Presentation
Admitted early March 2020, somewhere in the middle of nowhere in Germany with fever, dry cough and pleuritic pain, hypoxia, and hypocapnia.
Patient Data
Mildly increased cardiothoracic ratio (CTR): 52%.
Patchy, bilateral infiltrates, and airspace opacification predominantly in the mid and lower lung zones.
No visible pleural effusions.
Quality: suboptimal inspiration
Findings:
- normal contrast in the pulmonary arteries, coronary artery calcification
- no significant mediastinal lymphadenopathy
- bilateral irregular consolidations along the bronchovascular bundles in the lower lobes and middle lobe, with air bronchograms
- extensive patchy bilateral ground-glass opacities (GGO) with small consolidations again along and around the bronchovasular bundles and bronchial wall thickening
Impression:
Bilateral ground-glass opacities (GGO) and consolidations suggestive of atypical pneumonia.
Key findings:
- irregular areas of consolidation along the bronchovascular bundles pronounced in middle and lower lobes (arrows)
- diffuse ground-glass opacities again along and around the broncho-vascular bundles (red arrowheads), areas with interlobar thickening (blue arrowheads), and bronchial wall thickening (orange arrows)
- combinations of ground-glass opacities and consolidation (blue arrows)
Case Discussion
This case illustrates and shows the most common findings of influenza A pneumonia a combination of multifocal ground-glass opacities (GGO) and irregular consolidations, mainly along and around the bronchovascular bundles.
Real-time polymerase chain reaction (PCR) after respiratory swab was positive for influenza A virus RNA.
The patient was put under isolation and received supportive and antiviral therapy (oseltamivir) and an antibiotic regimen covering gram-positive cocci for 7 days. After a hospital course of 8 days, the patient recovered and was released home in a vastly improved condition.
Outpatient follow-up CT, three weeks later, was normal and showed complete resolution of the ground glass opacities and consolidations.
This is also an important differential diagnosis for COVID-19 pneumonia.
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