COVID-19 pneumonia

Case contributed by Dr Joachim Feger

Presentation

Admitted with choledocholithiasis. COVID-19 contact. SARS-CoV-2 negative PCR on admission. Three days later cough and fever.

Patient Data

Age: 70 years
Gender: Male
CT

low dose thoracic CT - day 3

Findings – day 3:

  • coronary sclerosis, mild aortic sclerosis
  • no significant mediastinal lymphadenopathy
  • two small areas of ground-glass opacity (GGO) in the posterior segment of the right upper lobe just above the fissures and in the upper segment of the left lower lobe
  • dilated intrahepatic and extrahepatic bile ducts

Impression:

  1. Findings are suggestive of COVID-19 pneumonia.
  2. Biliary obstruction.
CT

low dose thoracic CT - day 15

Findings – day 15:

  • endotracheal tube and right jugular central catheter in place
  • extensive crazy paving pattern with a central and peripheral distribution
  • extensive pulmonary consolidations more basal and peripheral
  • some mediastinal lymph nodes
  • small bilateral pleural effusions
  • status post biliary stent with some residual bile duct dilatation
Annotated image

Key findings:

  • two small areas of ground-glass opacity (GGO) on day 3
  • extensive crazy-paving pattern (red arrowhead) and consolidations (blue arrowheads) and bilateral pleural effusions (red measurement) on day 15

Case Discussion

A second real-time reverse transcriptase-polymerase chain reaction (PCR) test of the pharyngeal flora just after the first CT was positive for SARS-CoV-2 virus RNA. The patient received ERCP and biliary stent placement because of his biliary obstruction.

Subsequent real-time polymerase chain reaction (PCR) tests on day 12 and 15 were also positive.

This case illustrates a progressive course of COVID-19 pneumonia:

In the second CT, there are also bilateral pleural effusions and some mediastinal lymphadenopathy present, although this is rather atypical for COVID-19 pneumonia.

PlayAdd to Share

Case information

rID: 76307
Published: 19th Apr 2020
Last edited: 3rd May 2020
System: Chest
Inclusion in quiz mode: Included

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.