COVID-19 negative
All the patients on this page presented with symptoms raising the concern of COVID-19 lung disease. None of them tested swab positive and the imaging appearances suggests another diagnosis.
Important note:
- >50% of patients with COVID-19 have a normal chest X-ray
- COVID-19 can coexist with any lung disease and so should not be excluded simply because an another diagnosis is present
Patient 1
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Clinical information
- 90-year-old male
- History of heart disease
- Under investigation for lymphoma
- Recent stroke resulting in poor swallow (could not tolerate nasogastric tube)
- Episodes of reduced consciousness and suspected aspiration
- Poor air entry at lung bases
Patient 1
- Bilateral effusions have formed with atelectasis of the adjacent lungs
- A diagnosis of aspiration pneumonia with parapneumonic effusions was made
- Pleural effusions are uncommon in patients with COVID-19 lung disease
Patient 2
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Clinical information
- 70-year-old male
- Left chest pain
- Cough and sore throat
- COVID-19 suspected
Patient 2
- PA chest
- The pattern of shadowing raises a high suspicion of COVID-19 - patchy, peripheral, bilateral, basal
- Features of heart failure are present - the heart is enlarged and there is upper zone vessel prominence
- A review of previous CT showed calcified pleural plaques which contribute to the increased density peripherally on this chest X-ray (asterisks)
- The chest X-ray appearances were completely unchanged since mid 2019
Patient 3
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Clinical information
- 30-year-old female
- Cough and raised temperature
- COVID-19 swab negative
- Sputum positive for Haemophilus influenzae and Streptococcus pneumoniae
Patient 3
- PA chest
- Shadowing is unilateral, mid zone and is not peripherally located
- Air bronchogram indicates consolidation rather than a lung mass
- The features are not typical of COVID-19 lung disease but are more in keeping with a lobar pneumonia - probably of the upper segments of the right lower lobe
Patient 4
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Clinical information
- 30-year-old male
- Presented with cough, fever and right-sided chest pain
- Stony dullness to percussion at right lung base
- Swab negative for COVID-19
- Blood culture positive for Streptococcus pneumoniae
Patient 4
- Unilateral right lower zone consolidation had developed over several days in this patient despite antibiotics
- The left lung is clear
- Imaging features are of a pleural effusion secondary to a lobar pneumonia
- Pleural effusions are uncommon in COVID-19 lung disease
Patient 5
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Clinical information
- 70-year-old male life-long smoker
- New cough
- In the context of the pandemic this patient was considered likely to have COVID-19 lung disease
Patient 5
- PA chest
- Increased size and density of the right hilum and minor blunting of the left costophrenic angle
- The features are typical of a bronchogenic primary lung cancer (later biopsy proven) at the hilum and a small effusion
- COVID-19 could not account for these appearances