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World J Clin Infect Dis. Apr 26, 2022; 12(1): 1-19
Published online Apr 26, 2022. doi: 10.5495/wjcid.v12.i1.1
Imaging related to underlying immunological and pathological processes in COVID-19
Elena Ilieva, Alexandra Boyapati, Lyubomir Chervenkov, Milena Gulinac, Jordan Borisov, Kamelia Genova, Tsvetelina Velikova
Elena Ilieva, Alexandra Boyapati, Kamelia Genova, Department of Diagnostic Imaging, University Emergency Hospital (UMHATEM) "N. I. Pirogov”, Sofia 1606, Bulgaria
Lyubomir Chervenkov, Department of Diagnostic Imaging, Medical University, Plovdiv, University Hospital "St George", Plovdiv 4000, Bulgaria
Milena Gulinac, Department of General and Clinical Pathology, Medical University, Plovdiv, University Hospital "St George", Plovdiv 4000, Bulgaria
Jordan Borisov, Department of Diagnostic Imaging, MBAL-Dobrich” AD, Dobrich 9300, Bulgaria
Tsvetelina Velikova, Department of Clinical Immunology, University Hospital “Lozenetz”, Sofia 1407, Bulgaria
Tsvetelina Velikova, Medical Faculty, Sofia University “St. Kliment Ohridski”, Sofia 1407, Bulgaria
Author contributions: Boyapati A, Chervenkov L, Gulinac M, and Genova K performed the literature review; Chervenkov L, Ilieva E, Gulinac M, and Borisov Y collected and prepared the images from their institutes’ database; Genova K, Ilieva E, and Chervenkov L provided the text and explanations of the images; Ilieva E and Velikova T wrote the draft; all the authors wrote additional sections in the paper according to their specialty; Velikova T revised the final draft; all authors revised and approved the final version of the article.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
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: Tsvetelina Velikova, MD, PhD, Assistant Professor, Department of Clinical Immunology, University Hospital “Lozenetz”, Kozyak 1 str., Sofia University “St. Kliment Ohridski”, Sofia 1407, Bulgaria. tsvelikova@medfac.mu-sofia.bg
Received: June 7, 2021
Peer-review started: June 7, 2021
First decision: October 18, 2021
Revised: November 9, 2021
Accepted: March 4, 2022
Article in press: March 4, 2022
Published online: April 26, 2022
Abstract

The introduction of coronavirus disease-2019 (COVID-19) as a global pandemic has contributed to overall morbidity and mortality. With a focus on understanding the immunology and pathophysiology of the disease, these features can be linked with the respective findings of imaging studies. Thus, the constellation between clinical presentation, histological, laboratory, immunological, and imaging results is crucial for the proper management of patients. The purpose of this article is to examine the role of imaging during the particular stages of severe acute respiratory syndrome coronavirus 2 infection – asymptomatic stage, typical and atypical COVID-19 pneumonia, acute respiratory distress syndrome, multiorgan failure, and thrombosis. The use of imaging methods to assess the severity and duration of changes is crucial in patients with COVID-19. Radiography and computed tomography are among the methods that allow accurate characterization of changes.

Keywords: Coronavirus disease-2019, Ultrasound, Computed tomography, Magnetic resonance imaging, Ground-glass opacity, Acute respiratory distress syndrome, Cytokine storm, COVID-19 reporting and data system, High-resolution computed tomography, Severe acute respiratory syndrome coronavirus 2

Core Tip: The novel Coronavirus disease-2019 (COVID-19) infection may present as a multiorgan disease, with the lung being the most commonly affected target organ. The clinical presentation, course, and outcome of COVID-19 are heterogeneous. Various imaging modalities can be employed to evaluate different disease stages depending on the affected organ or system, with X-ray, computed tomography, and ultrasound being the most commonly used. Imaging plays an essential role in the primary diagnosis of all manifestations of the disease and its related complications, evaluating disease severity and follow-up. Proper utilization of different imaging modalities and interpretation of the key imaging findings are essential for effective patient management and treatment.