COVID-19 CT scan: Difference between revisions

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**Severity of illness
**Severity of illness


*Bilateral ground glass opacities ± [[consolidation]] in [[posterior]] and peripheral lung regions are considered as the '''hallmark''' for [[COVID-19]]. <ref name="pmid32017661">{{cite journal| author=Chung M, Bernheim A, Mei X, Zhang N, Huang M, Zeng X | display-authors=etal| title=CT Imaging Features of 2019 Novel Coronavirus (2019-nCoV). | journal=Radiology | year= 2020 | volume= 295 | issue= 1 | pages= 202-207 | pmid=32017661 | doi=10.1148/radiol.2020200230 | pmc=7194022 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32017661  }} </ref>
*Bilateral ground glass opacities ± [[consolidation]] in [[posterior]] and peripheral lung regions are considered as the hallmark for [[COVID-19]]. <ref name="pmid32017661">{{cite journal| author=Chung M, Bernheim A, Mei X, Zhang N, Huang M, Zeng X | display-authors=etal| title=CT Imaging Features of 2019 Novel Coronavirus (2019-nCoV). | journal=Radiology | year= 2020 | volume= 295 | issue= 1 | pages= 202-207 | pmid=32017661 | doi=10.1148/radiol.2020200230 | pmc=7194022 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32017661  }} </ref>
*However, there are a large number of typical and atypical [[chest]] [[CT]] findings for [[COVID-19]] that are summarized in the figure below. <ref name="pmid32193638">{{cite journal| author=Ye Z, Zhang Y, Wang Y, Huang Z, Song B| title=Chest CT manifestations of new coronavirus disease 2019 (COVID-19): a pictorial review. | journal=Eur Radiol | year= 2020 | volume=  | issue=  | pages=  | pmid=32193638 | doi=10.1007/s00330-020-06801-0 | pmc=7088323 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32193638  }} </ref> <ref name="pmid32489929">{{cite journal| author=Sun Z, Zhang N, Li Y, Xu X| title=A systematic review of chest imaging findings in COVID-19. | journal=Quant Imaging Med Surg | year= 2020 | volume= 10 | issue= 5 | pages= 1058-1079 | pmid=32489929 | doi=10.21037/qims-20-564 | pmc=7242306 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32489929  }} </ref>
*However, there are a large number of typical and atypical [[chest]] [[CT]] findings for [[COVID-19]] that are summarized in the figure below. <ref name="pmid32193638">{{cite journal| author=Ye Z, Zhang Y, Wang Y, Huang Z, Song B| title=Chest CT manifestations of new coronavirus disease 2019 (COVID-19): a pictorial review. | journal=Eur Radiol | year= 2020 | volume=  | issue=  | pages=  | pmid=32193638 | doi=10.1007/s00330-020-06801-0 | pmc=7088323 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32193638  }} </ref> <ref name="pmid32489929">{{cite journal| author=Sun Z, Zhang N, Li Y, Xu X| title=A systematic review of chest imaging findings in COVID-19. | journal=Quant Imaging Med Surg | year= 2020 | volume= 10 | issue= 5 | pages= 1058-1079 | pmid=32489929 | doi=10.21037/qims-20-564 | pmc=7242306 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32489929  }} </ref>
[[File:CT-COVID-19.PNG|800px|center]]
[[File:CT-FINDINGS-COVID-19.PNG|700px|center]]




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**Septal thickening
**Septal thickening
**Subpleural and lower lobe involvement more likely
**Subpleural and lower lobe involvement more likely
*[[Chest]] [[Computed tomography|CT scan]] findings common in [[Patient|patients]] [[Infection|infected]] with [[COVID-19]] are:
*[[Chest]] [[Computed tomography|CT scan]] findings in [[Patient|patients]] [[Infection|infected]] with [[COVID-19]] are usually:
**Bilateral '''peripheral''' lung opacities<ref name="LeiLi2020">{{cite journal|last1=Lei|first1=Junqiang|last2=Li|first2=Junfeng|last3=Li|first3=Xun|last4=Qi|first4=Xiaolong|title=CT Imaging of the 2019 Novel Coronavirus (2019-nCoV)                    Pneumonia|journal=Radiology|year=2020|pages=200236|issn=0033-8419|doi=10.1148/radiol.2020200236}}</ref>
**Bilateral peripheral [[lung]] [[opacities]]<ref name="LeiLi2020">{{cite journal|last1=Lei|first1=Junqiang|last2=Li|first2=Junfeng|last3=Li|first3=Xun|last4=Qi|first4=Xiaolong|title=CT Imaging of the 2019 Novel Coronavirus (2019-nCoV)                    Pneumonia|journal=Radiology|year=2020|pages=200236|issn=0033-8419|doi=10.1148/radiol.2020200236}}</ref>
**No subpleural sparing
**without subpleural sparing


