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      Atypical Presentation of COVID-19 Incidentally Detected at 18F-FDG PET/CT in an Asymptomatic Oncological Patient

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          Abstract

          The incidence of COVID-19, a severe acute respiratory syndrome caused by SARS-CoV-2, is rapidly growing worldwide. In this pandemic period, the chance of incidental pulmonary findings suggestive of COVID-19 at 18F-FDG PET/CT in asymptomatic oncological patients is not negligible. To suspect COVID-19 is more demanding whether its presentation is atypical. We describe the incidental PET/CT detection of an 18F-FDG–avid isolated centrilobular pulmonary consolidation in an asymptomatic lymphoma patient, which later resulted in an unexpected and atypical COVID-19 presentation. The nuclear medicine physicians should be prepared to suspect COVID-19 even in asymptomatic patients presenting with a “far-from-COVID-19” finding at PET/CT.

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          The species Severe acute respiratory syndrome-related coronavirus : classifying 2019-nCoV and naming it SARS-CoV-2

          Alexander E. Gorbalenya, Susan C. Baker, Ralph Baric … (2020)
          The present outbreak of a coronavirus-associated acute respiratory disease called coronavirus disease 19 (COVID-19) is the third documented spillover of an animal coronavirus to humans in only two decades that has resulted in a major epidemic. The Coronaviridae Study Group (CSG) of the International Committee on Taxonomy of Viruses, which is responsible for developing the classification of viruses and taxon nomenclature of the family Coronaviridae, has assessed the placement of the human pathogen, tentatively named 2019-nCoV, within the Coronaviridae. Based on phylogeny, taxonomy and established practice, the CSG recognizes this virus as forming a sister clade to the prototype human and bat severe acute respiratory syndrome coronaviruses (SARS-CoVs) of the species Severe acute respiratory syndrome-related coronavirus, and designates it as SARS-CoV-2. In order to facilitate communication, the CSG proposes to use the following naming convention for individual isolates: SARS-CoV-2/host/location/isolate/date. While the full spectrum of clinical manifestations associated with SARS-CoV-2 infections in humans remains to be determined, the independent zoonotic transmission of SARS-CoV and SARS-CoV-2 highlights the need for studying viruses at the species level to complement research focused on individual pathogenic viruses of immediate significance. This will improve our understanding of virus–host interactions in an ever-changing environment and enhance our preparedness for future outbreaks.
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            Chest CT manifestations of new coronavirus disease 2019 (COVID-19): a pictorial review

            Zheng Ye, Yun Zhang, Yi Wang … (2020)
            Coronavirus disease 2019 (COVID-19) outbreak, first reported in Wuhan, China, has rapidly swept around the world just within a month, causing global public health emergency. In diagnosis, chest computed tomography (CT) manifestations can supplement parts of limitations of real-time reverse transcription polymerase chain reaction (RT-PCR) assay. Based on a comprehensive literature review and the experience in the frontline, we aim to review the typical and relatively atypical CT manifestations with representative COVID-19 cases at our hospital, and hope to strengthen the recognition of these features with radiologists and help them make a quick and accurate diagnosis. Key Points • Ground glass opacities, consolidation, reticular pattern, and crazy paving pattern are typical CT manifestations of COVID-19. • Emerging atypical CT manifestations, including airway changes, pleural changes, fibrosis, nodules, etc., were demonstrated in COVID-19 patients. • CT manifestations may associate with the progression and prognosis of COVID-19.
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              Imaging and clinical features of patients with 2019 novel coronavirus SARS-CoV-2

