key: cord-0828584-xoxfctpl
authors: MESSINA, Francesco; TURANO, Lorena; TEBALA, Carmela; CALABRESE, Grazia; ARCADI, Nicola
title: Pericardial and pleural effusion in an elderly woman with Covid-19 pneumonia: CT findings
date: 2021-03-24
journal: Radiol Case Rep
DOI: 10.1016/j.radcr.2021.03.044
sha: c8fe1e8d6d7859614db397660ecea826e576ae15
doc_id: 828584
cord_uid: xoxfctpl

Coronavirus-19 disease is an acute respiratory syndrome infection that primarily infects the lungs, and may extend to other organs such as the cardiovascular system. Here we describe the case of a 90-year-old woman, affected by heart failure (NYHA, class III), with bilateral Covid-19 pneumonia, complicated by pleural and pericardial effusion. An unenhanced Computed Tomography, urgently made, allowed to hospitalize and treat the patient, monitoring her clinical situations.

Francesco MESSINA * , Lorena TURANO * , Carmela TEBALA * , Grazia 

Coronavirus-19 disease is an acute respiratory syndrome infection that primarily infects the lungs, and may extend to other organs such as the cardiovascular system. Here we describe the case of a 90-year-old woman, affected by heart failure (NYHA, class III), with bilateral Covid-19 pneumonia, complicated by pleural and pericardial effusion. An unenhanced Computed Tomography, urgently made, allowed to hospitalize and treat the patient, monitoring her clinical situations.

Since December 2019 the world is facing a rapidly expanding pandemic of lower respiratory tract infection by a novel coronavirus severe respiratory syndrome coronavirus-2 (SARS-CoV-2). In some patients, this viral infection causes a clinical syndrome referred to as coronavirus disease 2019 (Covid-19), but the heterogeneity of the disease course poses a challenge to healthcare providers and optimal management of patients. The use of CT imaging in the diagnosis and follow-up had rapidly grown, and radiological patterns along the disease course are increasingly understood [1] . To date, the most of all the available literature regarding SARS-CoV-2 infection relies on unenhanced CT, which is considered the first-line imaging tool [2] . Current guidelines advocate the use of unenhanced chest CT for the diagnosis, severity assessment and monitoring of Covid-19 disease [3].

In a 90 years old woman, affected by heart failure (NYHA, class III), nasopharyngeal sampling was positive for SARS-CoV-2. She had persistent chest pain (retrosternal, intensified when coughing and laying down), shortness of breath, and fever (38°C) since about seven days, without clinical improvements from taking paracetamol at home. At Emergency Department the patient had: -negative Ecg for ischemic alterations ; -auscultation: vescicular murmur was reduced in both lung areas ; -sO2 of 89% ; -Laboratory: leukopenia, thrombopenia and increased values of C-reactive protein.

An unenhanced chest Computed Tomography (high resolution computed tomography, HRCT) was urgently performed, that showed (Picture 1, a-f): the presence of typical, multifocal "ground-glass" (GGO) areas in both lungs, with bilateral consolidations areas in the posterior-basal segments of right and left lower lobes, and also the evidence of bilateral pulmonary interstitial thickenings. All these CT signs were suggestive for bilateral Covid-19 pneumonia. CT also showed (Picture 2, a-c): the presence of bilateral pleural effusion (mostly on the right); pericardial effusion (which is arranged around the heart, with maximum thickness of about 1cm), with enlargement of the heart; obliteration and thickening of the mediastinal adipose planes anteriorly. 

Correlation of chest CT and RT-PCR testing in Coronavirus Disease 2019 (COVID-19) in China: a report of 1014 cases

ACR recommendations for the use of chest radiography and computed tomography for suspected Covid-19 infection

Zheng Fang. The clinical and chest CT features associated with severe and critical Covid-19 pneumonia

End-stage heart failure with COVID-19: strong evidence of myocardial injury by 2019-nCoV

Acute myopericarditis with pericardial effusion and cardiac tamponade in a patient with Covid-19

Acute pericarditis and cardiac tamponade in a patient with Covid-19: a therapeutic challenge