Lobar expression of SARS-CoV-2 pneumonia
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A 59-year-old man with a personal history of gastritis and pulmonary tuberculosis of the left lung without sequelae 40 years earlier was admitted to the emergency department reporting of high fever (maximum 40°C), dry cough and haemoptysis for the past 5 days. He had been subjected to a SARS-CoV-2 PCR screening test 2 days earlier, with an inconclusive result.

Laboratory tests revealed lymphopenia and a mild elevation of hepatic transaminases, lactate dehydrogenase and C reactive protein. The chest X-ray was unremarkable; however, the CT scan revealed a wide area of ground-glass opacity in the right upper lobe.

The microscopic screening of the sputum was negative for tuberculosis. The patient was diagnosed with COVID-19 after a now-positive PCR result. He had a favourable evolution, with mild disease and neither respiratory distress nor hypoxemia. He was asymptomatic 5?days later and presented a normal chest X-ray and positive SARS-CoV-2 serology after 1?month of follow-up.

CT imaging has become an important tool in the evaluation of patients with COVID-19. Typical hallmarks of this infection include bilateral, multifocal, lower lobe and posterior-dominant ground-glass opacities and crazy-paving appearance. Lower lobe involvement can be seen in 90% of patients, while 86% present bilateral lesions. Amorphous patchy, nodular, patchy-nodular and rounded lesions are also commonly found.

Additionally, more extensive lung involvement with opacification is associated with dyspnoea and a more severe course of COVID-19. Isolated upper lobe involvement is infrequent and is more frequently found in early stages of the disease. Moreover, haemoptysis is a rare symptom, reported in less than 5%5 of cases, usually associated with a more severe clinical course.

Source: https://casereports.bmj.com/content/14/6/e242821?rss=1
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