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COVID-19 pneumonia

Case contributed by Roma Patel
Diagnosis certain

Presentation

Patient presented with pyrexia and dyspnea. Past medical history of hypertension, GERD, and asthma. Lymphopenia on admission.

Patient Data

Age: 60 years
Gender: Male

At presentation

x-ray

Subtle bilateral peripheral air space opacification predominantly in the right upper and both mid zones. No pleural effusions.

Hiatus hernia.

Day 8 clinical deterioration

x-ray

Radiological progression with dense peripheral right upper lobe consolidation. Peripheral areas of air space opacification in the left hemithorax are also now more conspicuous. 

The nasogastric tube is inappropriately positioned in the esophagus requiring resiting. 

Case Discussion

This case demonstrates the rapid progression of radiological findings from a mild to severe spectrum. Peripheral predominance is a highly reported finding of COVID-19 pneumonia. The pattern of progression in correlation with viral PCR was diagnostic of COVID-19 pneumonia. 

The initial radiograph could be considered 'equivocal' however appearances were confirmed with positive PCR analysis. Equivocal cases can be investigated further with chest CT imaging in the absence of a positive PCR. 

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