Poggiali Erika, Vercelli Andrea, Demichele Elena, Ioannilli Eva, Magnacavallo Andrea
Emergency Department, Guglielmo da Saliceto Hospital, Piacenza, Italy.
Eur J Case Rep Intern Med. 2020 May 27;7(6):001738. doi: 10.12890/2020_001738. eCollection 2020.
We describe the case of a young female patient admitted to our emergency department during the Italian COVID-19 epidemic, for fever and dry cough associated with symptoms of gastric reflux over the previous 5 days. Lung ultrasound showed diffuse bilateral B lines with irregular pleural thickening, and consolidation with air bronchogram and slight pleural effusion in the lower left lobe. Chest HRCT and abdominal CT scanning with contrast revealed diaphragmatic rupture with gastric perforation, and atelectasis of the left pulmonary lobe with unilateral pleural effusion, diffuse ground-glass opacities and multiple small consolidations in both lobes. A nasopharyngeal swab for 2019-nCoV was positive. A diagnosis of diaphragmatic rupture and gastric perforation in COVID-19 pneumonia was made. The patient was immediately hospitalized and surgically treated. Treatment for COVID-19 and empiric antibiotic therapy were promptly started.
Coronavirus disease (COVID-19) can cause fever, dry cough and acute respiratory failure.Cough can result in several complications, including rupture of the diaphragm and abdominal herniation.CT scanning is the gold standard technique to investigate COVID-19 pneumonia and diaphragmatic rupture.
我们描述了一名年轻女性患者的病例，该患者在意大利新冠疫情期间因发热、干咳以及过去5天出现的胃反流症状被收入我们的急诊科。肺部超声显示双侧弥漫性B线，伴有不规则胸膜增厚，左下叶有实变并伴有空气支气管征及少量胸腔积液。胸部高分辨率CT（HRCT）及腹部增强CT扫描显示膈肌破裂伴胃穿孔，左肺叶肺不张伴单侧胸腔积液，双肺弥漫性磨玻璃影及多发小结节。2019新型冠状病毒（2019-nCoV）鼻咽拭子检测呈阳性。诊断为新冠病毒肺炎合并膈肌破裂及胃穿孔。患者立即住院并接受手术治疗。同时迅速开始针对新冠病毒的治疗及经验性抗生素治疗。
冠状病毒病（COVID-19）可导致发热、干咳及急性呼吸衰竭。咳嗽可引发多种并发症，包括膈肌破裂及腹疝。CT扫描是排查新冠病毒肺炎及膈肌破裂的金标准技术。
