Figure 1
Portable semi-upright AP chest x-ray on admission demonstrated bilateral perihilar and peribronchial thickening with perihilar opacities.
COVID-19 infection with new onset atrial fibrillation
SectionChest imaging
Case TypeClinical Cases
Authors
Eric Han, MS1; Thanh-Lan Bui, MS4; Joseph Carbone, MS3; Justin Glavis-Bloom, MD; Roozbeh Houshyar, MD
Connected authors
71 years, male
Clinical History
A 71-year-old male with no known past medical history presented to the emergency department with fever (39.1°C), cough, shortness of breath, and myalgias for one week. Laboratory studies were remarkable for lymphopenia (0.4´103/mL, normal range 0.9´103/mL – 3.3´103/mL), elevated c-reactive protein, elevated ferritin, elevated interleukin-6, elevated d-dimer, and elevated procalcitonin.
Imaging Findings
AP chest x-ray on admission demonstrated bilateral perihilar and peribronchial thickening with perihilar opacities (Fig. 1).
Non-contrast chest CT on admission demonstrated multiple patchy, peripheral-predominant ground-glass and consolidative opacities. A “crazy-paving” appearance associated with interlobular septal thickening was noted. There was no significant intrathoracic or axillary lymphadenopathy (Figs. 2a-d).
Discussion
Background
Coronavirus disease-19 is a novel viral pandemic that primarily affects the lungs, causing respiratory symptoms including dry cough and shortness of breath [1]. However, recently there has been an increasing number of cardiac complications reported in patients with COVID-19 infection [2, 3]. The mechanism of myocardial injury in these patients is hypothesized to be the onset of cytokine storm in response to infection [4–6]. In addition, hydroxychloroquine, an antimalarial drug used to treat some severe cases of COVID-19, has been shown to increase atrioventricular depolarization length, potentially leading to drug-induced atrial and ventricular arrhythmias [7–9].
Clinical Perspective
Typical COVID-19 symptoms include fever, dry cough, myalgia, and lymphopenia [10]. Recent cases suggest that myocardial disease and injury may be a consequence of a COVID-19 induced cytokine storm [11, 12]. Elevated ferritin levels are associated with cytokine storm onset, which may predict myocardial damage related to severe inflammatory responses [13].
Imaging Perspective
Characteristic computed tomography (CT) findings for COVID-19 become more apparent as the disease progresses and may include multilobar ground-glass opacities and a crazy-paving pattern [14, 15]. CT may be more sensitive than chest x-ray for detection of classic COVID-19 findings, including ground-glass opacities [14–16].
Outcome
COVID-19 RT-PCR returned positive. On day two of admission, the patient was started on hydroxychloroquine. On day six of admission, he developed new-onset atrial fibrillation with rapid ventricular rate, requiring initiation of a beta-blocker for rate control.
Teaching Points
Potential cardiac complications should be monitored in patients with COVID-19 infection. Hydroxychloroquine has been associated with arrhythmias and should be administered with caution.
Differential Diagnosis List
Coronavirus disease-19 (COVID-19)
Influenza pneumonia
Multifocal bacterial pneumonia
Cryptogenic Organizing Pneumonia
Acute Respiratory Distress Syndrome (ARDS)
Final Diagnosis
Coronavirus disease-19 (COVID-19)
References
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Case information
| URL: | https://www.eurorad.org/case/16883 |
| DOI: | 10.35100/eurorad/case.16883 |
| ISSN: | 1563-4086 |
License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Figure 2
Non-contrast chest CT on admission demonstrated multiple patchy, peripheral-predominant ground-glass and consolidative opacities. A “crazy-paving” appearance associated with interlobular septal thickening was noted. There was no significant intrathoracic or axillary lymphadenopathy.
Non-contrast chest CT on admission demonstrated multiple patchy, peripheral-predominant ground-glass and consolidative opacities. A “crazy-paving” appearance associated with interlobular septal thickening was noted. There was no significant intrathoracic or axillary lymphadenopathy.
Non-contrast chest CT on admission demonstrated multiple patchy, peripheral-predominant ground-glass and consolidative opacities. A “crazy-paving” appearance associated with interlobular septal thickening was noted. There was no significant intrathoracic or axillary lymphadenopathy.
Non-contrast chest CT on admission demonstrated multiple patchy, peripheral-predominant ground-glass and consolidative opacities. A “crazy-paving” appearance associated with interlobular septal thickening was noted. There was no significant intrathoracic or axillary lymphadenopathy.
Portable semi-upright AP chest x-ray on admission demonstrated bilateral perihilar and peribronchial thickening with perihilar opacities.
Department of Radiologic Sciences, University of California Irvine Medical Center, School of Medicine, United States, 2020
Department of Radiologic Sciences, University of California Irvine Medical Center, School of Medicine, United States, 2020
Non-contrast chest CT on admission demonstrated multiple patchy, peripheral-predominant ground-glass and consolidative opacities. A “crazy-paving” appearance associated with interlobular septal thickening was noted. There was no significant intrathoracic or axillary lymphadenopathy.
Department of Radiologic Sciences, University of California Irvine Medical Center, School of Medicine, United States, 2020
Department of Radiologic Sciences, University of California Irvine Medical Center, School of Medicine, United States, 2020
Non-contrast chest CT on admission demonstrated multiple patchy, peripheral-predominant ground-glass and consolidative opacities. A “crazy-paving” appearance associated with interlobular septal thickening was noted. There was no significant intrathoracic or axillary lymphadenopathy.
Department of Radiologic Sciences, University of California Irvine Medical Center, School of Medicine, United States, 2020
Department of Radiologic Sciences, University of California Irvine Medical Center, School of Medicine, United States, 2020
Non-contrast chest CT on admission demonstrated multiple patchy, peripheral-predominant ground-glass and consolidative opacities. A “crazy-paving” appearance associated with interlobular septal thickening was noted. There was no significant intrathoracic or axillary lymphadenopathy.
Department of Radiologic Sciences, University of California Irvine Medical Center, School of Medicine, United States, 2020
Department of Radiologic Sciences, University of California Irvine Medical Center, School of Medicine, United States, 2020
Non-contrast chest CT on admission demonstrated multiple patchy, peripheral-predominant ground-glass and consolidative opacities. A “crazy-paving” appearance associated with interlobular septal thickening was noted. There was no significant intrathoracic or axillary lymphadenopathy.
Department of Radiologic Sciences, University of California Irvine Medical Center, School of Medicine, United States, 2020
Department of Radiologic Sciences, University of California Irvine Medical Center, School of Medicine, United States, 2020