Discussion
The symptoms of COVID-19 vary widely ranged across. The most of infected patients are asymptomatic. It can lead to only self-limiting respiratory illness in symptomatic patients. The most common medical conditions requiring hospitalization are related to diseases of pulmonary such as pneumonia, hypoxia. But in some patients, it could cause severe multisystem disease that can be fatal(1, 3, 4). So, the quickly and correctly diagnosis of the disease is a substantial entity. RT-PCR is the standard diagnostic method(10). However, the use of these tools could have impractical for clinical management due to related to concerns such as delaying the diagnosis or false-negative results. So, it may be necessary to use supportive diagnostic methods such as laboratory findings or imaging methods(10).
The chest radiographs commonly have no diagnostic value in the early stages of the disease. Thus, they are not useful clinically for diagnosis. But, pulmonary CT may include many findings even before symptom onset(9). Even if routine CT imaging is not recommended for diagnosis of COVID-19 pneumonia(11), for its contributions to the diagnosis, the rapid advice guideline recommended the pulmonary CT as strongly for patients with suspected COVID-19(12). The patients who are not yet suspected COVID-19 may have been characteristic pulmonary findings of COVID-19 pneumonia. Also, CT findings are could be support COVID-19 in patients who are investigated to novel viral pneumonia infection(13). The commonly characteristic CT patterns for COVID are included in; ground-glass opacities, bilateral or multilobar involvement, cavitation, bilateral patchy shadowing, septal or pleural thickening, linear opacities, and discrete pulmonary nodules etc.(14, 15). The most of cases with confirmed COVID-19 have initial abnormal CT manifestations. Even, some of these patients have not any symptoms related to COVID-19 and were imaged only for screening(16). Similarly, none of the patients in our study have any pulmonary symptoms. These patients were asymptomatic, or have non-pulmonary symptoms.
The radiologic modalities in urology practice have been used widespread in recent years(17). This widespread use of these tools such as ultrasonography, or abdominal CT enables incidental detection and early diagnosis of diseases such as renal cell carcinoma(18). Although there were some exceptions, most abdominal CT studies include a consistent portion, especially lung bases, of pulmonary component(19). In the study by Vu et al, it was presented that three patients without respiratory symptoms had doubtful imaging findings for COVID-19. None of these patients had pulmonary CT. Abnormal imaging findings were seen on the pulmonary component of abdominal CT in two of these patients(20). Similarly, other studies examining this issue consisted of case series(21-24). Moreover, in their study, Barkmeier et al. stated that there were 42 patients with COVID-19 have abdominal CT that visualized lung bases. They also stated that 79% of these patients have abnormal CT findings on lung bases(13). In this present study, we found that 9.7% of the patients had abnormal CT findings consistent with COVID-19 pneumonia. These findings were supported by another study which was showing the screening of the lung base images may benefit the diagnosis of COVID-19 for patients with abdominal CT(25).
COVID-19 has no directly pathological effect on the urinary tract. But, this disease, which takes hold all over the world, affects significantly daily clinical practice(26). In this pandemic time, many hospitals have served only patients with COVID-19, and the hospitals’ workload has increased considerably. This statement has led to an increase in the requirement for healthcare(27). So, a pragmatic approach must be necessary for the management of this disease. All medical doctors including urologists should increase their awareness of this disease. They are playing an important role in the fight against COVID-19 during this pandemic. They also must be aware of the potential signs of illness(28). Based on these findings, we evaluated the lung base findings of the patients’ abdominal CT. We found that a significant part of the patients has typical findings of COVID-19 pneumonia. This rate is a portion of the patients we encounter in our daily outpatient clinic, which cannot be ignored. So, it is too important to the assessment of imaging hallmarks for effective patient treatment and management with increasing concerns about the SARS-CoV-2 outbreak.
This present study has some limitations. First, we evaluated the patients who were admitted only to the urology outpatient clinic. So, the study population maybe not enough for generalization. Second, we could not correlate all of these patients with RT-PCR. Despite these limitations, this present study has significant findings of COVID-19 management.