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.