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Atypical Chest Computed Tomography Finding of Predominant Interstitial Thickening in a Patient with Coronavirus Disease 2019 (COVID-19) Pneumonia.
Am J Case Rep. 2020 Sep 21; 21:e926781.AJ

Abstract

BACKGROUND

Coronavirus disease 2019 (COVID-19) is caused by a novel coronavirus, SARS-CoV-2, and is associated with severe respiratory disease. There are extensive publications on the chest computed tomography (CT) findings of COVID-19 pneumonia, with ground-glass opacities (GGO) and mixed GGO and consolidation being the most common findings. Those with interstitial thickening manifesting as reticular opacities typically show superimposed ground-glass opacities, giving a crazy-paving pattern. CASE REPORT We report the case of a 77-year-old man with a background of asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) who presented with progressive cough and shortness of breath for 2 days. He was in close contact with a confirmed COVID-19 case. Reverse-transcription polymerase chain reaction analysis of a nasopharyngeal swab was positive for SARS-CoV-2. The initial chest radiograph was negative for lung consolidation and ground-glass opacities. During admission, he had worsening shortness of breath with desaturation, prompting a chest CT examination, which was performed on day 14 of illness. The chest CT revealed an atypical finding of predominant focal subpleural interstitial thickening in the right lower lobe. He was provided supportive treatment along with steroid and antibiotics. He recovered well and subsequently tested negative for 2 consecutive swabs. He was discharged after 34 days.

CONCLUSIONS

Interstitial thickening or reticular pattern on CT has been described in COVID-19 pneumonia, but largely in association with ground-glass opacity or consolidation. This case demonstrates an atypical predominance of interstitial thickening on chest CT in COVID-19 pneumonia on day 14 of illness, which is the expected time of greatest severity of the disease.

Authors+Show Affiliations

Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore, Singapore.Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore, Singapore.Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore, Singapore.Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore, Singapore.Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore, Singapore. Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

32952147

Citation

Lau, Jaclyn Yee Cheun, et al. "Atypical Chest Computed Tomography Finding of Predominant Interstitial Thickening in a Patient With Coronavirus Disease 2019 (COVID-19) Pneumonia." The American Journal of Case Reports, vol. 21, 2020, pp. e926781.
Lau JYC, Khoo HW, Hui TCH, et al. Atypical Chest Computed Tomography Finding of Predominant Interstitial Thickening in a Patient with Coronavirus Disease 2019 (COVID-19) Pneumonia. Am J Case Rep. 2020;21:e926781.
Lau, J. Y. C., Khoo, H. W., Hui, T. C. H., Kaw, G. J. L., & Tan, C. H. (2020). Atypical Chest Computed Tomography Finding of Predominant Interstitial Thickening in a Patient with Coronavirus Disease 2019 (COVID-19) Pneumonia. The American Journal of Case Reports, 21, e926781. https://doi.org/10.12659/AJCR.926781
Lau JYC, et al. Atypical Chest Computed Tomography Finding of Predominant Interstitial Thickening in a Patient With Coronavirus Disease 2019 (COVID-19) Pneumonia. Am J Case Rep. 2020 Sep 21;21:e926781. PubMed PMID: 32952147.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Atypical Chest Computed Tomography Finding of Predominant Interstitial Thickening in a Patient with Coronavirus Disease 2019 (COVID-19) Pneumonia. AU - Lau,Jaclyn Yee Cheun, AU - Khoo,Hau Wei, AU - Hui,Terrence Chi Hong, AU - Kaw,Gregory Jon Leng, AU - Tan,Cher Heng, Y1 - 2020/09/21/ PY - 2020/9/21/entrez PY - 2020/9/22/pubmed PY - 2020/10/21/medline SP - e926781 EP - e926781 JF - The American journal of case reports JO - Am J Case Rep VL - 21 N2 - BACKGROUND Coronavirus disease 2019 (COVID-19) is caused by a novel coronavirus, SARS-CoV-2, and is associated with severe respiratory disease. There are extensive publications on the chest computed tomography (CT) findings of COVID-19 pneumonia, with ground-glass opacities (GGO) and mixed GGO and consolidation being the most common findings. Those with interstitial thickening manifesting as reticular opacities typically show superimposed ground-glass opacities, giving a crazy-paving pattern. CASE REPORT We report the case of a 77-year-old man with a background of asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) who presented with progressive cough and shortness of breath for 2 days. He was in close contact with a confirmed COVID-19 case. Reverse-transcription polymerase chain reaction analysis of a nasopharyngeal swab was positive for SARS-CoV-2. The initial chest radiograph was negative for lung consolidation and ground-glass opacities. During admission, he had worsening shortness of breath with desaturation, prompting a chest CT examination, which was performed on day 14 of illness. The chest CT revealed an atypical finding of predominant focal subpleural interstitial thickening in the right lower lobe. He was provided supportive treatment along with steroid and antibiotics. He recovered well and subsequently tested negative for 2 consecutive swabs. He was discharged after 34 days. CONCLUSIONS Interstitial thickening or reticular pattern on CT has been described in COVID-19 pneumonia, but largely in association with ground-glass opacity or consolidation. This case demonstrates an atypical predominance of interstitial thickening on chest CT in COVID-19 pneumonia on day 14 of illness, which is the expected time of greatest severity of the disease. SN - 1941-5923 UR - https://www.unboundmedicine.com/medline/citation/32952147/Atypical_Chest_Computed_Tomography_Finding_of_Predominant_Interstitial_Thickening_in_a_Patient_with_Coronavirus_Disease_2019__COVID_19__Pneumonia_ L2 - https://www.amjcaserep.com/download/index/idArt/926781 DB - PRIME DP - Unbound Medicine ER -