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Coronavirus lung scans are a puzzle for doctors

Published Apr 8th, 2020 10:38AM EDT
coronavirus symptoms
Image: REMKO DE WAAL/EPA-EFE/Shutterstock

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  • Not all coronavirus patients appear to have lung damage, despite having low blood-oxygen levels. 
  • Scans show healthy lungs, but patients are struggling with oxygen anyway, leaving doctors puzzled. 
  • One possible explanation is that damaged areas of the lungs aren’t rerouting blood flow as they should, possibly due to some unique aspect of the novel coronavirus, but more research needs to be done to confirm this. 
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The novel coronavirus pandemic

has already cost thousands of lives, and when it comes to the most serious symptoms of COVID-19, it’s the virus’s effects on the lungs that are the most serious. The virus is known to trigger pneumonia in the most severe of cases, often requiring assisted breathing for patients who are affected. However, as WebMD reports, scans of a patient’s lungs are sometimes mysteriously unhelpful.

When a patient suspected of having coronavirus is admitted, blood work is done and, in a significant number of cases, low oxygen levels are noted. In cases like this, doctors would expect to see obstructions or damage in the lungs or labored breathing, but some patients appear to be breathing fine and X-ray scans show lungs that look relatively healthy.

“A whole bunch of these patients really have low oxygen, but their lungs don’t look all that bad,” Dr. Todd Bull, director for the Center of Lungs and Breathing at the University of Colorado School of Medicine, explains. But how can that be, and what other factor is affecting the ability of the lungs to provide oxygen for the bloodstream?

In patients with pneumonia that presents as cloudy areas in the lungs on medical scans, the lung tissue is irritated and swollen, and those patients typically require ventilation to ensure enough oxygen is in their systems. However, those with low oxygen levels in their blood but clear lung scans may be dealing with an entirely different aspect of the virus.

Dr. Luciano Gattinoni of the University of Gottingen in Germany believes that the damage the virus is doing in these cases is confined to the blood vessels in the lungs. As Dr. Gattinoni explains in a recent editorial published in Intensive Care Medicine, when lungs sustain damage the blood vessels in those areas shut down so that the healthy areas of the lungs can receive the bulk of the blood flow and maintain blood-oxygen levels.

In coronavirus patients, Dr. Gattinoni believes that the blood vessels in the damaged areas of the lungs aren’t shutting down as they normally would. Instead, they continue to push blood through areas of the lungs that aren’t functioning properly. On a scan, it appears that the lungs are working fine, but the blood flowing through the damaged areas isn’t actually being oxygenated, and the patient begins to suffer from low blood-oxygen levels.

At this point, the doctor’s theory remains unproven, but as we begin to learn more about how this particular virus affects humans, this will be one area where knowledge could save many lives.