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COVID-19 pneumonia mimicking CHF

Case contributed by Dr Balint Botz

Presentation

DM, hypertension, congestive heart failure, chronic kidney disease. Worsening dyspnea and leg swelling for one week, but no cough, or fever. SpO2 98% upon presentation. Signs of heart failure? Pleural effusion?

Patient Data

Age: 70 years
X-ray
  • enlarged heart with blurred margins
  • diffuse, bilateral, inhomogeneous airspace opacities, which do not show a perihilar predominance. Resultant aerobronchograms. 

Case Discussion

Considering the known chronic heart disease, and multiple other comorbidities, as well as the symptoms heart failure and resultant pulmonary edema could be on the list of differentials. However the absence of a perihilar predominance and the patchy distribution of airspace opacities also raises the possibility of diffuse pneumonia, including COVID-19 infection. This patient (although afebrile and without a cough) had a very high CRP and consequently tested positive for SARS-CoV-2 by RT-PCR.

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Case information

rID: 75971
Published: 10th Apr 2020
Last edited: 21st Mar 2021
System: Chest
Inclusion in quiz mode: Included
Institution: University of Pécs

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