COVID-19: case 54

R. Campa, A. Leonardi, C. Valentini, R. Occhiato

Radiologia AOU Policlinico Umberto I – Sapienza Università di Roma, Dir. Prof. C. Catalano.

Patient presented
for cough and dyspnea for 5 days, not responding to antibiotics. Potential risk
for SARS-CoV-2: he traveled from Florence to Rome by train coming from a “high-risk
area” on February 24.

Medical history: HTA. At physical examination: crackles of the left base.

Chest radiography

Ill-defined consolidations with peripheral distribution, associated with increased interstitial marking. No pleural effusion.

CT

Ground-glass opacities with reticulations in a peripheral distribution. No pleural effusion neither mediastinal or hilar adenopathies. Findings consistent with Covid-19 pneumonia.




COVID-19: case 53

Michele Forte

UO di radiologia diagnostica ed interventistica, Ospedale “Madonna delle Grazie”, Matera 

78-year-old patient with fever and cough for 1 week. pO2: 84 %.

CT

Diffuse ground-glass opacities associated with reticulations involving all lobes, predominantly in the upper lobes and in the left lower lobe.




COVID-19: case 52

Resta E.C., Del Buono F., D’Ettorre E., Burdi N., Di Stasi C.

S.S. Radiologia Oncologica Ospedale San Giuseppe Moscati Taranto

57-year-old male
patient smoker with COPD. No epidemiologic risk either exposure to Covid-19 patients.

The patient was admitted
to ED for dyspnea and fever not responding to therapy. Po2: 50%.

Blood analysis
revealed high C-RP levels, with normal value of the others parameters (included
procalcitonin).  RT-PCR positive for
SARS-CoV-2.

CT

Immagini assiali, ricostruzione con algoritmo Lung, scansione apicale, media e basale. Plurime aree di aumentata densità polmonare “a vetro smerigliato”, in particolare ai lobi superiori e lobo medio, a prevalente distribuzione peribroncovasale e subpleurica, cui si associa ispessimento settale inter- e intra-lobulare; aree di addensamento parenchimale, con broncogramma aereo pervio nel contesto, a livello dei lobi inferiori. Cannula endotracheale.

Multiple ground-glass opacities with peribronchial and subpleural distribution, predominantly in the upper lobes and in the ML, associated with reticulations. Alveolar consolidations in the lower lobes.




COVID-19: case 51

Resta E.C., Del Buono F., D’Ettorre E., Burdi N., Di Stasi C.

S.S. Radiologia Oncologica Ospedale San Giuseppe Moscati, Taranto

55-year-old
female patient affected by obesity and systemic lupus erythematosus in
treatment with steroids. Asymptomatic, exposure to Covid-19 patient (husband).
Swab negative.

10 days after, the
patient presented to the ED for cough, dyspnea and fever.

Blood analysis revealed high C-RP levels, with normal value of the others parameters (included procalcitonin).

CT

Multiple ground-glass opacities in a peribronchial and subpleural distribution located in the upper lobes, associated with alveolar consolidations in the lower lobes.




COVID-19: case 50

G. Carbognin, F. Lombardo, A. Nardi, G. Giannotti, G. Sala

UOC Radiologia, Direttore G. Carbognin – Ospedale IRCSS Sacro Cuore Don Calabria – Regione Veneto – Negrar di Valpolicella – VR

60-year-old male
patient with abdominal pain and fever for 4 days admitted to ED on March 14. No
previous medical history. Physical examination: unremarkable

Blood analysis at
the admission: lymphocytes 0.8 x 10mg/L, C-RP: 95/mg/l;

RT-PCR: positive
for SARS-CoV-2.

Blood analysis during the hospitalization: lymphocytes 1.1 x 10mg/L.

Chest film

CT




COVID-19: case 49

Stefania Ianniello, Carlo Giangregorio, Giovanna Calabrese, Pierfrancesco Ottaviani, Gavina Cuneo, Marco Di Pietropaolo, Caterina M.Trinci,  Valeria Saracco, Caterina Pizzi, Michele Galluzzo.

DIAGNOSTICA PER IMMAGINI NELL’URGENZA. AZ.OSP.SAN CAMILLO-FORLANINI ROMA.

84-years-old male
patient with fever for 2 weeks, recent evidence of moderate respiratory
failure.

RT-PCR: positive for SARS-CoV-2.

CT:

Typical features consistent with interstitial pneumonia, such as “crazy paving” pattern, ground-glass opacities and consolidation at lung bases. Small amount of pleural effusion and small mediastinal lymph-nodes are also detected, unusual findings in Covid-19 pneumonia. 




