Nsar Jamal Abdalla a, Kosar Mohamed Ali b, and Kamaran Amin Karadakhy b

a Kurdistan Respiratory Medicine Board Candidate, Shahid Hemn Hospital, Kurdistan Region, Iraq.

b College of Medicine, University of Sulaimani, Kurdistan Region, Iraq.

Submitted: 27/5/2022; Accepted: 21/10/2022; Published: 21/12/2022

DOI Link: https://doi.org/10.17656/jsmc.10382 



COVID-19 has been linked to a wide range of long-term respiratory consequences after the initial illness, both clinically and radiologically..


To find the prevalence of post covid respiratory complications and their relation with HRCT findings after six months from infection. 

Material and Methods

This cohort study was conducted in different Sulaimani city’s COVID-19 centers from September 1st to November 30, 2021; a total of 100 patients (65 male and 35 female), a mean age of 45.5 (18-91 years old) were randomly collected. All patients had High-Resolution CT during acute infection, followed by second HRCT 6 months after the initial infection.


Among 100 cases in the study, 64% of the patients have one or more chest symptoms, particularly cough (40%) and dyspnea (31%). Regardless of the age and comorbid illnesses, cough and chest tightness are predominantly found among female patients; moderately infected patients are more prone to have post-COVID symptoms than others (p-value 0.003 except for hemoptysis was 0.013). Concerning HRCT findings most common initial HRCT findings were ground glass opacity at 100%, consolidation49%, and reticulation at 46%, while on the follow-up scan, reticulation was the predominant finding at 44%. In addition, a significant correlation was found between cough and dyspnea with consolidation, crazy paving, and reticulation (p-value <0.001).


Cough and dyspnea are predominant features after six months and significantly correlate with HRCT findings of consolidation, crazy paving, and reticulation during active disease; smoking is not a risk factor for pulmonary complications.


SARS-Nov-2, high-resolution CT scan, ground glass opacity, reticulation.


1. Tenforde MW, Kim SS, Lindsell CJ, Billig Rose E, Shapiro NI, Files DC, Gibbs KW, Erickson HL, Steingrub JS, Smithline HA, et al: Symptom Duration and Risk Factors for Delayed Return to Usual Health Among Outpatients with COVID-19 in a Multistate Health Care Systems Network - United States, March-June 2020. MMWR Morb Mortal Wkly Rep 2020, 69:993-998.

2. Lopez-Leon S, Wegman-Ostrosky T: More than 50 Long-term effects of COVID-19: a systematic review and meta-analysis. 2021.

3. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, Zhang L, Fan G, Xu J, Gu X, et al: Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020, 395:497-506.

4. Menni C, Valdes AM: Real-time tracking of self-reported symptoms to predict potential COVID-19. 2020, 26:1037-1040.

5. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, Xiang J, Wang Y, Song B, Gu X, et al.: Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020, 395:1054-1062.

6. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, Liu L, Shan H, Lei CL, Hui DSC, et al: Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med 2020, 382:1708-1720.

7. Song WJ, Hui CKM, Hull JH, Birring SS, McGarvey L, Mazzone SB, Chung KF: Confronting COVID-19-associated cough and the post-COVID syndrome: role of viral neurotropism, neuroinflammation, and neuroimmune responses. Lancet Respir Med 2021, 9:533-544.

8. Stavem K, Ghanima W, Olsen MK, Gilboe HM, Einvik G: Persistent symptoms 1.5-6 months after COVID-19 in non-hospitalised subjects: a population-based cohort study. Thorax 2021, 76:405-407.

9. Petersen MS, Kristiansen MF, Hanusson KD, Danielsen ME, B ÁS, Gaini S, Strøm M, Weihe P: Long COVID in the Faroe Islands: A Longitudinal Study Among Nonhospitalized Patients. Clin Infect Dis 2021, 73:e4058-e4063.

10. Mandal S, Barnett J, Brill SE, Brown JS: 'Long-COVID': a cross-sectional study of persisting symptoms, biomarker and imaging abnormalities following hospitalisation for COVID-19. 2021, 76:396-398.

