COVID-19 pneumonia

Case contributed by Joachim Feger


Admitted with choledocholithiasis. COVID-19 contact. SARS-CoV-2 negative PCR on admission. Three days later cough and fever.

Patient Data

Age: 70 years
Gender: Male

low dose thoracic CT - day 3


Findings – day 3:

  • coronary sclerosis, mild aortic sclerosis
  • no significant mediastinal lymphadenopathy
  • two small areas of ground-glass opacity (GGO) in the posterior segment of the right upper lobe just above the fissures and in the upper segment of the left lower lobe
  • dilated intrahepatic and extrahepatic bile ducts


  1. Findings are suggestive of COVID-19 pneumonia.
  2. Biliary obstruction.

low dose thoracic CT - day 15


Findings – day 15:

  • endotracheal tube and right jugular central catheter in place
  • extensive crazy paving pattern with a central and peripheral distribution
  • extensive pulmonary consolidations more basal and peripheral
  • some mediastinal lymph nodes
  • small bilateral pleural effusions
  • status post biliary stent with some residual bile duct dilatation
Annotated image

Key findings:

  • two small areas of ground-glass opacity on day 3
  • extensive crazy-paving pattern (red arrowhead) and consolidations (blue arrowheads) and bilateral pleural effusions (red measurement) on day 15

Case Discussion

A second real-time reverse transcriptase-polymerase chain reaction (PCR) test of the pharyngeal flora just after the first CT was positive for SARS-CoV-2 virus RNA. The patient received ERCP and biliary stent placement because of his biliary obstruction.

Subsequent real-time polymerase chain reaction (PCR) tests on days 12 and 15 were also positive.

This case illustrates a progressive course of COVID-19 pneumonia:

In the second CT, there are also bilateral pleural effusions and some mediastinal lymphadenopathy present, although this is rather atypical for COVID-19 pneumonia.

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.