COVID-19: case 48 mini pediatric serial cases

Maria Sole Prevedoni Gorone, Francesco Ballati. Radiologia Pediatrica IRCCS Policlinico San Matteo Pavia. Direttore: dott Federico Zappoli Thyrion.

4 pediatric
patients, mean age 4.2 years old (range 3.5 months, 10.9 yo).

At the admission,
clinical features were the following:

  • Fever (39°) in 2 out 4 patients
  • Malaise and loss of appetite in 1/4
  • One of the patients was asymptomatic but he was admitted to take care of him since his parents were both hospitalized for Covid-19 pneumonia.
  •  Only one patient with fever also had moderate lymphopenia.
  • LDH was increased in the symptomatic patients.

Case 1

Case 2

Case 3

Case 4

Case 4: detail

Chest radiography:

Normal findings in
3 out of 4 patients (case 1 – 3)

In 1 patient with
fever (case 4) a blurred ill-defined consolidation with pleural effusion was
seen.  The nasal swab revealed only a low
viral load. This finding may be considered as the end-stage of the Covid-19
pneumonia, since the patient had symptoms for 1 week before coming to the ED.

None of the patient underwent CT The present case series – although the small sample – demonstrates that children may get SARS-CoV-2 infection, but they are usually asymptomatic or paucisymptomatic. In our experience, and as previously reported, pediatric patients may be hospitalized for preventive reasons.




COVID-19: case 47

Silvia Lucarini, Chiara Moroni, Antonella Masserelli, Edoardo Cavigli, Lina Bartolini, Alessandra Bindi, Silvia Pradella AOU Careggi, Firenze, Direttore Dr. Vittorio Miele.

61-years-old male
patient admitted to the ED for severe dyspnea, confusion on March 3.  Bedfast after a recent upper respiratory
infection. Medical history: DM type 2, HTA. Non-smoker.

Blood test: WBC
11.2; C-PR 301 (normal values < 5); LDH 738 (normal values 135-225);
Fibrinogen 798 (normal values 200-400); INR 1.4. ABG: PaO2 82; PCO2 32.

A CTA was performed for suspected pulmonary embolism:

Multiple aree di ground-glass estese diffusamente in entrambi i polmoni con inizali aspetti consolidativi nelle regioni basali ove si evidenzia risparmio subpleurico; coesiste moderata riduzione volumetrica di entrambi i polmoni.

Multiple and
diffuse ground-glass opacities involving both lungs, associated with
consolidations at the bases, those sparing the cortex. Lungs volume is also
reduced.

The patient was promptly intubated and a treatment with Lopinavir-Ritonavir and Cloroquine was also started.

Chest film after intubation (March 3):

Chest film on March 6:

comparing to the previous CRX, an improvement of the pulmonary involvement is seen.

On March 12, a chest radiography was required due an increase of the procalcitonin levels (1.96, normal values <0.5):

A new-onset
consolidation in the left base is noted, finding suspected for bacterial superimposed
infection.

Antibiotics are then introduced along with redemsivir.




COVID-19: case 46

Alessandro Rosa – Giuliano Gagliardi 

DIAGNOSTICA PER IMMAGINI AORN MOSCATI AVELLINO  

61-years-old male, transferred from another hospital. Onset of symptoms (arthralgia, asthenia) on February 27, 2020. Dyspnea and fever (38.5°) since March 2. Venturi mask with reservoir of 15l e pO2 85%, reaching 98% after positioning Venturi at 60% and 15 l.

CT

Subpleural
consolidations in the lower lobes, especially in the apical segments and in the
posterior segment of the RUL and the apicoposterior segment of the LUL.  Ground-glass opacities predominantly in the
subpleural regions are seen in the spared segments of the upper lobes. No
mediastinal nodes.

RT-PCR positive for SARS-CoV-2.

Bedside chest radiography

Diffuse interstitial marking and band atelectasis.




COVID-19: case 45

Cristina Veirana, Alessandro Gastaldo

UOC Radiologia, Ospedale San Paolo, Savona, Direttore dott. Alessandro Gastaldo

79-years-old patient, with cough and fever since February 29; the patient was hospitalized for pneumonia on March 1. 

Medical history: DM, cardiopathy. Potential risk for SARS-CoV-2 exposure (travel by bus from Venice – high-risk area – on February 16).

Chest Radiography:
slight interstitial marking at the left base.

On March 3, a CT was performed for clinical worsening:

Bilateral interstitial
pneumonia.

The patient was intubated and transferred to the infectious disease department.

The patient died on March 4.