Systematic Reviews
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Radiol. Aug 28, 2021; 13(8): 243-257
Published online Aug 28, 2021. doi: 10.4329/wjr.v13.i8.243
Differential diagnosis of COVID-19 at the chest computed tomography scan: A review with special focus on cancer patients
Fabiana Perrone, Maurizio Balbi, Chiara Casartelli, Sebastiano Buti, Gianluca Milanese, Nicola Sverzellati, Melissa Bersanelli
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.
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: 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
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.

Keywords: COVID-19, Computed tomography, Differential diagnosis, Cancer, Pneumonia, Radiological findings

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.