Diagnosis challenge of suspected COVID-19 pneumonia in cancer patients with radiation-induced pneumonitis

Abstract Background During the outbreak period of COVID-19 pneumonia, cancer patients have been neglected and in greater danger. Furthermore, the differential diagnosis between COVID-19 pneumonia and radiation pneumonitis in caner patients remains a challenge. The study aimed to determine their clinical presentations and radiological features to familiarize radiologists and clinical teams with them in order to early diagnosis and prompt early patient isolation.Methods From January 21, 2019 to February 18, 2020, the patients selected consecutively met the following criteria: (i) presumed COVID-19 pneumonia; (ii) patients with a history of malignancy and lung exposure to ionizing radiation. A retrospective analysis including all patients’ presenting was performed.Results 4 patients from 112 suspected individals were selected, including 2 males and 2 females with a median age of 54 years (39–64 years). After repeated pharyngeal swab nucleic acid tests, 1 case was confirmed and 3 cases were excluded from COVID-19 pneumonia.Conclusions Despite the comparable morphologic characteristics of lung CT imaging, the location, extent, and distribution of lung lesions between COVID-19 pneumonia and radiation pneumonitis differ significantly, further combined with clinical and laboratory findings that could facilitate early diagnosis and appropriate management.