|Year : 2022 | Volume
| Issue : 2 | Page : 78-79
Chest radiology in a COVID patient with hypoxia
M Vishnu Sharma, Joan Jerry Jacob
Department of Respiratory Medicine, A J Institute of Medical Sciences and Research Centre, Kuntikana, Mangalore, Karnataka, India
|Date of Submission||24-Oct-2021|
|Date of Acceptance||10-Nov-2021|
|Date of Web Publication||17-May-2022|
Dr. M Vishnu Sharma
Professor and Head, Department of Respiratory Medicine, A J Institute of Medical Sciences and Research Centre, Kuntikana, Mangalore, Karnataka
Source of Support: None, Conflict of Interest: None
|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
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?
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. 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., 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. 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. 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. 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.
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.
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Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]