*[[Right]] and [[left]] lower [[lung]] [[lobes]] were the most common involved [[lobes]] (65% and 63%) in [[COVID-19]]. <ref name="pmid32077789">{{cite journal| author=Bernheim A, Mei X, Huang M, Yang Y, Fayad ZA, Zhang N | display-authors=etal| title=Chest CT Findings in Coronavirus Disease-19 (COVID-19): Relationship to Duration of Infection. | journal=Radiology | year= 2020 | volume= 295 | issue= 3 | pages= 200463 | pmid=32077789 | doi=10.1148/radiol.2020200463 | pmc=7233369 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32077789  }} </ref>
*[[Right]] and [[left]] lower [[lung]] [[lobes]] were the most common involved [[lobes]] (65% and 63%) in [[COVID-19]]. <ref name="pmid32077789">{{cite journal| author=Bernheim A, Mei X, Huang M, Yang Y, Fayad ZA, Zhang N | display-authors=etal| title=Chest CT Findings in Coronavirus Disease-19 (COVID-19): Relationship to Duration of Infection. | journal=Radiology | year= 2020 | volume= 295 | issue= 3 | pages= 200463 | pmid=32077789 | doi=10.1148/radiol.2020200463 | pmc=7233369 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32077789  }} </ref>


*Time interval between onset of [[symptoms]] and [[chest]] [[CT]] manifestations is classified into 3 stages<ref name="pmid32077789">{{cite journal| author=Bernheim A, Mei X, Huang M, Yang Y, Fayad ZA, Zhang N | display-authors=etal| title=Chest CT Findings in Coronavirus Disease-19 (COVID-19): Relationship to Duration of Infection. | journal=Radiology | year= 2020 | volume= 295 | issue= 3 | pages= 200463 | pmid=32077789 | doi=10.1148/radiol.2020200463 | pmc=7233369 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32077789  }} </ref>:  
*Time interval between onset of [[symptoms]] and [[chest]] [[CT]] manifestations is classified into 3 stages<ref name="pmid32077789">{{cite journal| author=Bernheim A, Mei X, Huang M, Yang Y, Fayad ZA, Zhang N | display-authors=etal| title=Chest CT Findings in Coronavirus Disease-19 (COVID-19): Relationship to Duration of Infection. | journal=Radiology | year= 2020 | volume= 295 | issue= 3 | pages= 200463 | pmid=32077789 | doi=10.1148/radiol.2020200463 | pmc=7233369 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32077789  }} </ref>:  
** '''Early''':  between 0-2 days
** Early:  between 0-2 days
**'''Intermediate''': between 3-5 days
**Intermediate: between 3-5 days
**'''Late''': between 6-12 days
**Late: between 6-12 days
*[[Ground-glass opacities]] and [[consolidation]] are more likely to develop in the '''intermediate''' and '''late''' stages. <ref name="pmid32077789">{{cite journal| author=Bernheim A, Mei X, Huang M, Yang Y, Fayad ZA, Zhang N | display-authors=etal| title=Chest CT Findings in Coronavirus Disease-19 (COVID-19): Relationship to Duration of Infection. | journal=Radiology | year= 2020 | volume= 295 | issue= 3 | pages= 200463 | pmid=32077789 | doi=10.1148/radiol.2020200463 | pmc=7233369 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32077789  }} </ref>
*[[Ground-glass opacities]] and [[consolidation]] are more likely to develop in the intermediate and late stages. <ref name="pmid32077789">{{cite journal| author=Bernheim A, Mei X, Huang M, Yang Y, Fayad ZA, Zhang N | display-authors=etal| title=Chest CT Findings in Coronavirus Disease-19 (COVID-19): Relationship to Duration of Infection. | journal=Radiology | year= 2020 | volume= 295 | issue= 3 | pages= 200463 | pmid=32077789 | doi=10.1148/radiol.2020200463 | pmc=7233369 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32077789  }} </ref>
