COVID-19 pneumonia - rapidly progressive

Case contributed by Dr Edgar Lorente

Presentation

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

X-ray

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

12 hours later

X-ray

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

Three days later

X-ray

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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