COVID-19: case 68

Marta Brandani, Medico Radiologo, Ospedale Santa Maria alla Gruccia (Valdarno, Provincia di Arezzo)

77-years-old male admitted to ED for diarrhea, vomit and epigastralgia for 15 days.

Exposure to Covid-19 patient.

Medical history: HTA, polymyalgia rheumatica, Horton’s arteritis, ex-smoker.

Slight increase of LDH and CPR, lymphopenia.

Chest sonography: unremarkable

Chest radiography

The next morning: fever 39 C°, pO2 96% con O2 3 l/min. In the afternoon: EGA in O2 3l/min (PH 7.49, pO2 80.3, pCO2 31, satO2 95%, HCO3 24). Next check with ventimask 40%: PH 7.47, pO2 109, pCO2 35, satO2 97%, HCO3 25.

Chest sonography: bilateral interstitial disease with consolidations.

RT-PCR positive for SARS-CoV-2.




COVID-19: case 67

Michele Pietragalla , Letizia Vannucchi , Luca Carmignani , Andrea Pagliari , Claudia Calabresi, Giuseppe Alabiso , Silvia Rossi , Anna Talina Neri , Michele Trezzi , Massimo Di Pietro

SOC Radiodiagnostica Ospedale San Jacopo Pistoia
Reparto Malattie Infettive Ospedale San Jacopo Pistoia

83-year-old male patient admitted to the ED with cough and fever (39°C) for three days. Prior medical history: DM type 2, HTA, ex heavy-smoker.
pO2 95%, no leukopaenia, slight increase of CPR, LDH transaminase levels.

Chest ultrasound: bilateral interstitial engagement, basal consolidations with air broncogram and pleural effusion.

Chest radiography (supine):

bilateral pulmonary “ground-glass” opacities.

CT

Multiple and diffuse “ground-glass” opacities, predominantly in the mantellar regions of the lungs, with initial consolidations and “crazy paving” patterns.

RT-PCR was positive for SAR-CoV-2.

After 3 days of hospitalization, D-dimero was measured as a screening for Tolicizumab therapy, with very high values (17234 micrograms/ml). At the same time, the patient showed respiratory failure.
A CTA was performed for suspected pulmonary embolism.

Filling defects of segmental and subsegmental arteries of the lower lobes.

COVID patients have higher risk for pulmonary embolism:
Chen, Jianpu and Wang, Xiang and Zhang, Shutong and Liu, Bin and Wu, Xiaoqing and Wang, Yanfang and Wang, Xiaoqi and Yang, Ming and Sun, Jianqing and Xie, Yuanliang. Findings of Acute Pulmonary Embolism in COVID-19 Patients (3/1/2020). Available at SSRN: https://ssrn.com/abstract=3548771.




COVID-19: case 66

Izzo Andrea, D’Aversa Lucia, Cerimoniale Giuseppe, Mazzella Giuseppe, Pergoli Pericle, Faiola Eugenio Leone, Casale Lorenzo, Di Pastena Francesca 

U.O.C.  Diagnostica per immagini – Ospedale “Dono Svizzero” Formia DEA I livello– Asl Latina

71-year-old female
patient admitted to the ED with dyspnea and fever (39°C) for 3 days. Epidemiologic
risk for SARS-CoV-2 exposure.  Medical
history: COPD.

Dyspnea,
tachypnea, pO2 93%.

 RT-PCR on nasopharyngeal swab positive for
SARS-CoV-2.

Chest radiography:

Diffuse
interstitial markings and peripheral consolidations. Right pleural effusion.

The patient was hospitalized in a Covid-19 dedicated department with clinical improvement, as confirmed by CT scan performed 8 days after.

Small, blurred ground-glass opacities in the apicoposterior segment of the LUL and in the ML.  bilateral pleural effusion, more evident on the right. Emphysema.




COVID-19: case 65

Izzo Andrea, D’Aversa Lucia, Cerimoniale Giuseppe, Mazzella Giuseppe, Pergoli Pericle, Faiola Eugenio Leone, Casale Lorenzo, Di Pastena Francesca 

U.O.C.  Diagnostica per immagini – Ospedale “Dono Svizzero” Formia DEA I livello– Asl Latina

74-year-old male
patient presented to the ED with chest pain and vomiting for 12 hours. Medical
history: chronic myocardial ischemia, astma; in treatment with oral
anticoagulants. Epidemiologic risk for SARS-CoV-2 exposure. 

Medical
examination: dyspnea, tachypnea, no fever. pO2 94%.

Chest radiography:

Interstitial
markings with consolidation at the right basis and opacities in the upper and
medium lung regions.

Because of the
epidemiologic risk and chest findings, a CT is performed.

Multiple ground-glass opacities associated with areas of GGOs and reticulations in a “crazy-paving pattern”.  Consolidation at the right posterior base. Fibrotic bands at the left posterior base. Features consistent with Covid-19 pneumonia. RT-PCR test on nasopharyngeal swab was positive.




