Computed Tomography-Chest in COVID-19 Pneumonia and cardiac failure: An Imaging Enigma

BACKGROUND- Computed tomography (CT) of the chest is an efficient tool to assess COVID-19 pneumonia. Nevertheless, imaging characteristics that overlap with cardiogenic pulmonary edema are not infrequent. CT chest characteristics pose challenges for which additional transthoracic echocardiography is an additional invaluable simple tool to aid in the diagnosis. In this article, we present the CT chest findings of patients with only covid-19 pneumonia, isolated heart failure, and combined covid-19 pneumonia and heart failure. Methods- This study included 120 patients in a tertiary care hospital in South India with dyspnoea and SP02 ≤ 95% between April 2021 to March 2022 who were subjected to chest CT imaging and transthoracic echocardiography and the results were analyzed. Isolated COVID-19 (n=60), isolated heart failure (n=39), and combined covid-19 pneumonia and heart failure (n-21) were identified depending on the CT chest imaging features. Results- There was no statistical difference in the imaging findings like ground glass opacities, crazy pavementpatternswithCOVID-19pneumonia, HF, and also in combined (covid 19 + cardiac failure )groups. However, in HF patients, diffuse patterns were more common than in COVID-19 pneumonia, which was statistically significant (p=0.001). Notably, CT images in HF patients were more likely to have interlobular septal thickening (ILST)(p=0.001) cardiomegaly (p=0.001), increased artery-to-bronchus ratio (p=0.0001), and bilateral pleural effusion (p=0.0001 ), and pericardial effusion (p=0.0001 ) Conclusion- Chest CT is an indispensable tool in the early diagnosis of COVID-19 pneumonia.CT chest features overlap, and separating COVID-19 pneumonia from heart failure is not always easy. Yet, certain specific CT features may suggest heart failure over covid -19 pneumonia. In HF patients, thickening of the interlobular septa, increased artery-to-bronchus ratio, cardiomegaly, and bilateral pleural effusion, pericardial effusion are more common. Additional transthoracic echo showing dilated left ventricle with reduced ejection fraction is an additional key to aid diagnosis.