Respiratory Distress in SARS-CoV-2 without Lung Damage: Phre
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A never-smoking 58-year-old woman, with no significant medical history except for obesity, complained of fever, dysgeusia, anosmia and rapidly progressive dyspnoea on 16th March 2020. An RT-PCR test for COVID-19 was positive. A chest CT scan was normal.

On 24 March, dyspnoea at rest, fever and oxygen saturation of 88% in room air were noted. The patient refused hospitalization and remained at home in bed. Her clinical situation did not improve. On 3 April, CT angiography of the chest and a ventilation/perfusion scan were performed but did not show pulmonary embolism. Parenchyma remained normal. D-dimers, NT-pro-BNP and cardiac echocardiography were normal.

On 30 April, the patient consulted a pulmonologist in our clinic. Dyspnoea was improving but was still very severe, occurring with minimal effort. She complained of a dry cough and did not describe any haemoptysis. She had orthopnoea and paradoxical abdominal respiration in the supine position was observed. A pure restrictive pulmonary syndrome was noted with a forced vital capacity (FVC) of 1.28 litre (46%) and forced expiratory volume in 1 second (FEV1) of 1.1 litre (47%). The FEV1/FVC ratio was 86%. FVC worsened by more than 20% in the supine position to 0.98 litre.

Chest x-rays were taken in complete inspiration and expiration. The inspiration and expiration images were very similar, while the rib cage in profile does not expand during inspiration.

Phrenic paralysis should be considered in COVID-19 lung infection when orthopnoea and paradoxical abdominal respiration are present without vascular or parenchymal abnormalities on thoracic CT scan. The possibility of neurological assault by SARS-CoV-2 on peripheral nerves, especially the vagus nerve, should be determined by investigation. Its association with anosmia and dysgeusia, another neurological symptom, should be considered.

Dr. S●●●●y M●●●●●●●●i and 3 others like this