static.radiopaedia.org/images/52196997/b1921029beb35ebb6bc80b1bd5c043_big_gallery.jpeg","isStack":false,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52303343,"studyId":86969,"caseSlug":"covid-19-pneumonia-76","caption":"Case 43","thumbnail":"https://prod-images-static.radiopaedia.org/images/52303343/9f2ed2ef5c343793857faa927b25d8_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52303001,"studyId":86953,"caseSlug":"covid-19-pneumonia-58","caption":"Case 44","thumbnail":"https://prod-images-static.radiopaedia.org/images/52303001/8e12dc985075caacc502f4911006e6_big_gallery.jpeg","isStack":false,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52307073,"studyId":86987,"caseSlug":"covid-19-pneumonia-62","caption":"Case 45","thumbnail":"https://prod-images-static.radiopaedia.org/images/52307073/38cddebf4af53f3fedb09382690849_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52306583,"studyId":86985,"caseSlug":"early-stage-covid-19-pneumonia-1","caption":"Case 46: mild","thumbnail":"https://prod-images-static.radiopaedia.org/images/52306583/e21992d32cd6b8a2839aa52ffa0150_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52306813,"studyId":86986,"caseSlug":"covid-19-pneumonia-61","caption":"Case 47","thumbnail":"https://prod-images-static.radiopaedia.org/images/52306813/e1c90b0a302b323f5ce7f41b8205e5_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52307997,"studyId":86991,"caseSlug":"covid-19-pneumonia-63","caption":"Case 48","thumbnail":"https://prod-images-static.radiopaedia.org/images/52307997/6b86db9b42cf41fc0d7bca9d80dfee_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52310925,"studyId":87014,"caseSlug":"covid-19-pneumonia-64","caption":"Case 49","thumbnail":"https://prod-images-static.radiopaedia.org/images/52310925/ff8e3e4e11c0a697211a145c7e5442_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52311116,"studyId":87015,"caseSlug":"covid-19-pneumonia-mild","caption":"Case 50: mild","thumbnail":"https://prod-images-static.radiopaedia.org/images/52311116/89296bc5c3a3828510c684932858c1_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52311316,"studyId":87017,"caseSlug":"covid-19-pneumonia-66","caption":"Case 51","thumbnail":"https://prod-images-static.radiopaedia.org/images/52311316/60a4164955bda9af96ecebdfca1139_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52306123,"studyId":86983,"caseSlug":"covid-19-pneumonia-59","caption":"Case 52","thumbnail":"https://prod-images-static.radiopaedia.org/images/52306123/b787c7dd6c38586c98aad314115c6c_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52306364,"studyId":86984,"caseSlug":"covid-19-pneumonia-60","caption":"Case 53","thumbnail":"https://prod-images-static.radiopaedia.org/images/52306364/b9c3ef54f14af9464b177ce100952c_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52314331,"studyId":87049,"caseSlug":"covid-19-pneumonia-70","caption":"Case 54","thumbnail":"https://prod-images-static.radiopaedia.org/images/52314331/0c73464dd96e9cc99096b45895528d_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52314213,"studyId":87045,"caseSlug":"covid-19-pneumonia-68","caption":"Case 55","thumbnail":"https://prod-images-static.radiopaedia.org/images/52314213/308cc9a9c2a292e40ebbb63bc3c4e2_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52238424,"studyId":86540,"caseSlug":"covid-19-pneumonia-rapidly-progressive-2","caption":"Case 56: rapidly progressive","thumbnail":"https://prod-images-static.radiopaedia.org/images/52238424/f44373474437c99b2740062c914438_big_gallery.jpeg","isStack":false,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52326148,"studyId":87207,"caseSlug":"covid-19-pneumonia-early-stage","caption":"Case 57: mild","thumbnail":"https://prod-images-static.radiopaedia.org/images/52326148/9296e10c316b5dbd05844c52a2ec4c_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52325481,"studyId":87203,"caseSlug":"covid-19-pneumonia-incidental-finding-in-asymptomatic-patient-2","caption":"Case 58: incidental finding in asymptomatic patient","thumbnail":"https://prod-images-static.radiopaedia.org/images/52325481/5d84691c4bf3b9ddf1c19f2a5e5185_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52320337,"studyId":87130,"caseSlug":"covid-19-pneumonia-73","caption":"Case 