Chest CT in the emergency department for suspected COVID-19 pneumonia

Anna Palmisano, Giulia Maria Scotti, Davide Ippolito, Marco J. Morelli, Davide Vignale, Davide Gandola, Sandro Sironi, Francesco De Cobelli, Luca Ferrante, Marzia Spessot, Giovanni Tonon, Carlo Tacchetti, Antonio Esposito

Research output: Contribution to journalArticlepeer-review


Purpose: In overwhelmed emergency departments (EDs) facing COVID-19 outbreak, a swift diagnosis is imperative. CT role was widely debated for its limited specificity. Here we report the diagnostic role of CT in two EDs in Lombardy, epicenter of Italian outbreak. Material and methods: Admitting chest CT from 142 consecutive patients with suspected COVID-19 were retrospectively analyzed. CT scans were classified in “highly likely,” “likely,” and “unlikely” COVID-19 pneumonia according to the presence of typical, indeterminate, and atypical findings, or “negative” in the absence of findings, or “alternative diagnosis” when a different diagnosis was found. Nasopharyngeal swab results, turnaround time, and time to positive results were collected. CT diagnostic performances were assessed considering RT-PCR as reference standard. Results: Most of cases (96/142, 68%) were classified as “highly likely” COVID-19 pneumonia. Ten (7%) and seven (5%) patients were classified as “likely” and “unlikely” COVID-19 pneumonia, respectively. In 21 (15%) patients a differential diagnosis was provided, including typical pneumonia, pulmonary edema, neoplasia, and pulmonary embolism. CT was negative in 8/142 (6%) patients. Mean turnaround time for the first COVID-19 RT-PCR was 30 ± 13 h. CT diagnostic accuracy in respect of the first test swab was 79% and increased to 91.5% after repeated swabs and/or BAL, for 18 false-negative first swab. CT performance was good with 76% specificity, 99% sensitivity, 90% positive predictive value and 97% negative predictive value. Conclusion: Chest CT was useful to streamline patients’ triage while waiting for RT-PCR in the ED, supporting the clinical suspicion of COVID-19 or providing alternative diagnosis.

Original languageEnglish
Pages (from-to)498-502
Number of pages5
JournalRadiologia Medica
Issue number3
Publication statusPublished - Mar 2021


  • Computed tomography
  • COVID-19
  • Diagnosis
  • Emergency
  • Triage

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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