*[[Linear]] [[opacities]], [[crazy-paving pattern]], and [[reverse halo]] sign usually develop during the '''late''' stages. <ref name="pmid32077789">{{cite journal| author=Bernheim A, Mei X, Huang M, Yang Y, Fayad ZA, Zhang N | display-authors=etal| title=Chest CT Findings in Coronavirus Disease-19 (COVID-19): Relationship to Duration of Infection. | journal=Radiology | year= 2020 | volume= 295 | issue= 3 | pages= 200463 | pmid=32077789 | doi=10.1148/radiol.2020200463 | pmc=7233369 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32077789  }} </ref>
*[[Linear]] [[opacities]], [[crazy-paving pattern]], and [[reverse halo]] sign usually develop during the late stages. <ref name="pmid32077789">{{cite journal| author=Bernheim A, Mei X, Huang M, Yang Y, Fayad ZA, Zhang N | display-authors=etal| title=Chest CT Findings in Coronavirus Disease-19 (COVID-19): Relationship to Duration of Infection. | journal=Radiology | year= 2020 | volume= 295 | issue= 3 | pages= 200463 | pmid=32077789 | doi=10.1148/radiol.2020200463 | pmc=7233369 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32077789  }} </ref>
*The presence of [[consolidation]] is a sign of '''disease progression'''. <ref name="pmid32193638">{{cite journal| author=Ye Z, Zhang Y, Wang Y, Huang Z, Song B| title=Chest CT manifestations of new coronavirus disease 2019 (COVID-19): a pictorial review. | journal=Eur Radiol | year= 2020 | volume=  | issue=  | pages=  | pmid=32193638 | doi=10.1007/s00330-020-06801-0 | pmc=7088323 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32193638  }} </ref>
*The presence of [[consolidation]] is a sign of disease progression. <ref name="pmid32193638">{{cite journal| author=Ye Z, Zhang Y, Wang Y, Huang Z, Song B| title=Chest CT manifestations of new coronavirus disease 2019 (COVID-19): a pictorial review. | journal=Eur Radiol | year= 2020 | volume=  | issue=  | pages=  | pmid=32193638 | doi=10.1007/s00330-020-06801-0 | pmc=7088323 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32193638  }} </ref>
*The presence of [[pleural effusion]] in [[COVID-19]] is associated with poor [[prognosis]].<ref name="pmid32193638">{{cite journal| author=Ye Z, Zhang Y, Wang Y, Huang Z, Song B| title=Chest CT manifestations of new coronavirus disease 2019 (COVID-19): a pictorial review. | journal=Eur Radiol | year= 2020 | volume=  | issue=  | pages=  | pmid=32193638 | doi=10.1007/s00330-020-06801-0 | pmc=7088323 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32193638  }} </ref>
*The presence of [[pleural effusion]] in [[COVID-19]] is associated with poor [[prognosis]].<ref name="pmid32193638">{{cite journal| author=Ye Z, Zhang Y, Wang Y, Huang Z, Song B| title=Chest CT manifestations of new coronavirus disease 2019 (COVID-19): a pictorial review. | journal=Eur Radiol | year= 2020 | volume=  | issue=  | pages=  | pmid=32193638 | doi=10.1007/s00330-020-06801-0 | pmc=7088323 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32193638  }} </ref>
*The presence of [[lymphadenopathy]] and [[pericardial effusion]] are associated with severe [[COVID-19]] [[pneumonia]]. <ref name="pmid32193638">{{cite journal| author=Ye Z, Zhang Y, Wang Y, Huang Z, Song B| title=Chest CT manifestations of new coronavirus disease 2019 (COVID-19): a pictorial review. | journal=Eur Radiol | year= 2020 | volume=  | issue=  | pages=  | pmid=32193638 | doi=10.1007/s00330-020-06801-0 | pmc=7088323 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32193638  }} </ref>
*The presence of [[lymphadenopathy]] and [[pericardial effusion]] are associated with severe [[COVID-19]] [[pneumonia]]. <ref name="pmid32193638">{{cite journal| author=Ye Z, Zhang Y, Wang Y, Huang Z, Song B| title=Chest CT manifestations of new coronavirus disease 2019 (COVID-19): a pictorial review. | journal=Eur Radiol | year= 2020 | volume=  | issue=  | pages=  | pmid=32193638 | doi=10.1007/s00330-020-06801-0 | pmc=7088323 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32193638  }} </ref>

