CTICasesPost-COVID-19 Organizing Pneumonia Progressing to NSIP-pattern Fibrosis
Imaging findings
CT in a patient with severe COVID-19 pneumonia demonstrates extensive bilateral organizing pneumonia with consolidation, crazy-paving pattern, and ground-glass opacity in a predominantly basal and peripheral distribution. A follow-up CT obtained 8 to 12 weeks later shows evolution with persistent subpleural and basal reticulation, traction bronchiectasis, and areas of residual consolidation in an NSIP-like pattern, with some regions of probable irreversible fibrosis.
Key takeaways
A subset of patients with severe COVID-19 acute lung injury develop progressive fibrotic lung disease resembling NSIP on CT, with peripheral and basal reticulation, traction bronchiectasis, and volume loss. This fibrotic sequela of COVID-19 is analogous to post-ARDS fibrosis seen with other causes of acute lung injury such as SARS and MERS. Patients presenting 8 to 12 weeks after acute illness with persistent respiratory symptoms should undergo CT evaluation for this entity.
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