Longitudinal CT Findings in COVID-19 Pneumonia: Case Presenting Organizing Pneumonia Pattern

Abstract

A 54-year-old woman from Wuhan, China, the epicenter of the COVID-19 (formerly known as 2019 novel coronavirus [2019-nCoV]) outbreak (1,2), presented with a 2-day history of fever. The physical examination revealed a temperature of 39.0°C, and laboratory studies showed normal leukocyte with a differential of 82.8% neutrophils, 9.5% lymphocytes, and 0.1% eosinophils. Screening for multiple respiratory pathogens, including influenza A, influenza B, respiratory syncytial virus, adenovirus, human parainfluenza virus, Mycoplasma pneumoniae, and Chlamydia pneumoniae was negative. At presentation, nonenhanced chest CT showed multifocal nodular opacities in multiple lobes (Fig 1a). After 6 days of supportive treatment, follow-up CT showed decreased density of the opacities and development of ground glass and reversed halo sign (Fig 1b). The initial nasopharyngeal swab test for the COVID-19 nucleic acids had been negative, but a second test confirmed infection. After 3 days of treatment with oseltamivir, follow-up CT showed significant improvement in the extent and density of the ground-glass opacities (Fig 1c). A 54-year-old woman who presented with fever. (a) Axial thin-section unenhanced CT images showed multifocal nodular opacities with peribronchial and subpleural distribution (arrows) in both lungs on day 2 of symptoms. (b) Follow-up CT on day 8 showed newly developed ground-glass opacities (arrowheads) and decreasing density of the nodular opacities, with reversed halo sign (arrows). (c) Last follow-up CT on day 11, 3 days after initiation of antiviral treatment, showed significantly improvement of the ground-glass opacities. A 54-year-old woman who presented with fever. (a) Axial thin-section unenhanced CT images showed multifocal nodular opacities with peribronchial and subpleural distribution (arrows) in both lungs on day 2 of symptoms. (b) Follow-up CT on day 8 showed newly developed ground-glass opacities (arrowheads) and decreasing density of the nodular opacities, with reversed halo sign (arrows). (c) Last follow-up CT on day 11, 3 days after initiation of antiviral treatment, showed significantly improvement of the ground-glass opacities. A 54-year-old woman who presented with fever. (a) Axial thin-section unenhanced CT images showed multifocal nodular opacities with peribronchial and subpleural distribution (arrows) in both lungs on day 2 of symptoms. (b) Follow-up CT on day 8 showed newly developed ground-glass opacities (arrowheads) and decreasing density of the nodular opacities, with reversed halo sign (arrows). (c) Last follow-up CT on day 11, 3 days after initiation of antiviral treatment, showed significantly improvement of the ground-glass opacities.