Presentation
Three day history of productive cough, fever and generalized malaise in a high-risk unvaccinated patient.
Patient Data
Multiple bilateral peripherally positioned predominantly lower zone fluffy airspace opacities are consistent with COVID related disease. The heart size is upper limits normal with a dual lead left-sided pacemaker. There is no evidence for pneumothorax.
Diffuse pulmonary infiltrates in a peripheral and bilateral symmetric distribution is again evident, this mimics the x-ray is consistent given the history of COVID related pneumonitis.
Case Discussion
This 60-year-old unvaccinated Indigenous patient presented with respiratory symptoms and fever. COVID-19 PCR test was positive. She had increased work of breathing and an ongoing oxygen requirement which prompted treatment with systemic corticosteroids and Barcitinib (JAK-inhibitor). She was further treated with ceftriaxone and doxycycline empirically for suspected super-imposed community-acquired bacterial pneumonia.
The typical CT findings of COVID-19 are bilateral and peripheral predominant ground-glass opacities. Imaging findings peak 9-13 days after infection. Importantly, CT scan may be normal in an infected patient, particularly early in the disease. The probability that CT findings represent COVID-19, however, depends largely on the pretest probability of infection, which is in turn defined by community prevalence of infection.