Chest Computed Tomography Findings of Patients with Severe COVID-19 Complicated with Other Pathogens

Objective: To describe the characteristics of chest computed tomography (CT) findings of patients with severe COVID-19 complicated with other pathogens. Method: Chest CT data and outcomes of patients with severe COVID-19 complicated with other pathogens were retrospectively analyzed. Results: Twenty-seven patients were included in the study. Etiological examination showed that bacteria were isolated in 13 patients, fungi in 2 patients, and bacteria and fungi in the remaining 12 patients. Multiple lung lesions were found in the chest CT images of all 27 patients. Excluding the chest CT images of 6 patients with typical novel coronavirus pneumonia features, the remaining 21 cases mostly showed scattered or diffuse ground-glass, mixed density, patchy, and patchy-solid shadows distributed in the lung segments or lobes. Some of them were scattered in nodules or central lobular nodules, with the thickened interlobular septum showing "paving stone sign" and "vascular thickening sign" in the ground glass shadow, and air bronchial air images were visible in the solid shadows. Pleural effusion was found in most cases, with pulmonary air sacs in few cases, and mild lymph node enlargement in scattered cases. According to the outcomes, the patients were grouped into 6 patients who survived and 21 patients who died. The proportion of ground glass shadow and ground glass with solid shadow in the lung of the patients who died was higher than that of the patients who survived, and the other imaging findings were not statistically different. Conclusion: Secondary infections in patients with severe COVID-19 were mainly bacterial and fungal infections, with most infections were mixed pathogens. Chest CT images mainly showed ground glass, mixed density shadow, consolidation shadow, and nodular shadow without specific location distribution, and most cases were accompanied with pleural effusion, a few with lung sacs, and scattered cases with mild enlargement of chest lymph nodes, pavement stone sign, and vascular thickening sign. It showed the diverse imaging features of COVID-19 cases complicated with bacterial and fungal infections.