Differential diagnosis of high altitude pulmonary edema and COVID-19 with computed tomography feature_Journal of Biomedical Engineering

Authors：

LI Wenzhe ^1,5 , LI Kai ^2,5 , ZHANG Nan ^3,5 , CHEN Gaofeng ^4,5 , LI Wenjun ¹ , TANG Jun ⁶ ,  YUAN Fang ¹

1. Department of Diagnostic Radiology, Xinjiang General Hospital of PLA, Urumqi 830000, P.R.China;
2. Department of Clinical Laboratory, Xinjiang General Hospital of PLA, Urumqi 830000, P.R.China;
3. Department of Dermatology, Xinjiang General Hospital of PLA, Urumqi 830000, P.R.China;
4. Department of Radiology, PLA 948 Hospital, Wusu, Xinjiang 833000, P.R.China;
5. Medical Station of Sanshili Barracks, PLA 950 Hospital, Hetian, Xinjiang 845150, P.R.China;
6. Department of Health Service, Xinjiang General Hospital of PLA, Urumqi 830000, P.R.China;

Corresponding author：

YUAN Fang, Email: zyyfmxj@163.com

Keywords：

high altitude pulmonary edema; COVID-19; computed tomography; differential diagnosis

DOI：

10.7507/1001-5515.202007043

Video：

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To investigate the computed tomography (CT) characteristics and differential diagnosis of high altitude pulmonary edema (HAPE) and COVID-19, CT findings of 52 cases of HAPE confirmed in Medical Station of Sanshili Barracks, PLA 950 Hospital from May 1, 2020 to May 30, 2020 were collected retrospectively. The size, number, location, distribution, density and morphology of the pulmonary lesions of these CT data were analyzed and compared with some already existed COVID-19 CT images which come from two files, “Radiological diagnosis of COVID-19: expert recommendation from the Chinese Society of Radiology (First edition)” and “A rapid advice guideline for the diagnosis and treatment of 2019 novel corona-virus (2019-nCoV) infected pneumonia (standard version)”. The simple or multiple ground-glass opacity (GGO) lesions are located both in the HAPE and COVID-19 at the early stage, but only the thickening of interlobular septa, called “crazy paving pattern” belongs to COVID-19. At the next period, some increased cloudy shadows are located in HAPE, while lesions of COVID-19 are more likely to develop parallel to the direction of the pleura, and some of the lesions show the bronchial inflation. At the most serious stage, both the shadows in HAPE and COVID-19 become white, but the lesions of HAPE in the right lung are more serious than that of left lung. In summary, some cloudy shadows are the feature of HAPE CT image, and “crazy paving pattern” and “pleural parallel sign” belong to the COVID-19 CT, which can be used for differential diagnosis.

Citation： LI Wenzhe, LI Kai, ZHANG Nan, CHEN Gaofeng, LI Wenjun, TANG Jun, YUAN Fang. Differential diagnosis of high altitude pulmonary edema and COVID-19 with computed tomography feature. Journal of Biomedical Engineering, 2020, 37(6): 1031-1036. doi: 10.7507/1001-5515.202007043 Copy

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19.	王玮, 陈辉武, 魏经国, 等. 高原肺水肿的 CT 表现及动态观察. 中华放射学杂志, 2004, 38(11): 1172-1175.
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23.	Luks A M, Freer L, Grissom C K, et al. COVID-19 lung injury is not high altitude pulmonary edema. High Alt Med Biol, 2020, 21(2): 192-193.
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26.	Pun M, Turner R, Strapazzon G, et al. Lower incidence of COVID-19 at high altitude: facts and confounders. High Alt Med Biol, 2020, 21(3): 217-222.
27.	吴婧, 冯采莲, 冼新源, 等. 新型冠状病毒肺炎 130 例 CT 分布特点及征象研究. 中华结核和呼吸杂志, 2020, 43(4): 321-326.