11. Halpin SJ, McIvor C, Whyatt G, Adams A, Harvey O, McLean L, Walshaw C, Kemp S, Corrado J, Singh R, et al.: Postdischarge symptoms and rehabilitation needs in survivors of COVID-19 infection: A cross-sectional evaluation. 2021, 93:1013-1022.

12. Moradian ST, Parandeh A, Khalili R, Karimi L: Delayed Symptoms in Patients Recovered from COVID-19. Iran J Public Health 2020, 49:2120-2127.

13. Goërtz YMJ, Van Herck M, Delbressine JM, Vaes AW: Persistent symptoms 3 months after a SARS-CoV-2 infection: the post-COVID-19 syndrome? 2020, 6.

14. Cheng D, Calderwood C, Skyllberg E, Ainley A: Clinical characteristics and outcomes of adult patients admitted with COVID-19 in East London: a retrospective cohort analysis. BMJ Open Respir Res 2021, 8.

15. Zhao YM, Shang YM, Song WB, Li QQ, Xie H, Xu QF, Jia JL, Li LM, Mao HL, Zhou XM, et al.: Follow-up study of the pulmonary function and related physiological characteristics of COVID-19 survivors three months after recovery. EClinicalMedicine 2020, 25:100463.

16. Pan F, Ye T: Time Course of Lung Changes at Chest CT during Recovery from Coronavirus Disease 2019 (COVID-19). 2020, 295:715-721.

17. George PM, Barratt SL: Respiratory follow-up of patients with COVID-19 pneumonia. 2020, 75:1009-1016.

18. Wu Q, Zhong L: A Follow-Up Study of Lung Function and Chest Computed Tomography at 6 Months after Discharge in Patients with Coronavirus Disease 2019. 2021, 2021:6692409.

19. Nair A, Bhat R, Aggarwal P: Multi-loculated pneumothorax post COVID-19 pneumonia. Vis J Emerg Med 2022, 26:101260.

20. George PM, Wells AU, Jenkins RG: Pulmonary fibrosis and COVID-19: the potential role for antifibrotic therapy. Lancet Respir Med 2020, 8:807-815.

21. Wei J, Yang H, Lei P, Fan B, Qiu Y, Zeng B, Yu P, Lv J, Jian Y, Wan C: Analysis of thin-section CT in patients with coronavirus disease (COVID-19) after hospital discharge. Journal of X-Ray Science and Technology 2020, 28:383-389.

22. Zhang T, Sun LX, Feng RE: [Comparison of clinical and pathological features between severe acute respiratory syndrome and coronavirus disease 2019]. Zhonghua Jie He He Hu Xi Za Zhi 2020, 43:496-502.

23. Carfì A, Bernabei R, Landi F, Group ftGAC-P-ACS: Persistent Symptoms in Patients After Acute COVID-19. JAMA 2020, 324:603-605.

24. Daher A, Balfanz P, Cornelissen C, Müller A, Bergs I, Marx N, Müller-Wieland D, Hartmann B, Dreher M, Müller T: Follow-up of patients with severe coronavirus disease 2019 (COVID-19): Pulmonary and extrapulmonary disease sequelae. Respir Med 2020, 174:106197.

25. Chopra V, Flanders SA, O’Malley M, Malani AN, Prescott HC: Sixty-day outcomes among patients hospitalised with COVID-19. Annals of Internal Medicine 2021, 174:576-578.

26. Garrigues E, Janvier P, Kherabi Y, Le Bot A, Hamon A, Gouze H, Doucet L, Berkani S, Oliosi E, Mallart E, et al.: Post-discharge persistent symptoms and health-related quality of life after hospitalisation for COVID-19. J Infect 2020, 81:e4-e6.

27. Ryerson CJ: Eur Respir J.

28. Carfì A, Bernabei R, Landi F: Persistent Symptoms in Patients After Acute COVID-19. Jama 2020, 324:603-605.

29. D'Cruz RF, Waller MD: Chest radiography is a poor predictor of respiratory symptoms and functional impairment in survivors of severe COVID-19 pneumonia. 2021, 7.