Revision as of 19:12, 19 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sabawoon Mirwais, M.B.B.S, M.D.[2] Syed Hassan A. Kazmi BSc, MD [3] Aditya Ganti M.B.B.S. [4] Nasrin Nikravangolsefid, MD-MPH [5]

Overview

Non-contrast Chest CT scan is an effective method for the rapid diagnosis of COVID-19 and monitoring the disease progression. Chest CT scan findings in patients infected with coronavirus can include unilateral or bilateral pneumonia, mottling and ground glass opacity, focal or multifocal opacities, consolidation, and septal thickening with subpleural and lower lobe involvement more likely.

CT scan

  • Non-contrast Chest CT scan is an effective method not only for the rapid diagnosis of COVID-19 but also for monitoring the disease progression. [1]
  • Given the high sensitivity of chest CT, it can be used in suspected patients with negative RT-PCR. [2]
  • Various chest CT features have been found diagnostic for COVID-19 that are associated with:
    • Duration of illness
    • Severity of illness
  • Bilateral ground glass opacities ± consolidation in posterior and peripheral lung regions are considered as the hallmark for COVID-19. [3]
  • However, there are a large number of typical and atypical chest CT findings for COVID-19 that are summarized in the figure below. [4] [5]



Radiological Society of North America

The Radiological Society of North America (RSNA) classified CT findings of COVID-19 infection into four categories which were endorsed by the Society of Thoracic Radiology and the American College of Radiology (ACR):

RSNA CT findings classification of Covid-19[12]
Typical appearance
  • Peripheral, bilateral, GGO +/- consolidation or visible intralobular lines (“crazy paving” pattern)
  • Multifocal GGO of rounded morphology +/- consolidation or visible intralobular lines (“crazy paving” pattern)
  • reverse halo sign or other findings of organizing pneumonia
Indeterminate appearance Absence of typical CT findings and the presence of
  • Multifocal, diffuse, perihilar, or unilateral GGO +/- consolidation lacking a specific distribution and are non-rounded or non-peripheral
  • Few very small GGO with a non-rounded and non-peripheral distribution
Atypical appearance Absence of typical or indeterminate features and the presence of
  • Isolated lobar or segmental consolidation without GGO
  • Discrete small nodules (e.g. centrilobular, tree-in-bud)
  • Lung cavitation
  • Smoother interlobular septal thickening with pleural effusion
Negative for pneumonia No CT features to suggest pneumonia, in particular, absent GGO and consolidation

Images

CT scan showing pulmonary focal opacity in a patient infected with COVID-19. [13]
CT scan showing pulmonary multifocal opacities in a patient infected with COVID-19. [14]



CT shows bilateral, multilobar large areas of ground-glass opacities with septal thickening and a crazy-paving pattern.[15]
CT shows bilateral multilobar peripheral ground-glass opacities in both lungs predominantly in mid to lower zones.[16]



