COVID-19 pneumonia - rapidly progressive

Case contributed by Edgar Lorente
Diagnosis certain


Fever and odynophagia. Trip to Italy 7 days ago. Low oxygen saturation (SpO2 89%) and lymphopenia were observed. The patient presented clinical worsening during his stay in the emergency department, and radiological control was performed at 12 hours. SARS-CoV-2 RNA was detected.

Patient Data

Age: 60 years
Gender: Male

On admission


Faint, ill-defined alveolar consolidations in both upper lobes.

12 hours later


Radiological worsening with patchy, bilateral alveolar consolidations with panlobar opacities, suggesting ARDS secondary to COVID19.

Three days later


Radiological stability, with slight improvement of the alveolar consolidation in right lower lobe. The patient still needs supportive care measures.

Case Discussion

SARS-CoV-2 infection (COVID-19) can lead to rapidly progressive ARDS as shown in this case. The prognosis is poor and radiologic findings can go from ill-defined alveolar consolidations to bilateral consolidations with panlobar changes as seen in ARDS.

Radiographic and computed tomography (CT) imaging early in the disease course may be normal; chest CT has been described as more sensitive than chest x-ray for the detection of characteristic bilateral, peripherally-predominant ground-glass opacities. However, the patient's clinical situation often does not allow a CT scan.

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