30. Arnold DT, Hamilton FW, Milne A, Morley AJ, Viner J, Attwood M, Noel A, Gunning S, Hatrick J, Hamilton S, et al.: Patient outcomes after hospitalisation with COVID-19 and implications for follow-up: results from a prospective UK cohort. 2021, 76:399-401.

31. Xiong Q, Xu M, Li J, Liu Y, Zhang J, Xu Y, Dong W: Clinical sequelae of COVID-19 survivors in Wuhan, China: a single-centre longitudinal study. Clin Microbiol Infect 2021, 27:89-95.

32. Halpin SJ, McIvor C, Whyatt G, Adams A, Harvey O, McLean L, Walshaw C, Kemp S, Corrado J, Singh R: Postdischarge symptoms and rehabilitation needs in survivors of COVID-19 infection: a cross-sectional evaluation. Journal of medical virology 2021, 93:1013-1022.

33. Sonnweber T, Sahanic S, Pizzini A: Cardiopulmonary recovery after COVID-19: an observational prospective multicentre trial. 2021, 57.

34. Huang C, Huang L, Wang Y, Li X, Ren L, Gu X, Kang L, Guo L, Liu M, Zhou X: 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. The Lancet 2021, 397:220-232.

35. Petersen MS, Kristiansen MF, Hanusson KD, Danielsen ME, á Steig B, Gaini S, Strøm M, Weihe P: Long COVID in the Faroe Islands: a longitudinal study among nonhospitalised patients. Clinical Infectious Diseases 2021, 73:e4058-e4063.

36. Vijayakumar B, Tonkin J: CT Lung Abnormalities after COVID-19 at 3 Months and 1 Year after Hospital Discharge. 2021:211746.

37. Liang L, Yang B: Three-month Follow-up Study of Survivors of Coronavirus Disease 2019 after Discharge. 2020, 35:e418.

38. Myall KJ, Mukherjee B, Castanheira AM, Lam JL, Benedetti G, Mak SM, Preston R, Thillai M, Dewar A, Molyneaux PL, West AG: Persistent Post-COVID-19 Interstitial Lung Disease. An Observational Study of Corticosteroid Treatment. Ann Am Thorac Soc 2021, 18:799-806.

39. Augustin M, Schommers P, Stecher M, Dewald F, Gieselmann L, Gruell H, Horn C, Vanshylla K, Cristanziano VD, Osebold L, et al: Post-COVID syndrome in non-hospitalised patients with COVID-19: a longitudinal prospective cohort study. Lancet Reg Health Eur 2021, 6:100122.

40. McElvaney OJ, McEvoy NL, McElvaney OF, Carroll TP, Murphy MP, Dunlea DM, O NC, Clarke J, O'Connor E, Hogan G, et al: Characterization of the Inflammatory Response to Severe COVID-19 Illness. Am J Respir Crit Care Med 2020, 202:812-821.

41. Huang C, Huang L, Wang Y, Li X, Ren L, Gu X, Kang L, Guo L, Liu M, Zhou X, et al: 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. Lancet 2021, 397:220-232.

42. Bai F, Tomasoni D, Falcinella C, Barbanotti D, Castoldi R, Mulè G, Augello M, Mondatore D, Allegrini M, Cona A, et al: Female gender is associated with long COVID syndrome: a prospective cohort study. Clin Microbiol Infect 2021.

43. Carvalho-Schneider C, Laurent E, Lemaignen A, Beaufils E, Bourbao-Tournois C, Laribi S, Flament T, Ferreira-Maldent N, Bruyère F, Stefic K, et al: Follow-up of adults with noncritical COVID-19 two months after symptom onset. Clin Microbiol Infect 2021, 27:258-263.

44. Cares-Marambio K, Montenegro-Jiménez Y, Torres-Castro R, Vera-Uribe R, Torralba Y, Alsina-Restoy X, Vasconcello-Castillo L, Vilaró J: Prevalence of potential respiratory symptoms in survivors of hospital admission after coronavirus disease 2019 (COVID-19): a systematic review and meta-analysis. Chronic respiratory disease 2021, 18:14799731211002240.

