ABC | Volume 115, Nº1, July 2020

Review Article Costa et al. Cardiovascular Imaging and Interventional Procedures Arq Bras Cardiol. 2020; 115(1):111-126 because of the retrospective nature of the studies published, including the lack of strict criteria for imaging diagnosis and procedural differences for confirming infection. 31 The CT findings depend on when infected patients are imaged. In the initial phase, 57-98% of the patients will present usually bilateral, peripheral and rounded ground-glass opacities. 32 From 5% to 36% of the patients will have a ‘crazy paving’ pattern at disease peak (5 to 8 days after symptom onset). Consolidations are present in 2% to 64% of the patients, commonly in the elderly and those with the disease severe form. Later in the course of the disease, a reticular pattern is observed in 48% of the patients, as is the gradual resolution of the consolidations. 33,34 Other CT findings, although less frequent, in COVID-19 are as follows: subpleural lines, air bronchograms, lymph node enlargement, pleural thickening and effusion, and pericardial effusion. 35,36 4.3. Coronary Computed Tomography Angiography CCTA can be performed in patients with COVID-19 and high troponin levels to exclude CAD. In that situation, CCTA can be extremely helpful to exclude or confirm acute coronary syndrome if the clinical findings are uncertain, replacing invasive coronary angiography and the exposure of all cardiac catheterization laboratory (CCL) staff that comes with it. Another important and emerging role of CCTA during the pandemic is to replace TEE in ruling out a thrombus in the left atrial appendage before electrical cardioversion, limiting the exposure of the echocardiographer. 16 The Society of Cardiovascular Computed Tomography has offered guidance with recommendations to help physicians when performing CCTA during the pandemic, considering the need to prioritize urgent exams and chest CT in patients with COVID-19. 37 These are urgent indications, in which scanning should be performed within hours to 4 weeks: 37 • Acute chest pain with clinical suspicion for CAD; • Stable CAD at high risk for events or when there is concern for high-risk coronary anatomy; • Patient requiring urgent structural correction of heart disease; • Assessment of left atrial appendage in patients with acute atrial fibrillation prior to restoration of sinus rhythm; • Assessment of cardiomyopathy in low pretest probability of CAD, only if CCTA will change management; • Assessment of ventricular assist device dysfunction; Figure 1 – Chest X-ray (XR) and computed tomography (CT) in COVID-19. 115