case presentation€¦ · case presentation lisa mogil,md r2. 3.23.2020. s bhalla/c raptis. the...
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![Page 1: Case Presentation€¦ · Case Presentation Lisa Mogil,MD R2. 3.23.2020. S Bhalla/C Raptis. The Mallinckrodt Institute of Radiology. St. Louis ,Missouri. History • 68-year-old man,](https://reader033.vdocuments.net/reader033/viewer/2022052718/5f0630ce7e708231d416bfca/html5/thumbnails/1.jpg)
Case PresentationLisa Mogil,MD
R2
3.23.2020
S Bhalla/C Raptis
The Mallinckrodt Institute of Radiology
St. Louis ,Missouri
![Page 2: Case Presentation€¦ · Case Presentation Lisa Mogil,MD R2. 3.23.2020. S Bhalla/C Raptis. The Mallinckrodt Institute of Radiology. St. Louis ,Missouri. History • 68-year-old man,](https://reader033.vdocuments.net/reader033/viewer/2022052718/5f0630ce7e708231d416bfca/html5/thumbnails/2.jpg)
History
• 68-year-old man, returned from a trip 10 days prior to presentation.
• Presented to an urgent care with dyspnea, cough, fevers, chills, and myalgias.
• Diagnosed with pneumonia and prescribed doxycycline.
• Patient’s symptoms subsequently worsened and he was sent to Barnes for further work-up.
![Page 3: Case Presentation€¦ · Case Presentation Lisa Mogil,MD R2. 3.23.2020. S Bhalla/C Raptis. The Mallinckrodt Institute of Radiology. St. Louis ,Missouri. History • 68-year-old man,](https://reader033.vdocuments.net/reader033/viewer/2022052718/5f0630ce7e708231d416bfca/html5/thumbnails/3.jpg)
![Page 4: Case Presentation€¦ · Case Presentation Lisa Mogil,MD R2. 3.23.2020. S Bhalla/C Raptis. The Mallinckrodt Institute of Radiology. St. Louis ,Missouri. History • 68-year-old man,](https://reader033.vdocuments.net/reader033/viewer/2022052718/5f0630ce7e708231d416bfca/html5/thumbnails/4.jpg)
Findings
• Peripheral air-space opacities
• No pleural effusion, pneumothorax, or pulmonary edema.
![Page 5: Case Presentation€¦ · Case Presentation Lisa Mogil,MD R2. 3.23.2020. S Bhalla/C Raptis. The Mallinckrodt Institute of Radiology. St. Louis ,Missouri. History • 68-year-old man,](https://reader033.vdocuments.net/reader033/viewer/2022052718/5f0630ce7e708231d416bfca/html5/thumbnails/5.jpg)
Differential Diagnosis
• Organizing pneumonia
• Chronic Eosinophillic pneumonia
• Pulmonary infarction
![Page 6: Case Presentation€¦ · Case Presentation Lisa Mogil,MD R2. 3.23.2020. S Bhalla/C Raptis. The Mallinckrodt Institute of Radiology. St. Louis ,Missouri. History • 68-year-old man,](https://reader033.vdocuments.net/reader033/viewer/2022052718/5f0630ce7e708231d416bfca/html5/thumbnails/6.jpg)
![Page 7: Case Presentation€¦ · Case Presentation Lisa Mogil,MD R2. 3.23.2020. S Bhalla/C Raptis. The Mallinckrodt Institute of Radiology. St. Louis ,Missouri. History • 68-year-old man,](https://reader033.vdocuments.net/reader033/viewer/2022052718/5f0630ce7e708231d416bfca/html5/thumbnails/7.jpg)
Findings
• Ground-glass opacities in a peripheral distribution
• No pleural effusion, pulmonary edema, pneumothorax, or pulmonary embolism
![Page 8: Case Presentation€¦ · Case Presentation Lisa Mogil,MD R2. 3.23.2020. S Bhalla/C Raptis. The Mallinckrodt Institute of Radiology. St. Louis ,Missouri. History • 68-year-old man,](https://reader033.vdocuments.net/reader033/viewer/2022052718/5f0630ce7e708231d416bfca/html5/thumbnails/8.jpg)
Differential diagnosis• Organizing pneumonia from
• Viral pneumonia • Vasculitis• GVHD• Immunotherapy• Other medications
![Page 9: Case Presentation€¦ · Case Presentation Lisa Mogil,MD R2. 3.23.2020. S Bhalla/C Raptis. The Mallinckrodt Institute of Radiology. St. Louis ,Missouri. History • 68-year-old man,](https://reader033.vdocuments.net/reader033/viewer/2022052718/5f0630ce7e708231d416bfca/html5/thumbnails/9.jpg)
What is the most common CT manifestation of COVID-19? • A- Lymphadenopathy
• B- Ground glass opacities
• C- Pneumothorax
• D- Volume loss
![Page 10: Case Presentation€¦ · Case Presentation Lisa Mogil,MD R2. 3.23.2020. S Bhalla/C Raptis. The Mallinckrodt Institute of Radiology. St. Louis ,Missouri. History • 68-year-old man,](https://reader033.vdocuments.net/reader033/viewer/2022052718/5f0630ce7e708231d416bfca/html5/thumbnails/10.jpg)
What is the most common CT manifestation of COVID-19? • A- Lymphadenopathy
• B- Ground glass opacities
• C- Pneumothorax
• D- Volume loss
![Page 11: Case Presentation€¦ · Case Presentation Lisa Mogil,MD R2. 3.23.2020. S Bhalla/C Raptis. The Mallinckrodt Institute of Radiology. St. Louis ,Missouri. History • 68-year-old man,](https://reader033.vdocuments.net/reader033/viewer/2022052718/5f0630ce7e708231d416bfca/html5/thumbnails/11.jpg)
What is the best test for making the diagnosis of COVID-19 pneumonia? • A- CT
• B- RT-PCR
• C- PET-CT
• D- Leukocytosis
![Page 12: Case Presentation€¦ · Case Presentation Lisa Mogil,MD R2. 3.23.2020. S Bhalla/C Raptis. The Mallinckrodt Institute of Radiology. St. Louis ,Missouri. History • 68-year-old man,](https://reader033.vdocuments.net/reader033/viewer/2022052718/5f0630ce7e708231d416bfca/html5/thumbnails/12.jpg)
What is the best test for making the diagnosis of COVID-19 pneumonia? • A- CT
• B- RT-PCR
• C- PET-CT
• D- Leukocytosis
![Page 13: Case Presentation€¦ · Case Presentation Lisa Mogil,MD R2. 3.23.2020. S Bhalla/C Raptis. The Mallinckrodt Institute of Radiology. St. Louis ,Missouri. History • 68-year-old man,](https://reader033.vdocuments.net/reader033/viewer/2022052718/5f0630ce7e708231d416bfca/html5/thumbnails/13.jpg)
Differential diagnosis
• In the setting of the coronavirus pandemic, these findings are related to OP in COVID-19. This is especially true in a patient with no prior medical history who is not on any medical therapy
• COVID 19 pneumonia has been shown to manifest mainly as an organizing/viral pneumonia with peripheral ground glass opacities but the rate of coinfection can be as high as 25% with other organisms
• One cannot exclude COVID with CT
• A negative CT may be seen early in the disease
• The best study for making the diagnosis of COVID 19 pneumonia is RT-PCR
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References
• Ye, Z., Zhang, Y., Wang, Y. et al. Chest CT manifestations of new coronavirus disease 2019 (COVID-19): a pictorial review. Eur Radiol (2020). https://doi.org/10.1007/s00330-020-06801-0