45. Ahmad MS, Shaik RA, Ahmad RK, Yusuf M, Khan M, Almutairi AB, Alghuyaythat WKZ, Almutairi SB: "LONG COVID": an insight. Eur Rev Med Pharmacol Sci 2021, 25:5561-5577.

46. Jiang F, Deng L, Zhang L, Cai Y, Cheung CW, Xia Z: Review of the Clinical Characteristics of Coronavirus Disease 2019 (COVID-19). J Gen Intern Med 2020, 35:1545-1549.

47. Rana G, Gautam S, Mawari G, Daga MK, Kumar N, Raghu RV: Massive hemoptysis causing mortality in a post COVID-19 infected Asian male patient: Presenting as pulmonary mucormycosis, pulmonary tuberculosis and later sino-nasal mucormycosis. Respir Med Case Rep 2021, 34:101511.

48. Yong SJ: Long COVID or post-COVID-19 syndrome: putative pathophysiology, risk factors, and treatments. Infect Dis (Lond) 2021, 53:737-754.

49. Xiong Y, Sun D, Liu Y, Fan Y, Zhao L, Li X, Zhu W: Clinical and High-Resolution CT Features of the COVID-19 Infection: Comparison of the Initial and Follow-up Changes. Invest Radiol 2020, 55:332-339.

50. Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S, Huang H, Zhang L, Zhou X, Du C, et al: Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China. JAMA Intern Med 2020, 180:934-943.

51. Burnham EL, Janssen WJ, Riches DW, Moss M, Downey GP: The fibroproliferative response in acute respiratory distress syndrome: mechanisms and clinical significance. Eur Respir J 2014, 43:276-285.

52. Liu C, Ye L, Xia R, Zheng X, Yuan C, Wang Z, Lin R, Shi D, Gao Y, Yao J, et al: Chest Computed Tomography and Clinical Follow-Up of Discharged Patients with COVID-19 in Wenzhou City, Zhejiang, China. Ann Am Thorac Soc 2020, 17:1231-1237.

53. Han X, Fan Y, Alwalid O: Six-month Follow-up Chest CT Findings after Severe COVID-19 Pneumonia. 2021, 299:E177-e186.

54. Pan F, Ye T, Sun P, Gui S, Liang B, Li L, Zheng D, Wang J, Hesketh RL, Yang L: Time course of lung changes at chest CT during recovery from coronavirus disease 2019 (COVID-19). Radiology 2020, 295:715-721.

55. Koo HJ, Lim S, Choe J, Choi SH, Sung H, Do KH: Radiographic and CT Features of Viral Pneumonia. Radiographics 2018, 38:719-739.

56. Zoumot Z, Bonilla MF, Wahla AS, Shafiq I, Uzbeck M, El-Lababidi RM, Hamed F, Abuzakouk M, ElKaissi M: Pulmonary cavitation: an under-recognized late complication of severe COVID-19 lung disease. BMC Pulm Med 2021, 21:24.

57. Amaral LTW, Beraldo GL, Brito VM, Rosa MEE, Matos MJR, Fonseca E, Yokoo P, Silva MMA, Teles G, Shoji H, et al: Lung cavitation in COVID-19: co-infection complication or rare evolution? Einstein (Sao Paulo) 2020, 18:eAI5822.

58. Selvaraj DSS, Ommen AG, Ebenezer J: Coronoidoplasty in TMJ ankylosis treatment. BMJ Case Rep 2020, 13.

59. Xu Z, Pan A, Zhou H: Rare CT feature in a COVID-19 patient: cavitation. Diagnostic and Interventional Radiology 2020, 26:380.

60. Shan S, Guangming L, Wei L, Xuedong Y: Spontaneous pneumomediastinum, pneumothorax and subcutaneous emphysema in COVID-19: case report and literature review. Rev Inst Med Trop Sao Paulo 2020, 62:e76.

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