COVID-19 pneumonia

Case contributed by Joachim Feger


Recent onset of dry cough, severe dyspnea, fever and fatigue.

Patient Data

Age: 85 years
Gender: Male

Low dose thoracic CT



Quality: no artefacts

coronary sclerosis, mild aortic sclerosis

no significant mediastinal lymphadenopathy

Pulmonary findings:

  • extensive patchy bilateral multi-lobar ground-glass opacities (GGO)
  • predominantly peripheral distribution in the left lung, peripheral and central distribution in the right lung
  • partial consolidations along the bronchovasular bundles surrounded by ground-glass opacities (GGO)
  • superimposed inter-and intralobular septal thickening (crazy-paving pattern) in the right lower lobe
  • bilateral vascular dilatation

Additional findings:

  • pulmonary nodule (18mm) in the anteromedial segment of the left lower lobe
  • no pleural effusions


Findings are compatible with atypical pneumonia.

In view of the patient's symptoms and the current COVID-19 pandemic, this is indicative of COVID-19 pneumonia.

Annotated image

Key findings:

  • extensive ground-glass opacities (GGO) with bilateral and multi-lobar distribution
  • crazy paving pattern (red arrows)
  • combination of consolidations and surrounding ground-glass opacities also referred to as "Halo sign" (blue arrows)
  • vascular dilatation (green arrows)
  • fibrous bands or streaks (yellow arrow)
  • air bronchogram (orange arrows)

Case Discussion

This case illustrates a spectrum of findings in COVID-19 pneumonia:

  • extensive ground-glass opacities (GGO)
  • bilateral and multi-lobar distribution
  • crazy-paving pattern
  • combination of ground-glass opacities and consolidation

Real-time polymerase chain reaction (PCR) after pharyngeal swab was positive for SARS-CoV-2 virus RNA.

The patient has been put under isolation and referred to the intensive care unit (ICU).

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