COVID-19 pneumonia

Case contributed by Antonio Rodrigues de Aguiar Neto


This patient presented in the ER with headache, fever, asthenia, myalgia, vomiting, dry cough, respiratory distress, and low arterial oxygen saturation starting three days ago.

Patient Data

Age: 60 years
Gender: Female

Day three from symptoms onset


CT shows Bilateral sparse round areas of ground-glass opacities, predominating in a peripheral distribution, with no evidence of crazy-paving or airspace consolidating foci.

This patient tested positive RT-PCR test results for SARS-CoV-2, and the CT findings are typical of the initial stage (stage 1) for COVID-19 pneumonia.

Day six from symptoms onset


Follow-up CT images demonstrate a prominent pulmonary involvement progression, with increased size and density of the ground-glass opacities affecting both lungs, with interlobular septal thickening and a crazy-paving pattern. There are also small foci of consolidations starting to emerge.

These are CT imaging findings suggestive of COVID-19 pneumonia in the progressive stage (stage 2).

Day fifteen from symptoms onset


The CT reveals more consolidative opacities concerning the ground-glass compared to the previous examination. There are some subpleural parenchymal bands.

CT findings indicate the transition from the end of the peak stage (stage 3) to the beginning of the late/absorption stage (stage 4) in the evolution of COVID-19 pneumonia.

Day twenty-two from symptoms onset


CT shows improvement in the consolidations and ground-glass opacities, with some residual lesions and subpleural parenchymal bands in both lungs, usually found at the late/absorption stage (stage 4).

Case Discussion

Covid-19 is caused by the SARS-CoV-2 1-6. The four temporal stages of lung CT findings are early/initial stage (0-5 days after symptom onset), with normal findings or ground-glass opacities (GGOs). The progressive stage (5-8 days) shows an increase in the GGOs and crazy-paving pattern. Peak stage (9-13 days), with prevalent consolidations. The late/absorption stage (> 14 days) reveals subpleural parenchymal bands and the gradual resolution of the consolidations/GGOs 1-6

This patient had confirmatory laboratory testing for SARS-CoV-2, with follow-up chest CT illustrating the temporal features of COVID-19 pneumonia.

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