59","thumbnail":"https://prod-images-static.radiopaedia.org/images/52320337/f95d56c3815ce6a7efd530f74f0de5_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52347055,"studyId":87461,"caseSlug":"covid-19-pneumonia-75","caption":"Case 60","thumbnail":"https://prod-images-static.radiopaedia.org/images/52347055/213a7402eac2f2ddc57a3a88ca1288_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52351834,"studyId":87486,"caseSlug":"covid-19-pneumonia-45","caption":"Case 61","thumbnail":"https://prod-images-static.radiopaedia.org/images/52351834/aa2c1a6a484ce7aedd53709cfc9579_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52333508,"studyId":87161,"caseSlug":"covid-19-pneumonia-78","caption":"Case 62","thumbnail":"https://prod-images-static.radiopaedia.org/images/52333508/3a7a000f136a331916ab25645c5004_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52366910,"studyId":87677,"caseSlug":"covid-19-pneumonia-80","caption":"Case 63","thumbnail":"https://prod-images-static.radiopaedia.org/images/52366910/14d81f378173b86cc53f21d2d67040_big_gallery.jpeg","isStack":false,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52419934,"studyId":87991,"caseSlug":"early-stage-covid-19-pneumonia-4","caption":"Case 64: early stage","thumbnail":"https://prod-images-static.radiopaedia.org/images/52419934/7081807bc119bf30645e67567c2743_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52354709,"studyId":87517,"caseSlug":"covid-19-pneumonia-with-superadded-bacterial-infection-1","caption":"Case 65: with superadded bacterial infection","thumbnail":"https://prod-images-static.radiopaedia.org/images/52354709/52f7ca8c5b247efd23dc0cd0ed0957_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"probable"},{"imageId":52367828,"studyId":87678,"caseSlug":"covid-19-18","caption":"Case 66","thumbnail":"https://prod-images-static.radiopaedia.org/images/52367828/1141cc2b8b9cc394becce5d978b5a7_big_gallery.jpeg","isStack":false,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52376922,"studyId":87767,"caseSlug":"covid-19-pneumonia-82","caption":"Case 67","thumbnail":"https://prod-images-static.radiopaedia.org/images/52376922/5ed7d0109672bdd3d58a7db7841f6a_big_gallery.jpeg","isStack":false,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52379267,"studyId":87801,"caseSlug":"covid-19-pneumonia-81","caption":"Case 68","thumbnail":"https://prod-images-static.radiopaedia.org/images/52379267/7c38367c2b495ceb35e78027ad336a_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52385287,"studyId":87846,"caseSlug":"covid-19-pneumonia-84","caption":"Case 69","thumbnail":"https://prod-images-static.radiopaedia.org/images/52385287/4e71e0f261b2d543e1aa597a697577_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52403451,"studyId":87917,"caseSlug":"covid-19-pneumonia-88","caption":"Case 70","thumbnail":"https://prod-images-static.radiopaedia.org/images/52403451/12c8fcf50208ead88ed27ad30164ee_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52416743,"studyId":87957,"caseSlug":"covid-19-pneumonia-89","caption":"Case 71","thumbnail":"https://prod-images-static.radiopaedia.org/images/52416743/6356848f0c5ab27258bb02b59ccc57_big_gallery.jpeg","isStack":false,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52420179,"studyId":87992,"caseSlug":"early-stage-covid-19-pneumonia-5","caption":"Case 72: early stage","thumbnail":"https://prod-images-static.radiopaedia.org/images/52420179/c626eb529754e772bdc618f1d777b1_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52420531,"studyId":87993,"caseSlug":"covid-19-pneumonia-96","caption":"Case 73","thumbnail":"https://prod-images-static.radiopaedia.org/images/52420531/bf1ceec74b2f41a172c2063d582558_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52354015,"studyId":87500,"caseSlug":"covid-19-pneumonia-77","caption":"Case 74","thumbnail":"https://prod-images-static.radiopaedia.org/images/52354015/f66dae1947ea767ca8b21a3c0b0118_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52420739,"studyId":87994,"caseSlug":"early-stage-covid-19-pneumonia-6","caption":"Case 75: early