Incidental CT findings suggestive of Covid-19 | Figure 1

Incidental CT findings suggestive of Covid-19

A 42-year-old male presented to the emergency department for treatment of a rectal abscess. He reported a several day history of dry cough. He’s otherwise healthy with no past medical history and no recent travel.

Oxygen saturation was 99% on room air. Leukocytosis was attributed to the abscess. A CT abdomen and pelvis to investigate the extent of the rectal abscess incidentally revealed bilateral basal pneumonia with ground glass appearance suggestive of COVID.

He didn’t meet CDC requirements for screening, however a COVID nasal swab was sent to a private lab. He’s currently admitted and in isolation, receiving IV antibiotics. Vital signs are stable, and the dry cough persists. Awaiting results of the COVID results.

How many patients are we missing that don’t meet CDC requirements for screening? What do you think the epidemiological lessons will be in 20 years when all the statistics are in and the general population can be screened for antibodies to COVID? #COVID-19

Posted by Figure 1 on April 3, 2020.

Critical Case of COVID-19

A 42 year old male patient presented to ED with two day history of fever and mild shortness of breath. No cough, no sore throat, no runny nose, no myalgia, no anosmia/hyposmia, no nausea or vomiting, no Abdo pain and no diarrhoea. He has no past medical history, not on any medications and is an Ex-Smoker.

On examinations, he had high-grade fever and O2 Saturation of 91-92 on room air. Chest examinations revealed bibasal fine crepitations. Normal findings on CVS and abdominal examinations.

Chest X-Ray show Cannon ball opacities in both lung fields. ABG shows T1RF. Basic Blood tests show Lymphocytopenia, raised inflammatory markers and stage 1 AKI.

Patient was initially admitted to the ward but rapidly deteriorated and developed Haemoptysis and Severe Shortness of breath.

CT CAP with contrast shows Classic COVID-19 infection with CT severe score. No other abnormalities in abdomen or pelvis.

Nose and Throat swab tests are positive for COVID-19 four times. Full immunology, Rheumatology and Virology screen are all negative. Blood cultures did not show growth of any bacteria.

How would you treat this patient?

COVID discharge

85+ yo M with dementia, prior MRSA septic arthritis maintained on suppressive doxy, dementia and a stage IV sacral wound admitted from SNF with cough, found to have COVID pneumonia. He was treated with 5 days Azithro/hydroxychloroquine and max O2 requirement was 4 L NC. He was discharged back to SNF after 20 days. One would think the mortality rate would be very high in someone this old and frail. First image is CXR on admission, second is hospital day 11.

Fever and dyspnea

Fever, dyspnea and dry cough 7 days ago. Diagnosed with COVID-19 with positive nasal swab and IgM antibodies. Worsening dyspnea over past 2 days resulted in patient being sent to ED. D-dimer 9.05.

Case in clinic

A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis. He had a history of hypertension, long-term smoking, and a sedentary lifestyle. On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.

28-year-old woman with skin issues

A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets. Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.

Infant with skin lesions

A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days. Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.

Patient in late teens

Patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family, are there any features in this EKG that would warrant further work-up or is this just a pediatric EKG?