Positive HRCT Chest Findings in Patients with COVID-19 Pneumonia and Negative Real-Time Polymerase Chain Reaction Test- A Clinical Audit

Abstract

Background: Collection of abnormal amount of fluid in pleura space is referred to as pleural effusion. Etiology of pleural effusion is very wide, varying in different areas suggesting the role of environmental and geographical factors. Objective: The aim of study was to look in to the different causes of pleural effusions in patients presenting to chest outpatient department in Mardan medical complex. Methodology: This Descriptive cross sectional study was conducted in Department of Pulmonology and Medicine (medical B unit) of Mardan Medical Complex (MMC) from January 2018 to December 2019. Data was collected by non-probability convenience sampling technique.202 patients were included in study. Diagnosis of effusion was confirmed by chest radiography and where needed with chest ultrasound. Pleura fluid was aspirated in all cases. Pleural fluid analysis was then followed by the relevant investigations like pleural fluid cytology, culture, pleural biopsy, computer tomoghraphy, echocardiography and connective tissue profile for diagnosis of underlying cause of pleural effusion. Results: A total of 180 patients, 99 (55%) males, and 81 (45%) females were included. Out of these patients,95.5% (172) patients had positive findings of COVID-19 on HRCT chest scan. 4.44% (08) had negative HRCT chest findings; while 65% (117) hadpositive and 30.55% (55) had negative first PCR respectively. Among the patients who had an initial negative PCR, a repeat second PCR was performed on 32 patients. On repeated PCR, 65.6% (21) came out negative and 15.87% (10) showed positive PCR results. Conclusion: Diagnosis of COVID-19 pneumonia can be made on HRCT findings prior to the RT-PCR test result. Moreover, the diagnosis of this rapidly spreading disease should not be excluded on the basis of a negative RT-PCR test. Key words: RT-PCR; HRCT chest; COVID-19 pneumonia; GGO (ground-glass opacity)