Perrone F, Balbi M, Casartelli C, Buti S, Milanese G, Sverzellati N, Bersanelli M. Differential diagnosis of COVID-19 at the chest computed tomography scan: A review with special focus on cancer patients. World J Radiol 2021; 13(8): 243-257 [PMID: 34567434 DOI: 10.4329/wjr.v13.i8.243]
Corresponding Author of This Article
Melissa Bersanelli, MD, Adjunct Professor, Chief Doctor, Medical Oncology Unit, University Hospital of Parma, Via Gramsci 14, Parma 43126, Italy. bersamel@libero.it
Research Domain of This Article
Radiology, Nuclear Medicine & Medical Imaging
Article-Type of This Article
Systematic Reviews
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Perrone F, Balbi M, Casartelli C, Buti S, Milanese G, Sverzellati N, Bersanelli M. Differential diagnosis of COVID-19 at the chest computed tomography scan: A review with special focus on cancer patients. World J Radiol 2021; 13(8): 243-257 [PMID: 34567434 DOI: 10.4329/wjr.v13.i8.243]
Fabiana Perrone, Chiara Casartelli, Sebastiano Buti, Melissa Bersanelli, Medical Oncology Unit, University Hospital of Parma, Parma 43126, Italy
Fabiana Perrone, Chiara Casartelli, Melissa Bersanelli, Department of Medicine and Surgery, University of Parma, Parma 43126, Italy
Maurizio Balbi, Gianluca Milanese, Nicola Sverzellati, Department of Surgical Sciences, Institute of Diagnostic and Interventional Radiology, University of Parma, Parma 43126, Italy
Author contributions: Bersanelli M, Perrone F, and Casartelli C designed the work, planned the literature review according to PRISMA methods, and identified the areas of interest to discuss; Perrone F and Casartelli C collected the data; Balbi M prepared the figures; Perrone F and Balbi M wrote the first draft of the manuscript; Bersanelli M revised the manuscript for relevant scientific content and copyediting; Buti S, Milanese G, and Sverzellati N revised the manuscript for relevant scientific content; All authors have read and approved the final version of the manuscript.
Conflict-of-interest statement: Melissa Bersanelli received honoraria as a speaker at scientific events by Bristol-Myers Squibb (BMS), Novartis, Astra Zeneca, Pierre Fabre, and Pfizer and as a consultant for advisory role by Novartis, BMS, IPSEN, and Pfizer; she also received fees for copyright transfer by Sciclone Pharmaceuticals and research funding by Roche S.p.A., Seqirus UK, Pfizer, Novartis, BMS, Astra Zeneca, and Sanofi Genzyme. Sebastiano Buti received honoraria as a speaker at scientific events and advisory role by Bristol-Myers Squibb (BMS), Pfizer; MSD, Ipsen, Roche, Eli-Lilly, AstraZeneca and Novartis; he also received research funding from Novartis. All the other authors declare they have no conflicts of interest to disclose.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Corresponding author: Melissa Bersanelli, MD, Adjunct Professor, Chief Doctor, Medical Oncology Unit, University Hospital of Parma, Via Gramsci 14, Parma 43126, Italy. bersamel@libero.it
Received: January 28, 2021 Peer-review started: January 28, 2021 First decision: May 6, 2021 Revised: May 18, 2021 Accepted: August 2, 2021 Article in press: August 2, 2021 Published online: August 28, 2021 Processing time: 208 Days and 14.1 Hours
Abstract
BACKGROUND
Given the several radiological features shared by coronavirus disease 2019 pneumonia and other infective or non-infective diseases with lung involvement, the differential diagnosis is often tricky, and no unequivocal tool exists to help the radiologist in the proper diagnosis. Computed tomography is considered the gold standard in detecting pulmonary illness caused by severe acute respiratory syndrome coronavirus 2.
AIM
To conduct a systematic review including the available studies evaluating computed tomography similarities and discrepancies between coronavirus disease 2019 pneumonia and other pulmonary illness, then providing a discussion focus on cancer patients.
METHODS
Using pertinent keywords, we performed a systematic review using PubMed to select relevant studies published until October 30, 2020.
RESULTS
Of the identified 133 studies, 18 were eligible and included in this review.
CONCLUSION
Ground-glass opacity and consolidations are the most common computed tomography lesions in coronavirus disease 2019 pneumonia and other respiratory diseases. Only two studies included cancer patients, and the differential diagnosis with early lung cancer and radiation pneumonitis was performed. A single lesion associated with pleural effusion and lymphadenopathies in lung cancer and the onset of the lesions in the radiation field in the case of radiation pneumonitis allowed the differential diagnosis. Nevertheless, the studies were heterogeneous, and the type and prevalence of lesions, distributions, morphology, evolution, and additional signs, together with epidemiological, clinical, and laboratory findings, are crucial to help in the differential diagnosis.
Core Tip: In the coronavirus disease 2019 era, the differential diagnosis of pneumonitis, already challenging in patients with multiple comorbidities and polypharmacological therapy, has become even more challenging. The gold-standard technique for diagnosing coronavirus disease 2019-related pneumonia is still not established. Still, a computed tomography scan is essential for the differential diagnosis of drug-induced pneumonitis, infectious pneumonia, and other conditions such as cancer progression. With this review, we have dealt with frequent radiological diatribes in the radiological diagnosis of coronavirus disease 2019 pneumonitis, with a special focus on cancer patients, for whom clinical elements can be more confounding than helpful as a compendium to the correct diagnostic conclusion.
