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The Target Sign and Its Variant in COVID-19 Pneumonia

2020; Radiological Society of North America; Volume: 2; Issue: 4 Linguagem: Inglês

10.1148/ryct.2020200435

2638-6135

Lucas de Pádua Gomes de Farias, Fernando Henrique Caixeta Souza, Gustavo Borges da Silva Teles,

COVID-19 diagnosis using AI

HomeRadiology: Cardiothoracic ImagingVol. 2, No. 4 PreviousNext Images in Cardiothoracic ImagingFree AccessVascular ImagingThe Target Sign and Its Variant in COVID-19 PneumoniaLucas de Pádua Gomes de Farias , Fernando Henrique Caixeta Souza, Gustavo Borges da Silva TelesLucas de Pádua Gomes de Farias , Fernando Henrique Caixeta Souza, Gustavo Borges da Silva TelesAuthor AffiliationsFrom UnitedHealth Group Brazil, Hospital Samaritano, R. Conselheiro Brotero 1486, Higienópolis, São Paulo, SP 01232-010, Brazil.Address correspondence to L.d.P.G.d.F. (e-mail: [email protected]).Lucas de Pádua Gomes de Farias Fernando Henrique Caixeta SouzaGustavo Borges da Silva TelesPublished Online:Aug 13 2020https://doi.org/10.1148/ryct.2020200435MoreSectionsPDF ToolsAdd to favoritesCiteTrack Citations ShareShare onFacebookXLinked In The target sign, identified at chest CT, has been recently described by Müller et al (1) as a nodular opacity in the center of a ring-like opacity in patients with pneumonia caused by the severe acute respiratory syndrome coronavirus 2. Pulmonary vascular alterations are significantly associated with coronavirus disease 2019 (COVID-19) (2,3), and lung autopsies showed distinctive vascular features characterized by endothelial injury with disrupted cell membranes (endothelialitis), widespread thrombosis with microangiopathy, and angiocentric inflammation (4). Thus, the central nodular opacity may reflect the perivascular inflammation or focal enlargement of the pulmonary artery (1). Furthermore, the ring-like opacities may be correlated with the underlying pathophysiologic mechanisms of the disease process as it organizes, indicating that the organizing pneumonia is one of the mechanisms of lung injury, but distinct from the reversed halo sign and the perilobular opacity (1). The variant of target sign here described is characterized by multiple concentric perivascular ring-like opacities. Further evaluation and pathologic studies are required to investigate the contribution of this sign in the diagnosis of COVID-19 pneumonia (Figs 1, 2).Figure 1: Schematic drawing, A, E, and chest CT images (B, axial, C, coronal, D, sagittal, and E, sagittal oblique) show the target sign characterized by nodular opacity in the center of a ring-like opacity. Some multiplanar reformatted planes, E, show the central nodule as a pulmonary arteriole (arrowhead) with perivascular ground-glass tubular opacity, as illustrated in F.Figure 1:Download as PowerPointFigure 2: Schematic drawing, A, and chest CT images (B-D, axial oblique, E, coronal, and F, sagittal) show the variant target sign characterized by multiple concentric ring-like opacities with a central nodular peribronchovascular opacity.Figure 2:Download as PowerPointDisclosures of Conflicts of Interest: L.d.P.G.d.F. disclosed no relevant relationships. F.C.S. disclosed no relevant relationships. G.T. disclosed no relevant relationships.Keywords: Adults and Pediatrics, CT, Infection, Lung, Thorax, Vascular Authors declared no funding for this work. References1. Müller CIS, Müller NL. Chest CT target sign in a couple with COVID-19 pneumonia. Radiol Bras 2020;53(4):252–254. MedlineGoogle Scholar2. Bai HX, Hsieh B, Xiong Z, et al. Performance of Radiologists in Differentiating COVID-19 from Non-COVID-19 Viral Pneumonia at Chest CT. Radiology 2020;296(2):E46–E54. Google Scholar3. Lang M, Som A, Carey D, et al. Pulmonary vascular manifestations of COVID-19 pneumonia. Radiol Cardiothorac Imaging 2020;2(3):e200277. Google Scholar4. Ackermann M, Verleden SE, Kuehnel M, et al. Pulmonary Vascular Endothelialitis, Thrombosis, and Angiogenesis in Covid-19. N Engl J Med 2020;383(2):120–128. 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