stage","thumbnail":"https://prod-images-static.radiopaedia.org/images/52420739/65d26fd660c014cc00f7cb6654491b_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52420902,"studyId":87996,"caseSlug":"covid-19-pneumonia-98","caption":"Case 76","thumbnail":"https://prod-images-static.radiopaedia.org/images/52420902/df67ef2c41b568b7281005ff5beb83_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52421212,"studyId":87997,"caseSlug":"covid-19-pneumonia-99","caption":"Case 77","thumbnail":"https://prod-images-static.radiopaedia.org/images/52421212/f62a65e2fe0af5d0bdc164eccf977c_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52421486,"studyId":87998,"caseSlug":"covid-19-pneumonia-in-a-patient-with-old-tuberculosis","caption":"Case 78","thumbnail":"https://prod-images-static.radiopaedia.org/images/52421486/f69ec5050d4e4d10a87db0c339679c_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52450986,"studyId":88332,"caseSlug":"covid-19-pneumonia-115","caption":"Case 79","thumbnail":"https://prod-images-static.radiopaedia.org/images/52450986/2efde068d5850e84b0091f5090264a_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52437263,"studyId":88192,"caseSlug":"covid-19-pneumonia-109","caption":"Case 80","thumbnail":"https://prod-images-static.radiopaedia.org/images/52437263/5cdd68bde3bda88e3261975025fc1e_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52421596,"studyId":87999,"caseSlug":"covid-19-pneumonia-101","caption":"Case 81","thumbnail":"https://prod-images-static.radiopaedia.org/images/52421596/ffad54f999494b9803e5b9ad22386e_big_gallery.jpeg","isStack":false,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52532612,"studyId":88950,"caseSlug":"covid-19-pneumonia-124","caption":"Case 82","thumbnail":"https://prod-images-static.radiopaedia.org/images/52532612/cb57899d2eccbaef19c314f1642d0e_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52447739,"studyId":88316,"caseSlug":"covid-19-pneumonia-116","caption":"Case 83","thumbnail":"https://prod-images-static.radiopaedia.org/images/52447739/919b3948574fcec14cec7132bf7f62_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52447874,"studyId":88322,"caseSlug":"covid-19-pneumonia-113","caption":"Case 84","thumbnail":"https://prod-images-static.radiopaedia.org/images/52447874/139b6482d2976d75f0da48984d8059_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52448013,"studyId":88324,"caseSlug":"covid-19-pneumonia-114","caption":"Case 85","thumbnail":"https://prod-images-static.radiopaedia.org/images/52448013/3a87957db08a250d48df8536937e9a_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52457924,"studyId":88380,"caseSlug":"acute-appendicitis-and-covid-19-pneumonia","caption":"Case 86","thumbnail":"https://prod-images-static.radiopaedia.org/images/52457924/9a4270f399c571d1fff04168675634_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52468043,"studyId":88485,"caseSlug":"covid-19-pneumonia-117","caption":"Case 87","thumbnail":"https://prod-images-static.radiopaedia.org/images/52468043/41cd7d018ddcf12578a149eec58e002b079a1944a43db98328b6db33387ad93a_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52417152,"studyId":87971,"caseSlug":"covid-19-pneumonia-91","caption":"Case 88","thumbnail":"https://prod-images-static.radiopaedia.org/images/52417152/c63a1e0ab7600a91fd5023e82eaf14_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52437539,"studyId":88193,"caseSlug":"covid-19-pneumonia-110","caption":"Case 89","thumbnail":"https://prod-images-static.radiopaedia.org/images/52437539/7101fa79ffed645f8a0be71f3f9810_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52542650,"studyId":89023,"caseSlug":"covid-19-pneumonia-85","caption":"Case 90","thumbnail":"https://prod-images-static.radiopaedia.org/images/52542650/50c5f109c00b2249fbb833430efa6d_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_unsubstantiated"},{"imageId":52542690,"studyId":88552,"caseSlug":"covid-19-pneumonia-serial-radiographs-1","caption":"Case 91","thumbnail":"https://prod-images-static.radiopaedia.org/images/52542690/2eadbbb367a0366d8c34350d083a83_big_gallery.jpeg","isStack":false,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52527747,"studyId":88906,"caseSlug":"covid-19-pneumonia-123","caption":"Case 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