CT scan of a COVID‐positive patient

Abstract

A 45‐year‐old man with no medical history, non‐smoker, presented with several days of cough and fever. He became short of breath on the day of presentation. He had a low‐grade fever of 100.1°F with normal heart rate (HR) (80s) and respiratory rate (RR) (16–18); however, he was hypoxic on presentation, SpO2 89% on RA. He was started on 4 L nasal cannula and improved to 96%. Chest x‐ray is shown (Figure 1). He became tachypneic (RR 20–25) and further hypoxic (SpO2 92%) despite an increase of nasal cannula to 6 LPM. The chest x‐ray did not appear to fully explain how this patient had become so hypoxic so a CT chest was done (Figures 2, 3, 4, 5). Patient was endotracheally intubated after further decompensation, despite high flow nasal cannula at 50 LPM. The CT scan attached demonstrates a severe example of the novel coronavirus (COVID19), commonly seen in hospitals around the globe. The high oxygen requirement needed by many of these patients and the intense reduction of the pulmonary reserve is leading to more and more endotracheal intubations. Frequently, providers are finding chest x‐ray results to be equivocal, thus multiple modalities of imaging must be explored. Although a chest x‐ray may be easily obtainable, portable, and rapidly interpretable, frequently patients are poorly positioned and may have confounding previous comorbidities that impact interpretation. CT scan on the other hand has improved specificity and visibility when investigating the lungs. When a CT chest is obtained, providers may fully recognize the severity of lung infiltration. Some major negatives to obtaining CT scans on these patients are time consumption, availability of CT scanners, and isolation cleaning requirements implemented after the patient has obtained their scan. Point‐of‐care ultrasound has been proposed to be a useful imaging modality when evaluating these patients. Ultrasound, however, is operator dependent and may demonstrate B‐lines or subpleural consolidation only in dependent regions of the lung, which in the setting of patients with multiple comorbidities may be non‐specific. With this patient, point‐of‐care ultrasonography was performed and demonstrated only a few B‐lines, leading it to be unclear as to the extent of the disease. With COVID19 testing in most hospitals having a turnaround time of 3–5 days, it is important for health care providers to be able to recognize both symptoms and classic imaging of severe COVID19 infections in real time. While many patients have minimal chest x‐ray findings, this case shows how hypoxia in the setting of suspected COVID19 can be further explained with CT imaging. FIGURE 1 Chest X‐ray FIGURE 2 CT scan of chest FIGURE 3 CT scan of chest FIGURE 4 CT scan of chest FIGURE 5 CT scan of chest