• Users Online: 38
  • Print this page
  • Email this page


 
 Table of Contents  
IMAGE WINDOW
Year : 2022  |  Volume : 2  |  Issue : 2  |  Page : 78-79

Chest radiology in a COVID patient with hypoxia


Department of Respiratory Medicine, A J Institute of Medical Sciences and Research Centre, Kuntikana, Mangalore, Karnataka, India

Date of Submission24-Oct-2021
Date of Acceptance10-Nov-2021
Date of Web Publication17-May-2022

Correspondence Address:
Dr. M Vishnu Sharma
Professor and Head, Department of Respiratory Medicine, A J Institute of Medical Sciences and Research Centre, Kuntikana, Mangalore, Karnataka
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jalh.jalh_22_21

Rights and Permissions

How to cite this article:
Sharma M V, Jacob JJ. Chest radiology in a COVID patient with hypoxia. J Adv Lung Health 2022;2:78-9

How to cite this URL:
Sharma M V, Jacob JJ. Chest radiology in a COVID patient with hypoxia. J Adv Lung Health [serial online] 2022 [cited 2022 Jul 6];2:78-9. Available from: http://www.jalh.com/text.asp?2022/2/2/78/345377



A 46-year-old male, chronic smoker, diabetic with poor glycemic control was admitted with a history of fever, cough, and sore throat for 3 days. He was breathless on admission. His oxygen saturation on room air was 78%. His rapid antigen test for Novel Covirus2019 was positive. His chest X-ray and high resolution computed tomography (CT) scan of the thorax were done on admission [Figure 1],[Figure 2],[Figure 3],[Figure 4]. What is the most likely cause for his breathlessness and hypoxia?
Figure 1: Chest X-ray

Click here to view
Figure 2: Computed tomography scan of the thorax coronal section

Click here to view
Figure 3: Computed tomography scan of the thorax lung window

Click here to view
Figure 4: Computed tomography scan of the thorax mediastinal window

Click here to view


CT scan thorax is typical of cardiogenic pulmonary edema. His electrocardiogram showed extensive anterior and lateral wall myocardial infarction. Echocardiogram showed left ventricular ejection fraction 30%.

nCovid19 bronchopneumonia usually starts after 4–5 days after the onset of initial upper respiratory symptoms/fever.[1] If a patient develops severe hypoxia before day 5 of illness in nCovid19, other causes for hypoxia should be evaluated. It should be remembered that in a given patient, hypoxia may be multifactorial. Hence, proper history focused physical examination and relevant investigations should be done in all patients with nCovid19 presenting with breathlessness and hypoxia at any stage of the illness.

The most common causes for hypoxia other than bronchopneumonia in nCovid19 patients include cardiogenic pulmonary edema, volume overload in patients on regular hemodialysis, obstructive airway disease, other preexisting lung diseases, severe anemia.[2],[3] It should be remembered that patients with chronic renal disease and heart disease are at higher risk to develop nCovid19. Hence, all nCovid19 patients should be evaluated for comorbidities. Proper management of comorbidities is essential to improve the outcome in these patients.

In some patients with underlying cardiac, renal disease and uncontrolled hypertension history, physical examination and chest X-ray may not be sufficient to determine the cause for hypoxia. In cases where the diagnosis is uncertain or multifactorial causes for hypoxia is suspected, high resolution of CT scan of the thorax will be useful to delineate the extent of lung involvement.[2] CT scan of the thorax is useful to differentiate pulmonary edema from Covid bronchopneumonia in such patients.

CT scan in nCovid19 bronchopneumonia will show bilateral, basal, peripheral, subpleural lesions. Lesions usually start as ground-glass opacities progressing to crazy paving and consolidation.[4] During resolution honeycombing, fibrosis, traction bronchiectasis, linear opacities, and band-like opacities may be seen. When the whole lung is involved upper zones will show ground glassing, crazy paving pattern, mid zone may show consolidation whereas lower zone may show features of fibrosis, organizing pneumonia pattern, early honeycombing, fibrosis.[5] This pattern if present is diagnostic of nCovid19 bronchopneumonia. In cardiogenic and fluid overload pulmonary edema perihilar shadows with peripheral and subpleural sparing, bilateral small pleural effusion, fissural effusion, Kerley B lines are characteristic.

Learning points

When a patient with nCovid19 presents with hypoxia and pulmonary opacities, proper history, focused physical examination and investigations should be done to find the cause for hypoxia. The most common causes for hypoxia other than bronchopneumonia in nCovid19 patients include cardiogenic pulmonary edema, volume overload in patients on regular hemodialysis, obstructive airway disease, other preexisting lung diseases, and severe anemia.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: A descriptive study. Lancet 2020;395:507-13.  Back to cited text no. 1
    
2.
Moleyar VS, Noojibail A, Shetty NI, Harsha DS, Nithish Bhandary M. Role of CT scan thorax in COVID-19 – A case-based review. Egypt J Radiol Nucl Med 2021;52:148.  Back to cited text no. 2
    
3.
Bhandary NM, Sharma V, Megha SN. Rapidly progressive dyspnea in an elderly diabetic. J Adv Lung Health 2021;1:31-4.  Back to cited text no. 3
  [Full text]  
4.
Rubin GD, Ryerson CJ, Haramati LB, Sverzellati N, Kanne JP, Raoof S, et al. The role of chest imaging in patient management during the COVID-19 Pandemic: A multinational consensus statement from the fleischner society. Radiology 2020;296:172-80.  Back to cited text no. 4
    
5.
Wang Y, Dong C, Hu Y, Li C, Ren Q, Zhang X, et al. Temporal changes of CT findings in 90 patients with COVID-19 pneumonia: A longitudinal study. Radiology 2020;296:E55-64.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
References
Article Figures

 Article Access Statistics
    Viewed117    
    Printed10    
    Emailed0    
    PDF Downloaded15    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]