References

  1. ↑ Xu B, Xing Y, Peng J, Zheng Z, Tang W, Sun Y; et al. (2020). "Chest CT for detecting COVID-19: a systematic review and meta-analysis of diagnostic accuracy". Eur Radiol. doi:10.1007/s00330-020-06934-2. PMC 7227176 Check |pmc= value (help). PMID 32415585 Check |pmid= value (help).
  2. ↑ Fang Y, Zhang H, Xie J, Lin M, Ying L, Pang P; et al. (2020). "Sensitivity of Chest CT for COVID-19: Comparison to RT-PCR". Radiology: 200432. doi:10.1148/radiol.2020200432. PMC 7233365 Check |pmc= value (help). PMID 32073353 Check |pmid= value (help).
  3. ↑ Chung M, Bernheim A, Mei X, Zhang N, Huang M, Zeng X; et al. (2020). "CT Imaging Features of 2019 Novel Coronavirus (2019-nCoV)". Radiology. 295 (1): 202–207. doi:10.1148/radiol.2020200230. PMC 7194022 Check |pmc= value (help). PMID 32017661 Check |pmid= value (help).
  4. ↑ 4.0 4.1 4.2 4.3 Ye Z, Zhang Y, Wang Y, Huang Z, Song B (2020). "Chest CT manifestations of new coronavirus disease 2019 (COVID-19): a pictorial review". Eur Radiol. doi:10.1007/s00330-020-06801-0. PMC 7088323 Check |pmc= value (help). PMID 32193638 Check |pmid= value (help).
  5. ↑ Sun Z, Zhang N, Li Y, Xu X (2020). "A systematic review of chest imaging findings in COVID-19". Quant Imaging Med Surg. 10 (5): 1058–1079. doi:10.21037/qims-20-564. PMC 7242306 Check |pmc= value (help). PMID 32489929 Check |pmid= value (help).
  6. ↑ Paul NS, Roberts H, Butany J, Chung T, Gold W, Mehta S, Konen E, Rao A, Provost Y, Hong HH, Zelovitsky L, Weisbrod GL (2004). "Radiologic pattern of disease in patients with severe acute respiratory syndrome: the Toronto experience". Radiographics. 24 (2): 553–63. doi:10.1148/rg.242035193. PMID 15026600.
  7. ↑ Ajlan AM, Ahyad RA, Jamjoom LG, Alharthy A, Madani TA (October 2014). "Middle East respiratory syndrome coronavirus (MERS-CoV) infection: chest CT findings". AJR Am J Roentgenol. 203 (4): 782–7. doi:10.2214/AJR.14.13021. PMID 24918624.
  8. ↑ Chen, Nanshan; Zhou, Min; Dong, Xuan; Qu, Jieming; Gong, Fengyun; Han, Yang; Qiu, Yang; Wang, Jingli; Liu, Ying; Wei, Yuan; Xia, Jia'an; Yu, Ting; Zhang, Xinxin; Zhang, Li (2020). "Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study". The Lancet. doi:10.1016/S0140-6736(20)30211-7. ISSN 0140-6736.
  9. ↑ Lei, Junqiang; Li, Junfeng; Li, Xun; Qi, Xiaolong (2020). "CT Imaging of the 2019 Novel Coronavirus (2019-nCoV) Pneumonia". Radiology: 200236. doi:10.1148/radiol.2020200236. ISSN 0033-8419.
  10. ↑ 10.0 10.1 10.2 10.3 Bernheim A, Mei X, Huang M, Yang Y, Fayad ZA, Zhang N; et al. (2020). "Chest CT Findings in Coronavirus Disease-19 (COVID-19): Relationship to Duration of Infection". Radiology. 295 (3): 200463. doi:10.1148/radiol.2020200463. PMC 7233369 Check |pmc= value (help). PMID 32077789 Check |pmid= value (help).
  11. ↑ Pan, Feng; Ye, Tianhe; Sun, Peng; Gui, Shan; Liang, Bo; Li, Lingli; Zheng, Dandan; Wang, Jiazheng; Hesketh, Richard L.; Yang, Lian; Zheng, Chuansheng (2020). "Time Course of Lung Changes at Chest CT during Recovery from Coronavirus Disease 2019 (COVID-19)". Radiology. 295 (3): 715–721. doi:10.1148/radiol.2020200370. ISSN 0033-8419.
  12. ↑ Simpson, Scott; Kay, Fernando U.; Abbara, Suhny; Bhalla, Sanjeev; Chung, Jonathan H.; Chung, Michael; Henry, Travis S.; Kanne, Jeffrey P.; Kligerman, Seth; Ko, Jane P.; Litt, Harold (2020). "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". Radiology: Cardiothoracic Imaging. 2 (2): e200152. doi:10.1148/ryct.2020200152. ISSN 2638-6135.
  13. ↑ Case courtesy of Medico Assistente Dr. Chong Keng Sang, Sam, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/73890">rID: 73890</a>
  14. ↑ Case courtesy of Medico Assistente Dr. Chong Keng Sang, Sam, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/73890">rID: 73890</a>
  15. ↑ Case courtesy of Dr Antonio Rodrigues de Aguiar Neto, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/76921">rID: 76921</a>
  16. ↑ Case courtesy of Dr Bahman Rasuli, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/75768">rID: 75768</a>
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