              Xi Xu, Chengcheng Yu, Jing Qu … (2020)
              Background The pneumonia caused by the 2019 novel coronavirus (SARS-CoV-2, also called 2019-nCoV) recently break out in Wuhan, China, and was named as COVID-19. With the spread of the disease, similar cases have also been confirmed in other regions of China. We aimed to report the imaging and clinical characteristics of these patients infected with SARS-CoV-2 in Guangzhou, China. Methods All patients with laboratory-identified SARS-CoV-2 infection by real-time polymerase chain reaction (PCR) were collected between January 23, 2020, and February 4, 2020, in a designated hospital (Guangzhou Eighth People’s Hospital). This analysis included 90 patients (39 men and 51 women; median age, 50 years (age range, 18–86 years). All the included SARS-CoV-2-infected patients underwent non-contrast enhanced chest computed tomography (CT). We analyzed the clinical characteristics of the patients, as well as the distribution characteristics, pattern, morphology, and accompanying manifestations of lung lesions. In addition, after 1–6 days (mean 3.5 days), follow-up chest CT images were evaluated to assess radiological evolution. Findings The majority of infected patients had a history of exposure in Wuhan or to infected patients and mostly presented with fever and cough. More than half of the patients presented bilateral, multifocal lung lesions, with peripheral distribution, and 53 (59%) patients had more than two lobes involved. Of all included patients, COVID-19 pneumonia presented with ground glass opacities in 65 (72%), consolidation in 12 (13%), crazy paving pattern in 11 (12%), interlobular thickening in 33 (37%), adjacent pleura thickening in 50 (56%), and linear opacities combined in 55 (61%). Pleural effusion, pericardial effusion, and lymphadenopathy were uncommon findings. In addition, baseline chest CT did not show any abnormalities in 21 patients (23%), but 3 patients presented bilateral ground glass opacities on the second CT after 3–4 days. Conclusion SARS-CoV-2 infection can be confirmed based on the patient’s history, clinical manifestations, imaging characteristics, and laboratory tests. Chest CT examination plays an important role in the initial diagnosis of the novel coronavirus pneumonia. Multiple patchy ground glass opacities in bilateral multiple lobular with periphery distribution are typical chest CT imaging features of the COVID-19 pneumonia.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Clin Nucl Med
                Journal ID (iso-abbrev): Clin Nucl Med
                Journal ID (publisher-id): RLU
                Title: Clinical Nuclear Medicine
                Publisher: Lippincott Williams & Wilkins
                ISSN (Print): 0363-9762
                ISSN (Electronic): 1536-0229
                Publication date (Print): 8 June 2020
                Publication date (Electronic): 08 June 2020
                Electronic Location Identifier: 10.1097/RLU.0000000000003175
                Affiliations
                From the [∗ ]Department of Neurosciences, Imaging and Clinical Sciences, “G. D’Annunzio” Chieti-Pescara University, Chieti
                [† ]UOC di Medicina Nucleare, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma
                [‡ ]Center for the Diagnosis and Treatment of Lymphomas, Department of Oncology and Hematology, Spirito Santo Hospital, Pescara
                [§ ]Radiology Unit, Annunziata Hospital, Sulmona (AQ)
                [∥ ]Nuclear Medicine Unit, Spirito Santo Hospital, Pescara, Italy.
                Author notes
                [*]Correspondence to: Maria Vittoria Mattoli, MD, Department of Neurosciences, Imaging and Clinical Sciences, “G. D’Annunzio” Chieti-Pescara University, Via Luigi Polacchi, 11, 66100 Chieti, Italy. E-mail: mvittoriamattoli@ 123456yahoo.it .
                Article
                DOI: 10.1097/RLU.0000000000003175
                PMC ID: 7315841
                PubMed ID: 32520513
                SO-VID: 10b03e8d-eae9-4d4e-b6c8-ab6c11544ca6
                Copyright © Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
                License:

                This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.

                History
                Date received : 1 May 2020
                Date revision received : 12 May 2020
                Categories
                Subject: Interesting Image
                Custom metadata
                PUBSTATE POST-AUTHOR-CORRECTIONS

                Keywords: 18f-fdg,consolidation,covid-19,pet/ct,pneumonia,sars-cov-2
                Data availability:
                Keywords: 18f-fdg, consolidation, covid-19, pet/ct, pneumonia, sars-cov-2

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