COVID-19: case 64

Izzo Andrea, D’Aversa Lucia, Cerimoniale Giuseppe, Mazzella Giuseppe, Pergoli Pericle, Faiola Eugenio Leone, Casale Lorenzo, Di Pastena Francesca 

U.O.C.  Diagnostica per immagini – Ospedale “Dono Svizzero” Formia DEA I livello– Asl Latina

57-year-old male
patient admitted to the ED with fever, cough and dyspnea for 3 days. No prior
medical history.  No epidemiologic risk
for SARS-CoV-2 exposure. 

Medical
examination: dyspnea, tachypnea, fever (39°C). pO2 90%.

Chest radiography:

Interstitial markings with opacities at the left base.

CT

Multiple
ground-glass opacities associated with scattered areas of GGOs and reticulations
in a “crazy-paving pattern” and consolidations.

Features were consistent
with Covid-19 pneumonia.

 RT-PCR on nasopharyngeal swab was positive.




COVID-19: case 63

Izzo Andrea, D’Aversa Lucia, Cerimoniale Giuseppe, Mazzella Giuseppe, Pergoli Pericle, Faiola Eugenio Leone, Casale Lorenzo, Di Pastena Francesca

U.O.C.  Diagnostica per immagini – Ospedale “Dono Svizzero” Formia DEA I livello– Asl Latina

49-year-old male
patient admitted to the ED with fever (39°C) and dyspnea for 4 days, in
treatment with antibiotics for 2 days. No prior medical history

Portable chest film (performed in a tent set up outside the ED):

slight interstitial markings w/o alveolar consolidations.

CT

Multiple
ground-glass opacities with predominant subpleural distribution in the RUL, in
the ML and in the lower lobes. The findings were consistent with Covid-19 pneumonia.

The RT-PCR test on nasopharyngeal swab turned positive.




COVID-19: case 62

Izzo Andrea, D’Aversa Lucia, Cerimoniale Giuseppe, Mazzella Giuseppe, Pergoli Pericle, Faiola Eugenio Leone, Casale Lorenzo, Di Pastena Francesca

U.O.C.  Diagnostica per immagini – Ospedale “Dono Svizzero” Formia DEA I livello– Asl Latina

56-year-old male patient presented to the ED with fever, anosmia, ageusia, pharyngalgia for 1 week. In self-isolation for Covid-19 positive contact. No prior medical history. Physical examination: no fever, pO2 97%.

CT

Ground-glass opacities with subpleural distribution in the apical and in the medial basal segments of the LLL, features consistent with interstitial pneumonia.




COVID-19: case 61

Izzo Andrea, D’Aversa Lucia, Cerimoniale Giuseppe, Mazzella Giuseppe, Pergoli Pericle, Faiola Eugenio Leone, Casale Lorenzo, Di Pastena Francesca

U.O.C.  Diagnostica per immagini – Ospedale “Dono Svizzero” Formia DEA I livello– Asl Latina 

70 year-old male patient presented to the ED with fever for 10 days, occurred after exposure to a Covid-19 patient. No dyspnea neither cough. pO2: 95%.  Medical history: chronic thyroiditis, HTA.

Portable chest film (performed in a tent set up outside the ED):

diffuse interstitial markings w/o alveolar consolidations.

CT

Multiple and
bilateral ground-glass opacities with predominant subpleural distribution in
the upper lobes, in the ML and in the lower lobes. The findings were consistent
with COvid-19 pneumonia.

The RT-PCR test on nasopharyngeal swab turned positive.




COVID-19: case 60

P.Nespoli, P. Moretto, D. Sardo, P. Hosseinollahi, A. De Pascale, G. Garofalo, A. Veltri

AOU San Luigi Gonzaga, Orbassano, Radiodiagnostica, Direttore: Prof. A. Veltri

60-year-old male
patient with dyspnea and fever. No prior medical history.

Chest Radiography, March 6, 2020:

Bilateral
pulmonary “ground-glass” opacities in the upper pulmonary lobes, findings
consistent with pneumonia.

Chest Radiography, March 13, 2020:

Compared to the previous examination a radiological worsening is seen, with the onset of multiple and diffuse consolidations involving also the lower lobes. Findings consistent with multifocal pneumonia.




COVID-19: case 59

P.Nespoli, P. Moretto, D. Sardo, P. Hosseinollahi, A. De Pascale, G. Garofalo, A. Veltri

AOU San Luigi Gonzaga, Orbassano, Radiodiagnostica, Direttore: Prof. A. Veltri

30-year-old male
patient with general malaise and fever for 5 days. Cough and dyspnea for two
days. No prior medical history.

Chest Radiography,
March 16, 2020:

Bilateral pulmonary consolidations, predominantly in the right lung.