Indian Journal of Respiratory Care

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VOLUME 11 , ISSUE 1 ( January-March, 2022 ) > List of Articles

Original Article

Analysis of High-resolution Computed Tomography Chest in Interferon Gamma Release Assay negative COVID-19 Patients: From a COVID Hospital of Odisha, India

Sudhansu Sekhar Mohanty, Kamal Kumar Sen, Asim Mitra, Sangram Panda, Jagadeesh Kuniyil, Dipti Pattanaik, Roopak Dubey

Keywords : Atypical COVID-19, high-resolution computed tomography chest, interferon-gamma release assay/QuantiFERON TB gold, tuberculosis

Citation Information : Mohanty SS, Sen KK, Mitra A, Panda S, Kuniyil J, Pattanaik D, Dubey R. Analysis of High-resolution Computed Tomography Chest in Interferon Gamma Release Assay negative COVID-19 Patients: From a COVID Hospital of Odisha, India. Indian J Respir Care 2022; 11 (1):52-58.

DOI: 10.4103/ijrc.ijrc_128_21

License: CC BY-NC-SA 4.0

Published Online: 06-12-2022

Copyright Statement:  Copyright © 2022; Indian Journal of Respiratory Care.


Background: Atypical category of COVID-19 could not be differentiated from tuberculosis (TB) in high-resolution computed tomography (HRCT) of the chest because of similar imaging features. This study aims to distinguish between the HRCT features of TB and atypical COVID-19. Methodology: Interferon-gamma release assay (IGRA) was performed in all the 54 COVID-positive patients, showing atypical COVID features that are suspicious of TB on the HRCT chest. Atypical imaging features such as a tree in bud nodules, patchy consolidations, cavitation with surrounding consolidation, discrete nodules, mediastinal lymphadenopathy, and pleural effusion were analyzed in 50 IGRA-negative patients. Results: We found trees in bud nodules (93%) and consolidations (56%) involving predominantly lower lobes, i.e., superior and posterobasal segments. Discrete nodules and cavitation with surrounding consolidation were seen involving predominantly upper lobes (78 and 57% cases, respectively), i.e., apicoposterior and lingular segments of the left upper lobe. The maximum number (67%) of right paratracheal enlarged nodes and bilateral pleural effusions (71%) were found in IGRA-negative COVID-19 patients. Conclusions: It is not always possible to differentiate features of atypical COVID-19 from TB based on HRCT chest alone because of similar appearances and distribution of tree in bud nodules, consolidation, cavitation, and lymphadenopathy in HRCT chest. Since both bilateral and unilateral pleural effusions may be seen in TB, it is impossible to differentiate COVID-19 from TB based on pleural effusion. Therefore, exclusion of TB will need supportive, relevant laboratory investigations (Sputum acid fast bacilli, cartridge-based nucleic acid amplification test, and IGRA) for appropriate diagnosis and management.