1. 国家卫生健康委员会. 国家卫健委: 外防输入内防扩散从三方面进行疫情防控[EB/OL]. (2020-03-20) [2020-07-19]. https://baijiahao.baidu.com/s?id=1661678116905720536&wfr=spider&for=pc.
2. Roach H H A R. High altitude pulmonary edema. Wild Environ Med, 1990, 1(1): 3-26.
3. 国家卫生健康委员会. 新型冠状病毒肺炎诊疗方案(试行第七版)[EB/OL]. (2020-03-14) [2020-07-19]. http://www.nhc.gov.cn/yzygj/s7653p/202003/46c9294a7dfe4cef80dc7f5912eb1989.shtml.
4. Stream J O, Grissom C K. Update on high-altitude pulmonary edema: Pathogenesis, prevention, and treatment. Wild Environ Med, 2008, 19(4): 293-303.
5. Altmayer S, Zanon M, Pacini G S, et al. Comparison of the computed tomography findings in COVID-19 and other viral pneumonia in immunocompetent adults: a systematic review and meta-analysis. Eur Radiol, 2020, 30: 6485-6496.
6. 中华医学会放射学分会. 新型冠状病毒肺炎的放射学诊断: 中华医学会放射学分会专家推荐意见(第一版). 中华放射学杂志, 2020, 54(4): 279-280.
7. 靳英辉, 蔡林, 程真顺, 等. 新型冠状病毒(2019-nCoV)感染的肺炎诊疗快速建议指南(标准版). 解放军医学杂志, 2020, 45(1): 1-20.
8. 史河水, 韩小雨, 樊艳青, 等. 新型冠状病毒(2019-nCoV)感染的肺炎临床特征及影像学表现. 临床放射学杂志, 2020, 39(1): 8-11.
9. 中华医学会第三次全国高原医学学术讨论会. 我国高原病命名、分型及诊断标准. 高原医学杂志, 1996, 6(1): 2-4.
10. Swenson E R. High-altitude pulmonary edema//Yuan J X J, Garcia J G N, West J B, et al. Textbook of pulmonary vascular disease. Boston: Springer US, 2011: 871-888.
11. 曹轶, 赵一蓉, 任何. 高原肺水肿的影像学特征及早期诊断价值. 影像研究与医学应用, 2019, 3(18): 8-10.
12. 陈蕾, 刘辉国, 刘威, 等. 2019 新型冠状病毒肺炎 29 例临床特征分析. 中华结核和呼吸杂志, 2020, 43(3): 203-208.
13. 查婧, 潘军平, 熊文文, 等. 肺部 CT 对新型冠状病毒肺炎与支原体肺炎的鉴别诊断. 南昌大学学报: 医学版, 2020, 60(2): 13-17.
14. 刘发明, 丁惠玲, 龚晓明, 等. 新型冠状病毒肺炎(COVID-19)的胸部 CT 表现与临床特点. 放射学实践, 2020, 35(3): 266-268.
15. 王正通, 陈月芹, 秦文恒, 等. 胸部 CT 在普通型新型冠状病毒肺炎与支原体肺炎鉴别诊断中的价值. 中华放射学杂志, 2020, 54(7): 683-687.
16. 白君, 周洁, 马婉玲, 等. 新型冠状病毒肺炎的初诊 CT 特征及与流感病毒性肺炎的鉴别诊断. 中国中西医结合影像学杂志, 2020, 18(3): 246-248.
17. 袁宏丽, 范恒全, 马彦华. 新型冠状病毒肺炎与其他常见病毒性肺炎的 CT 鉴别诊断. 解放军医药杂志, 2020, 32(4): 5-8.
18. 向兴利, 杜智敏, 马志习, 等. 高原肺水肿的 CT 诊断. 中华放射学杂志, 2002(2): 41-42.
19. 王玮, 陈辉武, 魏经国, 等. 高原肺水肿的 CT 表现及动态观察. 中华放射学杂志, 2004, 38(11): 1172-1175.
20. Xu Z, Shi L, Wang Y, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med, 2020, 8(4): 420-422.
21. Swenson E R, Bärtsch P. High-altitude pulmonary edema. Compr Physiol, 2012, 2(4): 2753.
22. Solaimanzadeh I. Acetazolamide, nifedipine and phosphodiesterase inhibitors: Rationale for their utilization as adjunctive countermeasures in the treatment of coronavirus disease 2019 (COVID-19). Cureus, 2020, 12(3): e7343.
23. Luks A M, Freer L, Grissom C K, et al. COVID-19 lung injury is not high altitude pulmonary edema. High Alt Med Biol, 2020, 21(2): 192-193.
24. Zeng J, Peng S, Lei Y, et al. Clinical and imaging features of COVID-19 patients: Analysis of data from high-altitude areas. J Infect, 2020, 80(6): e34-e36.
25. Segovia-Juarez J, Castagnetto J, Gonzales G F. High altitude reduces infection rate of COVID-19 but not case-fatality rate. Respir Physiol Neurobiol, 2020, 281: 103494.
26. Pun M, Turner R, Strapazzon G, et al. Lower incidence of COVID-19 at high altitude: facts and confounders. High Alt Med Biol, 2020, 21(3): 217-222.
27. 吴婧, 冯采莲, 冼新源, 等. 新型冠状病毒肺炎 130 例 CT 分布特点及征象研究. 中华结核和呼吸杂志, 2020, 43(4): 321-326.

Journal of Biomedical Engineering

Differential diagnosis of high altitude pulmonary edema and COVID-19 with computed tomography feature

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