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Prof. Ege University Faculty of Medicine, Department of Radiology. Dr. Recep Savaş made the following explanations about the study they did in their own hospitals and published in the British College of Surgeons Annuals.
The Royal College of Surgeons, on April 7, 2020, in the last month; He has published an updated guide on COVID-19. This guide stresses that emergency services, including cancer surgeries, must be maintained during the pandemic.
In the guideline, he recommends having an abdominal CT scan for elective cancer surgery during a pandemic, as well as abstaining from the CT scan of the chest for his patients. Postoperative respiratory complications can significantly increase in patients with a positive and unrecognized Covid-19 period.
The PCR test alone or the CT of the chest contain 25-30% false negativity for the diagnosis of the SARS-Cov-2 virus. For this reason, all patients, especially before the surgical operation; be asymptomatic for less than 7 days, be socially isolated for 14 days, and have a negative Covid-19 nasopharyngeal swab (PCR) in the past 48 hours. In the manual, if the patient was requested in emergency conditions and an abdominal CT was requested, these patients should be asked for a chest CT.
However, if the patient had an abdominal CT, will a chest CT be required? For this purpose, we have retrospectively analyzed our patients who underwent chest CT scans at the Ege University School of Medicine, Department of Radiology:
We evaluated the subdiaphragmatic findings of chest CT scans of a patient with CT findings and a diagnosis of 178 covid PCR-positive patients. Because abdominal CT scans always pass over the level of the diaphragm and slightly, they include lung bases. In many studies on Covid-19 radiology, the involvement of the lower lobe (right, left, or bilateral) on CT is greater than 90%. As a result of our evaluation:
There were findings under the diaphragm in 155 patients (87.1%). 116 patients (74.8%) were bilateral and 145 patients had the appearance of ground glass.
This means that patients who have undergone abdominal CT for surgery or other reasons should also be examined in the lung parenchyma window. The probability of showing covid-19 findings with CT at or below the level of the diaphragm in patients with positive PCR is 87.1%. For this reason, unnecessary chest CT scans can be prevented and therefore unnecessary radiation from patients.
In the image, CT images that pass through the diaphragm near the diaphragm show consistent changes with Covid-19 disease in both lungs.
Resources:
- https://www.rcsed.ac.uk/news-public-affairs/news/2020/april/intercollegiate-guidance-for-pre-operative-chest-ct-imaging-for-elective-cancer-surgery-during- Covidien-19-the-pandemic
- Dai H, Zhang X, Xia J et al. High-resolution chest CT characteristics and clinical characteristics of patients infected with COVID-19 in Jiangsu, China. Int J Infect Dis 2020 April 6.
- Chest radiographic examination and COVID-19. Sayiner A, Cinkooglu A, Tasbakan MS, Basoglu ÖK, Ceylan N, Savas R, Bayraktaroglu S, Özhan MH. Ann R Coll Surg Engl. 2020 May; 102 (5): 334. doi: 10.1308 / rcsann.2020.0099.
