CASE 16903 Published on 22.07.2020

COVID-19 presenting with a small ground-glass opacity in the upper lobe of the lung

Section

Chest imaging

Case Type

Clinical Cases

Authors

Akin Cinkooglu MD*, Habib Ahmad Esmat MD*, Savas Recep MD, Mohammad Naim Forogh MD,

Chest Imaging Section, Department of Radiology, EGE University Hospital, Izmir Turkey

Patient

19 years, male

Categories
Area of Interest Thorax ; Imaging Technique CT-High Resolution
Clinical History

A 19-year-old male presented to our hospital with fever and cough. No history of traveling or other comorbidity. The Chest X-Ray was unremarkable (Fig.1), but, on his chest CT, a small single ground-glass opacity in the left upper lobe of the lung was observed (Figs. 2a, 2b, 2c). His real-time PCR was positive for COVID-19.

Imaging Findings

In the left upper lobe of the lung, a small area of ground-glass opacity was observed, however, both lungs aeration and vascularization were within normal limits. Pleura and interlobar fissures were normal.

Discussion

Background

The initial cases of pneumonia of unknown aetiology first identified on Dec 31, 2019, by the Health Commission of Hubei province of China. [1]. On February 11, 2020, the World Health Organization named this disease as Corona Virus 2019 (COVID-19) [2]. The virus is also called as SARS-Cov2, which is a class of enveloped, positive-sense, single-strand RNA viruses that can cause respiratory, enteric, hepatic, and neurologic diseases [3]. It is mainly transmitted through nosocomial transmission, respiratory droplets, and contact [4]. Studies support the COVID-19 S-protein interaction with human ACE2 receptors in the pathogenesis of COVID -19, leading to cellular entry [5].

Clinical Perspective

The common symptoms of disease are fever, cough, myalgia, fatigue, and dyspnoea [6]. Although the real-time reverse-transcription-polymerase chain reaction (RT-PCR) is the standard of diagnosis, imaging can play a useful complementary role in determination and management of COVID-19 pneumonia [7].

Imaging Perspective

Bilateral multifocal ground-glass opacities (GGO) in the lower lobes are the most common initial findings on CT [8]. Pleural thickening, bronchiectasis, and septal thickening are less common imaging manifestations and mainly seen in the later stages [9]. The PCR is the reference standard for the diagnosis of COVID-19 but, in some cases of the early stages of diseases, it may have a false-negative result [10]. Thus, in patients with typical clinical features, chest CT may play a useful complementary role in the integrated diagnosis of disease even when the PCR result is negative [11].

Outcome

COVID-19 pneumonia has nonspecific and diverse CT imaging findings but, GGO is the most typical feature. [12]. In patients with typical clinical features and high suspension, chest CT may play a useful complementary role in disease diagnosis and management, especially where the PCR access is difficult [7, 11].

 

Take-Home Message

Although the COVID-19 pneumonia often manifests as multifocal GGO with peripheral distribution in the lower lobes it can be presented as a single GGO in the upper lobe.

Differential Diagnosis List
COVID -19 pneumonia
Viral pneumonia due to other viruses
Atypical bacterial pneumonia
Solitary pulmonary nodule
Interstitial lung disease
Pulmonary oedema
Final Diagnosis
COVID -19 pneumonia
Case information
URL: https://www.eurorad.org/case/16903
ISSN: 1563-4086