Severe shadowing (admission image)
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Clinical information
- 60-year-old male
- Cough, fever and increasingly short of breath
- 60-year-old male
- O2 saturation of 80% on air
- COVID-19 swab positive 5 days after this chest X-ray (2 negative swabs)
Severe shadowing (admission image)
- PA chest
- Bilateral lung shadowing spares only the upper zones
- Classification: Severe
Severe shadowing (admission to ITU)
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Clinical information
- Worsening of O2 requirement over several hours
- Patient admitted to ITU
Severe shadowing (admission to ITU)
- The endotracheal tube (ET tube) tip is located at the level of the carina and entering the right main bronchus - the tube was subsequently withdrawn a few centimetres
- A nasogastric tube has also been inserted
- Distribution of shadowing appears worse when compared with the previous PA image
- Direct comparison is not possible - this is an AP supine image with incomplete inspiration (intubated patients cannot hold their breath in deep inspiration)
CT Chest - lung apices (axial slice)
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Clinical information - day 14 after admission
- Worsening respiratory failure and raised D-dimer
- This patient remained in ITU until he died 22 days after this scan
CT Chest - lung apices (axial slice)
- A CT Pulmonary Angiogram (CTPA) was requested to exclude pulmonary embolus (no PE was visible)
- A non-contrast CT was acquired first
- This axial image passes through the lung apices - see the (red line) on the 'scout image' (top right)
- Multiple 'ground-glass opacities' are shown
CT Chest - anterior lungs (coronal slice)
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CT Chest - anterior lungs (coronal slice)
- This slice (mid-axillary line) shows areas of ground glass opacification superiorly with denser areas of consolidation in the lower lungs
- Ground glass opacification is more dominant in non-dependent areas of the lungs
- Ground-glass opacification is a typical feature of COVID-19 lung disease seen on CT
- In some areas there is sparing of the sub-pleural lung (the extreme lung periphery)
CT Chest - lower lungs (axial slice)
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CT Chest - lower lungs (axial slice)
- Lower in the lungs there is dense consolidation in the dependent part of the lungs posteriorly
- Ground glass opacities are seen more anteriorly
- Consolidation is a sign of disease severity in COVID-19 lung disease
- The sub-pleural sparing seen in areas affected by ground-glass opacification is not present in areas of dense consolidation
CT Chest - posterior lungs (coronal slice)
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CT Chest - posterior lungs (coronal slice)
- This slice (posterior to the mid-axillary line) shows dense consolidation of the dependent (posterior) parts of both lungs
- Air bronchogram is the characteristic feature of consolidation
- Consolidation is more dominant in dependent areas of the lungs (posterior in a patient nursed in the supine position)