  1. India TB Report 2020. Available from: [Last accessed on 2021 Jan 06].
  2. Sy KT, Haw NJ, Uy J. Previous and active tuberculosis increases risk of death and prolongs recovery in patients with COVID-19. Infect Dis (Lond) 2020;52:902-7.
  3. Simpson S, Kay FU, Abbara S, Bhalla S, Chung JH, Chung M, et al. Radiological society of north america expert consensus statement on reporting chest CT findings related to COVID-19. Endorsed by the Society of Thoracic Radiology, the American College of Radiology, and RSNA - Secondary publication. J Thorac Imaging 2020;35:219-27.
  4. Bomanji JB, Gupta N, Gulati P, Das CJ. Imaging in tuberculosis. Cold Spring Harb Perspect Med 2015;5:a017814.
  5. Lewinsohn DM, Leonard MK, LoBue PA, Cohn DL, Daley CL, Desmond E, et al. Official American Thoracic Society/Infectious Diseases Society of America/Centers for Disease Control and Prevention clinical practice guidelines: Diagnosis of tuberculosis in adults and children. Clin Infect Dis 2017;64:111-5.
  6. Lalvani A, Pareek M. Interferon gamma release assays: Principles and practice. Enferm Infecc Microbiol Clin 2010;28:245-52.
  7. Pai M, Denkinger CM, Kik SV, Rangaka MX, Zwerling A, Oxlade O, et al. Gamma interferon release assays for detection of Mycobacterium tuberculosis infection. Clin Microbiol Rev 2014;27:3-20.
  8. Takasaki J, Manabe T, Morino E, Muto Y, Hashimoto M, Iikura M, et al. Sensitivity and specificity of QuantiFERON-TB Gold Plus compared with QuantiFERON-TB Gold In-Tube and T-SPOT.TB on active tuberculosis in Japan. J Infect Chemother 2018;24:188-92.
  9. De Keyser E, De Keyser F, De Baets F. Tuberculin skin test versus interferon-gamma release assays for the diagnosis of tuberculosis infection. Acta Clin Belg 2014;69:358-66.
  10. Jamil SM, Oren E, Garrison GW, Srikanth S, Lewinsohn DM, Wilson KC, et al. Diagnosis of tuberculosis in adults and children. Ann Am Thorac Soc 2017;14:275-8.
  11. Zwerling A, Behr MA, Verma A, Brewer TF, Menzies D, Pai M. The BCG world atlas: A database of global BCG vaccination policies and practices. PLoS Med 2011;8:e1001012.
  12. Horvath I, Weiszhar Z. Induced sputum analysis: Step by step. Breathe 2013;9:301-6.
  13. Jin YH, Cai L, Cheng ZS, Cheng H, Deng T, Fan YP, et al. A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version). Mil Med Res 2020;7:4.
  14. Gosset N, Bankier AA, Eisenberg RL. Tree-in-bud pattern. AJR Am J Roentgenol 2009;193:W472-7.
  15. Im JG, Itoh H, Shim YS, Lee JH, Ahn J, Han MC, et al. Pulmonary tuberculosis: CT findings- early active disease and sequential change with anti-tuberculous therapy. Radiology 1993;186:653-60.
  16. Lee KS, Im JG. CT in adults with tuberculosis of the chest: Characteristic findings and role in management. AJR Am J Roentgenol 1995;164:1361-7.
  17. Rossi SE, Franquet T, Volpacchio M, Giménez A, Aguilar G. Tree-in-bud pattern at thin-section CT of the lungs: Radiologic-pathologic overview. Radiographics 2005;25:789-801.
  18. Kjeldsberg KM, Oh K, Murray KA, Cannon G. Radiographic approach to multifocal consolidation. Semin Ultrasound CT MR 2002;23:288-301.
  19. Song F, Shi N, Shan F, Zhang Z, Shen J, Lu H, et al. Emerging 2019 novel coronavirus (2019-nCoV) pneumonia. Radiology 2020;295:210-7.
  20. Shi H, Han X, Jiang N, Cao Y, Alwalid O, Gu J, et al. Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: A descriptive study. Lancet Infect Dis 2020;20:425-34.
  21. Yeh JJ, Chen SC, Chen CR, Yeh TC, Lin HK, Hong JB, et al. A high-resolution computed tomography-based scoring system to differentiate the most infectious active pulmonary tuberculosis from community-acquired pneumonia in elderly and non-elderly patients. Eur Radiol 2014;24:2372-84.
  22. Bhalla AS, Goyal A, Guleria R, Gupta AK. Chest tuberculosis: Radiological review and imaging recommendations. Indian J Radiol Imaging 2015;25:213-25.
  23. Yeh JJ, Chen SC, Teng WB, Chou CH, Hsieh SP, Lee TL, et al. Identifying the most infectious lesions in pulmonary tuberculosis by high-resolution multi-detector computed tomography. Eur Radiol 2010;20:2135-45.
  24. El-Solh AA, Hsiao CB, Goodnough S, Serghani J, Grant BJ. Predicting active pulmonary tuberculosis using an artificial neural network. Chest 1999;116:968-73.
  25. Boitsios G, Bankier AA, Eisenberg RL. Diffuse pulmonary nodules. AJR Am J Roentgenol 2010;194:W354-66.
  26. Castiglioni M, Pelosi G, Meroni A, Tagliabue M, Uslenghi E, Salaris D, et al. Surgical resections of superinfected pneumatoceles in a COVID-19 patient. Ann Thorac Surg 2021;111:e23-5.
  27. Selvaraj V, Dapaah-Afriyie K. Lung cavitation due to COVID-19 pneumonia. BMJ Case Rep 2020;13:e237245.
  28. Xu Z, Pan A, Zhou H. Rare CT feature in a COVID-19 patient: Cavitation. Diagn Interv Radiol 2020;26:380-1.
  29. Liu K, Zeng Y, Xie P, Ye X, Xu G, Liu J, et al. COVID-19 with cystic features on computed tomography: A case report. Medicine (Baltimore) 2020;99:e20175.
  30. Menter T, Haslbauer JD, Nienhold R, Savic S, Hopfer H, Deigendesch N, et al. Postmortem examination of COVID-19 patients reveals diffuse alveolar damage with severe capillary congestion and variegated findings in lungs and other organs suggesting vascular dysfunction. Histopathology 2020;77:198-209.
  31. Yao XH, Li TY, He ZC, Ping YF, Liu HW, Yu SC, et al. A pathological report of three COVID-19 cases by minimal invasive autopsies. Zhonghua Bing Li Xue Za Zhi 2020;49:411-7.
  32. Raniga S, Parikh N, Arora A, Vaghani M, Vora PA, Vaidya V. Is HRCT reliable in determining disease activity in pulmonary tuberculosis? Indian J Radiol Imaging 2006;16:221-8.
  33. Van Dyck P, Vanhoenacker FM, Van den Brande P, De Schepper AM. Imaging of pulmonary tuberculosis. Eur Radiol 2003;13:1771-85.
  34. Gadkowski LB, Stout JE. Cavitary pulmonary disease. Clin Microbiol Rev 2008;21:305-33.
  35. Garg MK, Kalra N. Radiological manifestations of pulmonary tuberculosis. In: Chowdhury V, Gupta AK, Khandelwal N, editors. Diagnostic Radiology. 3rd ed. New Delhi, India: Jaypee Brother Medical; 2010. p. 60-8.
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