Consensus Statement on Chest Imaging in Patients with COVID-19 (Fleischner Society, 2020)

Fleischner Society

This is a quick summary of the guidelines without analysis or commentary. For more information, go directly to the guidelines by clicking the link in the reference.

April 27, 2020

An multinational consensus statement from the Fleischner Society on the role of chest imaging in the management of patients with COVID-19 was published in April 2020 (FDA).[1]

Patients with mild features of COVID-19

Imaging is advised for patients with risk factors for COVID-19 progression and either positive COVID-19 testing or moderate-to-high pre-test probability in the absence of COVID-19 testing.

Imaging is not indicated in asymptomatic patients or those with suspected COVID-19 and mild clinical features unless they are at risk for disease progression.

Imaging is indicated in COVID-19 patients with worsening respiratory status.

Patients with moderate-to-severe features of COVID-19

Imaging is advised regardless of the results or availability of COVID-19 testing for patients who present with moderate-to-severe features consistent with COVID-19 infection and a pre-test probability of infection.

For patients with COVID-19, imaging establishes baseline pulmonary status and identifies underlying cardiopulmonary abnormalities that may facilitate risk stratification for clinical worsening.

Patients with moderate-to severe-features of COVID-19 in a resource-constrained environment

Imaging is advised when point-of-care COVID-19 testing is available and positive.

Imaging is indicated for medical triage in resource-constrained environments for patients with suspected COVID-19 with moderate-to-severe clinical features and high pretest probability of the virus.

There is no role for imaging of patients with mild features of COVID-19 if there are significant constraints on resources.

Patients recovered from COVID-19

Imaging is appropriate in patients with functional impairment and/or hypoxemia after recovery from COVID-19.

Other scenarios

Daily chest radiographs are not indicated in stable intubated patients with COVID-19.

COVID-19 testing is indicated in patients who are found incidentally to have typical findings of the virus on a CT scan.

For more Clinical Practice Guidelines, go to COVID-19 Clinical Guidelines.

For more information, go to Novel Coronavirus Resource Center and Coronavirus Disease 2019 (COVID-19).

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