COMPUTED TOMOGRAPHY ASSESSMENT OF LUNG INVOLVEMENT IN PATIENTS WITH ACUTE RESPIRATORY INFECTION: CORRELATION WITH CLINICAL SEVERITY AND RELEVANCE TO KHYBER PAKHTUNKHWA, PAKISTAN — A NARRATIVE REVIEW

Abstract

The 2026 US-Iran ceasefire is a crucial geopolitical event that caught the Background: Acute respiratory infections (ARIs) remain an important cause of morbidity and mortality worldwide and represent a substantial clinical burden in Pakistan. Chest computed tomography (CT) provides detailed assessment of pulmonary parenchymal abnormalities and can demonstrate the extent and distribution of lung involvement in patients with respiratory infections. Several studies, particularly those conducted during the COVID-19 pandemic, have investigated the relationship between CT abnormalities, CT severity scores, and clinical disease severity. However, evidence specifically relevant to the population of Khyber Pakhtunkhwa (KPK), Pakistan, remains limited. To review and synthesize the published literature regarding the role of chest CT in assessing pulmonary involvement in patients with acute respiratory infections, and to examine the reported relationship between CT findings, CT severity scores, and clinical severity, with particular emphasis on the relevance of available evidence to Khyber Pakhtunkhwa, Pakistan.

Methods: A narrative review of published literature was undertaken using major biomedical databases and scholarly sources, including PubMed/MEDLINE, Scopus, and Google Scholar. Literature concerning chest CT findings in acute respiratory infections, CT severity scoring systems, and clinical outcomes was reviewed, with particular attention to literature from Pakistan and, where available, KPK.

Results: Ground-glass opacity and consolidation were the most frequently reported abnormalities, with bilateral, peripheral, and multilobar involvement commonly described in viral pneumonia. Higher CT severity scores were consistently associated with greater clinical severity and adverse outcomes across international and Pakistani cohorts. A tertiary-care study of 500 patients from Rawalpindi identified a CT severity score threshold of 18.5 for severe COVID-19 (sensitivity 84.3%, specificity 92.5%), and pooled meta-analytic data indicated moderate-to-good prognostic accuracy of CT severity scores for mortality (pooled sensitivity ~67%, specificity ~79%, summary ROC area ~0.82). No study identified in this review originated specifically from Khyber Pakhtunkhwa.

Conclusion: Chest CT is a valuable adjunctive tool for evaluating the extent of pulmonary involvement and stratifying risk in patients with acute respiratory infections, but findings are non-specific and must be interpreted alongside clinical and laboratory data. A clear regional research gap exists for KPK, and prospective, locally validated studies are needed before existing CT severity thresholds can be applied to this population.