key: cord-0899468-j6xhe2t1
authors: Kadyrova, A.; Kulbaeva, B.; Antipina, I.; Pan, K.; Baudinov, I.; Amiraev, N.; Mohhamed, M. Ali
title: IDENTIFYING PULMONARY MANIFESTATIONS OF COVID-19 ON CT
date: 2020-09-25
journal: Vis J Emerg Med
DOI: 10.1016/j.visj.2020.100902
sha: 10d052a6ab240a17a1d1b4ce1691be526612429b
doc_id: 899468
cord_uid: j6xhe2t1

nan

Introduction. In March 11, 2020, the declared pandemic of COVID-19 set tasks for health care workers to provide timely, rapid and accurate diagnostics and treatment. At present, information on the clinical characteristics, prevention and treatment of this disease is constantly being supplemented. At this time, it is believed that the main route of transmission is through droplet spread from an infected person.

It is known that COVID-19 strikes primarily respiratory and cardiovascular systems, and can pass through the hematoencephalic barrier. The most common clinical manifestation of the new variant of coronavirus infection is bilateral pneumonia, whereas 3-4 per cent of patients have developed acute respiratory distress syndrome [1, 2] . The principal task for every doctor of any specialty, a paramedic, a resident or any other health care professional when providing emergency treatment is to be able to use the diagnostic tactics that are essential for identifying main radiological signs, such as ground glass opacity (GGO), crazy paving (GGO + inter-/intralobular septal thickening), air space opacification, peribronchial and perivascular thickening, and try to have the minimum ability to differentiate between viral and bacterial infections.

Chest CT is an important area of ongoing research in COVID-19 diagnostics and disease progression. Plain two-dimensional radiography has low informative value in primary diagnostics of interstitial changes and GGO due to its superimposition effect. But the role of it is indispensable for estimating dynamics in an intensive care ward. However, with development of secondary bacterial infection or acute respiratory distress syndrome, the diagnostic value of the method significantly increases.

The purpose of our work is to show a clinical case and educate a wide range of readers on main radiological markers in chest CT practice. The patient was transferred to an intensive care unit on April 12, 2020, as there was no significant increase in SpO 2 , ceftriaxone was replaced with ciprofloxacin 400 mg/day. SpO 2 increased to 94-95% with unassisted breathing with constant oxygen supply through a nose catheter. On April 15, 2020 he was transferred to the general ward, and later discharged from hospital in a satisfactory condition, was prescribed hydroxichloroquine 400 mg/day for 7 days.

No further complaints of fever, dyspnea or weakness after hospital discharge.

Patient underwent a CT scan on May 12, 2020 to assess the dynamics (Fig.   2 ).

Air space consolidation in S2 of the right lung transformed in to a small focus of ground glass opacity (long arrow). Previous foci of ground glass opacity were reversed.

Follow-up CT image shows dynamics of coronaviral lung injury: starts and ends as ground glass opacity. it is appropriate to assume that a sudden deterioration of the patient's condition is associated with development of ARDS and requires alertness on doctor's side. Also, there is a clear dependence of the radiographic pattern on the position of the patient's body.

Correct Answer = C. It is correct to suspect pulmonary thromboembolism as a complication of COVID-19, based on the presented data. CT angiography will allow visualizing the thrombi themselves as a filling defect and the degree of blood supply distal to the thrombus, as well as gaining detailed information on other pulmonary pathology (for example, identifying pneumonia and excluding PE as a cause of hypoxia or pleurisy as the cause of chest pain).

We wish to confirm that there are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome. 

Avinash Mani et all. CT in coronavirus disease 2019 (COVID-19): a systematic review of chest CT findings of 4410 adult patients

Chest CT features and their role in Covid-19. Review. Radiology of infectious diseases