Presentation
Worsening dyspnea. Past history of COPD. T2DM. Previous pancreatectomy. ETOH excess. Lymphopenia on admission.
Patient Data
Chest radiograph on admission demonstrates bilateral, almost symmetrical areas of peripheral consolidation with perihilar infiltrates and an indistinct left heart border. In an endemic area, appearances are highly suggestive of COVID-19.
The patient underwent a CTPA three days later for subsequent deterioration with hypoxia.
Single slice axial acquisition in the lung windows demonstrates 'classical' appearances of subpleural organizing areas of consolidation with patchy peripheral ground-glass opacities.
Appearances represent a severe case of COVID-19 pneumonia.
Case Discussion
An elderly patient with multiple co-morbidities.
Chest radiograph suspicious of COVID-19, which was later PCR confirmed.
Peripheral predominance and progression to organizing pneumonia are currently a well-recognized finding in COVID-19.
In cases of clinical deterioration where other causes are thought likely (such as a pulmonary embolus), CT imaging is indicated. Otherwise, chest radiographs are thought appropriate to monitor progress.
Lymphopenia on admission may increase the pre-test probability in COVID-19.
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