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World J Radiol. Jan 28, 2022; 14(1): 13-18
Published online Jan 28, 2022. doi: 10.4329/wjr.v14.i1.13
Chest radiological finding of COVID-19 in patients with and without diabetes mellitus: Differences in imaging finding
Sunay Gangadharan, Storm Parker, Fahad Wali Ahmed
Sunay Gangadharan, Storm Parker, Department of Radiology, University Hospitals Sussex NHS Foundation Trust, Brighton BN2 5BE, United Kingdom
Fahad Wali Ahmed, Department of Medical Oncology, King Faisal Specialist Hospital and Research Centre, Madinah 42522, Saudi Arabia
Author contributions: Gangadharan S and Parker S contributed to writing the manuscript substantially; Ahmed FW conceived the idea of this article and contributed to writing, design and editing of the manuscript.
Conflict-of-interest statement: The authors declare that they have no competing or conflicts of interests.
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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Fahad Wali Ahmed, FRCP, MBBS, PhD, Consultant Physician-Scientist, Department of Medical Oncology, King Faisal Specialist Hospital and Research Centre, 7345, Madinah 42522, Saudi Arabia. fahadwali@yahoo.com
Received: March 30, 2021
Peer-review started: March 30, 2021
First decision: October 17, 2021
Revised: November 16, 2021
Accepted: December 28, 2021
Article in press: December 28, 2021
Published online: January 28, 2022
Abstract

The pandemic of novel coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Diabetes mellitus is a risk factor for developing severe illness and a leading cause of death in patients with COVID-19. Diabetes can precipitate hyperglycaemic emergencies and cause prolonged hospital admissions. Insulin resistance is thought to cause endothelial dysfunction, alveolar capillary micro-angiopathy and interstitial lung fibrosis through pro-inflammatory pathways. Autopsy studies have also demonstrated the presence of microvascular thrombi in affected sections of lung, which may be associated with diabetes. Chest imaging using x-ray (CXR) and computed tomography (CT) of chest is used to diagnose, assess disease progression and severity in COVID-19. This article reviews current literature regarding chest imaging findings in patients with diabetes affected by COVID-19. A literature search was performed on PubMed. Patients with diabetes infected with SARS-CoV-2 are likely to have more severe infective changes on CXR and CT chest imaging. Severity of airspace consolidation on CXR is associated with higher mortality, particularly in the presence of co-morbidities such as ischaemic heart disease. Poorly controlled diabetes is associated with more severe acute lung injury on CT. However, no association has been identified between poorly-controlled diabetes and the incidence of pulmonary thromboembolism in patients with COVID-19.

Keywords: Diabetes mellitus, COVID-19, Chest X-Ray, Chest imaging using x-ray, Computed tomography of chest

Core Tip: COVID-19 infection can present as multifocal peripheral airspace changes on chest imaging using x-ray (CXR). Ground-glass opacities are the most common computed tomography finding in coronavirus disease 2019 (COVID-19). Post admission daily bloody glucose readings are a strong predictor for COVID-19 CXR changes that indicate poorer outcomes. Poorly controlled diabetes is associated with increased volumes of ground-glass opacity and consolidation. Diabetes is also linked with endothelial dysfunction and hypercoagulability, which may result in the formation of microvascular thrombi in peripheral segments of lung.