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World J Radiol. Dec 28, 2020; 12(12): 289-301
Published online Dec 28, 2020. doi: 10.4329/wjr.v12.i12.289
COVID-19 or non-COVID viral pneumonia: How to differentiate based on the radiologic findings?
Azadeh Eslambolchi, Ana Maliglig, Amit Gupta, Ali Gholamrezanezhad
Azadeh Eslambolchi, Independent Radiologist Researcher, Bellevue, WA 98005, United States
Ana Maliglig, Department of Radiology, Cardiothoracic and Advanced Body Imaging Division, Integrated Credential Committee, Clinical Radiology and Medicine, Keck School of Medicine, University of Southern California (USC) of Southern California (USC), Los Angeles, CA 90033, United States
Amit Gupta, Department of Radiology, Case Western Reserve University, Cardiothoracic Division, Modality Director Diagnostic Radiography, University Hospital Cleveland Medical Center, Cleveland, OH 44106, United States
Ali Gholamrezanezhad, Department of Radiology, Keck School of Medicine, University of Sothern California (USC), Los Angeles, CA 90033, United States
Author contributions: Eslambolchi A contributed to writing-original draft, data curation, conceptualization, review and editing; Maliglig A and Gupta A contributed to data curation, conceptualization, review and editing; Gholamrezanezhad A contributed to conceptualization, data curation, writing-review, editing, and supervision; all authors have read and approve the final manuscript.
Conflict-of-interest statement: The authors have no financial relationships relevant to this article to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ali Gholamrezanezhad, MD, Assistant Professor, Department of Radiology, Keck School of Medicine, University of Sothern California (USC), 1500 San Pablo Street, Los Angeles, CA 90033, United States. ali.gholamrezanezhad@med.usc.edu
Received: November 11, 2020
Peer-review started: November 11, 2020
First decision: November 29, 2020
Revised: December 3, 2020
Accepted: December 8, 2020
Article in press: December 8, 2020
Published online: December 28, 2020
Processing time: 47 Days and 8.3 Hours
Abstract

Influenza viruses were responsible for most adult viral pneumonia. Presently, coronavirus disease 2019 (COVID-19) has evolved into serious global pandemic. COVID-19 outbreak is expected to persist in months to come that will be synchronous with the influenza season. The management, prognosis, and protection for these two viral pneumonias differ considerably and differentiating between them has a high impact on the patient outcome. Reverse transcriptase polymerase chain reaction is highly specific but has suboptimal sensitivity. Chest computed tomography (CT) has a high sensitivity for detection of pulmonary disease manifestations and can play a key-role in diagnosing COVID-19. We reviewed 47 studies and delineated CT findings of COVID-19 and influenza pneumonia. The differences observed in the chest CT scan can be helpful in differentiation. For instance, ground glass opacities (GGOs), as the most frequent imaging finding in both diseases, can differ in the pattern of distribution. Peripheral and posterior distribution, multilobular distribution, pure or clear margin GGOs were more commonly reported in COVID-19, whereas central or peri-bronchovascular GGOs and pure consolidations were more seen in influenza A (H1N1). In review of other imaging findings, further differences were noticed. Subpleural curvilinear lines, sugar melted sign, intra-lesional vascular enlargement, reverse halo sign, and fibrotic bands were more reported in COVID-19 than H1N1, while air space nodule, tree-in-bud, bronchiectasia, pleural effusion, and cavitation were more seen in H1N1. This delineation, when combined with clinical manifestations and laboratory results may help to differentiate these two viral infections.

Keywords: Coronavirus; COVID-19; Computed tomography; Viral pneumonia; H1N1; Influenza

Core Tip: Co-incidence of coronavirus disease 2019 (COVID-19) and influenza in the influenza season can be challenging for the health system. The management, prognosis, and protection for these two viral pneumonias differ considerably. Chest computed tomography (CT) has a high sensitivity for detection of pulmonary disease manifestations and can be helpful in diagnosing COVID-19. In this review, we made a comparative study of CT findings in COVID-19 and influenza A pneumonia, as well as their clinical manifestations, by a thorough review of literature. Delineation of differences observed in the chest CT scan of COVID-19 and influenza can be helpful in differentiation.