A 78-year-old Japanese man with a history of right upper lobectomy due to lung abscess was transferred to our emergency department for dyspnea. The patient experienced progressive episodes of exertional dyspnea over a two-year period because of underlying chronic obstructive pulmonary disease (COPD), which was unmanaged. The patient was a former smoker. He smoked 40 cigarettes per day for 28 years. On the day before admission, he experienced a significantly worse episode of dyspnea triggering his decision to visit a local clinic. On arrival, he presented with the following: body temperature, 37.3°C; respiratory rate, 30/minute; and oxygen saturation, 74% (room air). A chest X-ray (Figure 1) revealed bilateral opacities peripherally. Chest computed tomography (CT) (Figure 2) revealed diffuse low attenuation areas and increased concentrations along the circumference of the emphysema. Three weeks before admission, his wife was hospitalized because of COVID-19. A reverse transcription–polymerase chain reaction test for SARS-CoV-2 was positive.
Chest X-ray. A chest X-ray revealed bilateral opacities peripherally.
Citation: The American Journal of Tropical Medicine and Hygiene 103, 2; 10.4269/ajtmh.20-0605
Computed tomography (CT) of the lung. Chest CT revealed diffuse low attenuation areas and increased concentrations along the circumference of the emphysema in a peripheral, bilateral, posterior, and lower lung zone distribution.
Citation: The American Journal of Tropical Medicine and Hygiene 103, 2; 10.4269/ajtmh.20-0605
Chest CT findings related to COVID-19 typically present with ground-glass opacities with or without consolidation in a peripheral, bilateral, posterior, and diffuse or lower lung zone distribution. Ground-glass opacities have also been reported to have round morphology or a “crazy paving” pattern.1 However, the combination of COVID-19 pneumonia and advanced structural lung damage caused by COPD can culminate in atypical CT findings such as a peripheral “Swiss cheese” appearance.2 The peripheral distribution of “Swiss cheese” appearances may denote COVID-19 pneumonia in patients with underlying COPD and could be exploited for use in its diagnosis.
REFERENCES
- 1.↑
Simpson S et al. 2020. Radiological society of north America expert consensus statement on reporting chest CT findings related to COVID-19. Endorsed by the society of thoracic radiology, the American College of Radiology, and RSNA. J Thorac Imaging doi: 10.1097/RTI.0000000000000524.
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Nambu A, Ozawa K, Kobayashi N, Tago M, 2014. Imaging of community-acquired pneumonia: roles of imaging examinations, imaging diagnosis of specific pathogens and discrimination from noninfectious diseases. World J Radiol 6: 779–793.