COVID-19 pneumonia - progression and regression

Case contributed by Dr Ian Bickle

Presentation

New oxygen demands and bibasal crepitations.

Patient Data

Age: 55 years
Gender: Male

Moderate amount of mid zone airspace opacification in both mid zones with a peripheral predominance.

Day 6: just stepped down from HDU. New oxygen requirements

X-ray

Extensive bilateral airspace opacification in both lungs, more pronounced on the right and with relative sparing of the left upper lobe.  The airspace opacification has a peripheral distribution.

No pleural effusions. 

 

Day 11: ITU admission

X-ray

Endotracheal tube, nasogastric tube and right internal jugular lines suitable sited.

Bilateral airspace opacification persists, but it has partially regressed since the prior radiograph.

Lines and tubes suitably sited.

Minor regression in the appearances of the lungs from the radiograph of 2 days earlier.

Day 20: increasing oxygen requirements

X-ray

Extubated.  Positive pressure ventilation mask in use.

Widespread bilateral airspace opacification in both lungs.  No longer is the distribution peripheral or sparing the apices.

No pleural effusions or lobar consolidation.

Extubated since the prior radiograph.

Partial regression of the diffuse lungs changes, however air bronchograms are now evident in both upper lobes.

Remarkable improvement in appearances since the radiograph 4 days earlier.    The current appearances of the lungs are nearly normal and better than the day 1 admission appearances.

Case Discussion

Serial chest radiographs over nearly a month since admission through HDU, ICU and back to the ward.

The progression of changes and subsequent regression is illustrated.

I would like to convey a special thanks to all the nurses, ward and ICU based medics, radiographers doing portable imaging and the infrastructure of the NHS for their brave endeavors in the treatment of all patients suffering from COVID-19.

This longitudinal illustration is to share with the global medical community in our united effort to treat patients with this disease, eventually developing treatments and a return to more conventional living. 

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.