Diagnostic challenges of incidental lung lesions on liver MR
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To date, there are few descriptions of the infection on MRI and this gap in knowledge may contribute to missed opportunities to diagnose the disease. This report describes the diagnostic challenges emerging from the detection of incidental lesions in the lung bases on liver MRI in a 49-year-old woman.

The patient presented to the emergency department with tachycardia, vertigo, fever and a non-productive cough. Blood tests revealed serum alanine transaminase of 69?IU/L and alkaline phosphatase of 323 IU/L. RT-PCR respiratory swab for 2019-nCoV RNA at the time of arrival was negative. Ultrasound of the liver showed hepatic steatosis and a hypoechocic lesion. A standard protocol liver MRI performed to further characterise the hepatic lesion diagnosed two liver haemangiomata and confirmed steatosis. The liver MRI also obtained limited slices of the lung bases which demonstrated non-specific areas of peripheral high signal on the T2-weighted imaging with focal areas of restricted diffusion on diffusion-weighted imaging (DWI) in the left lower lobe.

The day after her MRI the patient underwent a CT of the thorax, abdomen and pelvis for weight loss. The CT uncovered multiple ground glass opacities in a bilateral, multilobar and peripheral distribution, corresponding to the British Society of Thoracic Imaging classification of, classic/probable COVID-19 infection. Appropriate precautions were taken to avoid transmission and the patient had a repeat 2019-nCoV RNA respiratory swab which again produced a negative result.

This case provides early insight into a clinical dilemma that may arise more frequently in the later parts of the COVID-19 pandemic as the frequency of routine MRI and MRI for non-respiratory conditions increases. The lack of sensitivity of RT-PCR and the poor specificity of thoracic CT, which are currently the two most commonly used diagnostic tests for COVID-19 infection, make it difficult to draw definite conclusions about suspicious lesions on MRI.

Source: https://casereports.bmj.com/content/13/7/e237430?rss=1
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