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<p class="first" id="d195155e290"> <b>Aims:</b> During the COVID-19 epidemic, chest computed tomography (CT) has been highly recommended for screening of patients with suspected COVID-19 because of an unclear contact history, overlapping clinical features, and an overwhelmed health system. However, there has not been a full comparison of CT for diagnosis of heart failure or COVID-19 pneumonia. </p><p id="d195155e295"> <b>Methods:</b> Patients with heart failure ( <i>n</i>=23) or COVID-19 pneumonia ( <i>n</i>=23) and one patient with both diseases were retrospectively enrolled. Clinical information and chest CT images were obtained and analyzed. </p><p id="d195155e306"> <b>Results:</b> There was no difference in ground-glass opacity, consolidation, crazy paving pattern, the lobes affected, and septal thickening between heart failure and COVID-19 pneumonia. However, a less rounded morphology (4% vs. 70%, P=0.00092), more peribronchovascular thickening (70% vs. 35%, P=0.018) and fissural thickening (43% vs. 4%, P=0.002), and less peripheral distribution (30% vs. 87%, P=0.00085) were found in the heart failure group than in the COVID-19 group. Importantly, there were also more patients with upper pulmonary vein enlargement (61% vs. 4%, P=0.00087), subpleural effusion (50% vs. 0%, P=0.00058), and cardiac enlargement (61% vs. 4%, P=0.00075) in the heart failure group than in the COVID-19 group. Besides, more fibrous lesions were found in the COVID-19 group, although there was no statistical difference (22% vs. 4%, P=0.080). </p><p id="d195155e311"> <b>Conclusions:</b> Although there is some overlap of CT features between heart failure and COVID-19, CT is still a useful tool for differentiating COVID-19 pneumonia. </p>