Article ; Online: Atypical Chest Computed Tomography Finding of Predominant Interstitial Thickening in a Patient with Coronavirus Disease 2019 (COVID-19) Pneumonia.
The American journal of case reports
2020 Volume 21, Page(s) e926781
Abstract: BACKGROUND Coronavirus disease 2019 (COVID-19) is caused by a novel coronavirus, SARS-CoV-2, and is associated with severe respiratory disease. There are extensive publications on the chest computed tomography (CT) findings of COVID-19 pneumonia, with ... ...
| Abstract | BACKGROUND Coronavirus disease 2019 (COVID-19) is caused by a novel coronavirus, SARS-CoV-2, and is associated with severe respiratory disease. There are extensive publications on the chest computed tomography (CT) findings of COVID-19 pneumonia, with ground-glass opacities (GGO) and mixed GGO and consolidation being the most common findings. Those with interstitial thickening manifesting as reticular opacities typically show superimposed ground-glass opacities, giving a crazy-paving pattern. CASE REPORT We report the case of a 77-year-old man with a background of asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) who presented with progressive cough and shortness of breath for 2 days. He was in close contact with a confirmed COVID-19 case. Reverse-transcription polymerase chain reaction analysis of a nasopharyngeal swab was positive for SARS-CoV-2. The initial chest radiograph was negative for lung consolidation and ground-glass opacities. During admission, he had worsening shortness of breath with desaturation, prompting a chest CT examination, which was performed on day 14 of illness. The chest CT revealed an atypical finding of predominant focal subpleural interstitial thickening in the right lower lobe. He was provided supportive treatment along with steroid and antibiotics. He recovered well and subsequently tested negative for 2 consecutive swabs. He was discharged after 34 days. CONCLUSIONS Interstitial thickening or reticular pattern on CT has been described in COVID-19 pneumonia, but largely in association with ground-glass opacity or consolidation. This case demonstrates an atypical predominance of interstitial thickening on chest CT in COVID-19 pneumonia on day 14 of illness, which is the expected time of greatest severity of the disease. |
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| MeSH term(s) | Adrenal Cortex Hormones/administration & dosage ; Aged ; Anti-Bacterial Agents/administration & dosage ; COVID-19 ; COVID-19 Testing ; Clinical Laboratory Techniques ; Contrast Media ; Coronavirus Infections/complications ; Coronavirus Infections/diagnosis ; Cough/diagnosis ; Cough/etiology ; Disease Progression ; Dyspnea/diagnosis ; Dyspnea/etiology ; Follow-Up Studies ; Humans ; Intensive Care Units ; Length of Stay ; Lung Diseases, Interstitial/complications ; Lung Diseases, Interstitial/diagnostic imaging ; Lung Diseases, Interstitial/therapy ; Male ; Multidetector Computed Tomography/methods ; Pandemics ; Pneumonia, Viral/complications ; Pneumonia, Viral/diagnosis ; Pneumonia, Viral/diagnostic imaging ; Radiographic Image Enhancement ; Risk Assessment ; Severe Acute Respiratory Syndrome/diagnostic imaging ; Severe Acute Respiratory Syndrome/virology ; Treatment Outcome |
| Chemical Substances | Adrenal Cortex Hormones ; Anti-Bacterial Agents ; Contrast Media |
| Keywords | covid19 |
| Language | English |
| Publishing date | 2020-09-21 |
| Publishing country | United States |
| Document type | Case Reports ; Journal Article |
| ZDB-ID | 2517183-5 |
| ISSN | 1941-5923 ; 1941-5923 |
| ISSN (online) | 1941-5923 |
| ISSN | 1941-5923 |
| DOI | 10.12659/AJCR.926781 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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