Lau Jaclyn Yee Cheun, Khoo Hau Wei, Hui Terrence Chi Hong, Kaw Gregory Jon Leng, Tan Cher Heng
Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore, Singapore.
Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
Am J Case Rep. 2020 Sep 21;21:e926781. doi: 10.12659/AJCR.926781.
BACKGROUND Coronavirus disease 2019 (COVID-19) is caused by a novel coronavirus, SARS-CoV-2, and is associated with severe respiratory disease. There are extensive publications on the chest computed tomography (CT) findings of COVID-19 pneumonia, with ground-glass opacities (GGO) and mixed GGO and consolidation being the most common findings. Those with interstitial thickening manifesting as reticular opacities typically show superimposed ground-glass opacities, giving a crazy-paving pattern. CASE REPORT We report the case of a 77-year-old man with a background of asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) who presented with progressive cough and shortness of breath for 2 days. He was in close contact with a confirmed COVID-19 case. Reverse-transcription polymerase chain reaction analysis of a nasopharyngeal swab was positive for SARS-CoV-2. The initial chest radiograph was negative for lung consolidation and ground-glass opacities. During admission, he had worsening shortness of breath with desaturation, prompting a chest CT examination, which was performed on day 14 of illness. The chest CT revealed an atypical finding of predominant focal subpleural interstitial thickening in the right lower lobe. He was provided supportive treatment along with steroid and antibiotics. He recovered well and subsequently tested negative for 2 consecutive swabs. He was discharged after 34 days. CONCLUSIONS Interstitial thickening or reticular pattern on CT has been described in COVID-19 pneumonia, but largely in association with ground-glass opacity or consolidation. This case demonstrates an atypical predominance of interstitial thickening on chest CT in COVID-19 pneumonia on day 14 of illness, which is the expected time of greatest severity of the disease.
背景 2019 冠状病毒病（COVID-19）由新型冠状病毒 SARS-CoV-2 引起，与严重的呼吸道疾病相关。关于 COVID-19 肺炎的胸部计算机断层扫描（CT）表现已有大量文献报道，磨玻璃影（GGO）以及混合性 GGO 和实变是最常见的表现。那些表现为网状影的间质增厚通常伴有磨玻璃影，呈现出铺路石样改变。病例报告 我们报告一例 77 岁男性患者，有哮喘-慢性阻塞性肺疾病（COPD）重叠综合征（ACOS）病史，因进行性咳嗽和气短 2 天就诊。他与一名确诊的 COVID-19 病例有密切接触。鼻咽拭子的逆转录聚合酶链反应分析显示 SARS-CoV-2 呈阳性。最初的胸部 X 光片显示肺部实变和磨玻璃影均为阴性。入院期间，他的气短加重且出现氧饱和度下降，促使在发病第 14 天进行了胸部 CT 检查。胸部 CT 显示右肺下叶以局灶性胸膜下间质增厚为主的非典型表现。给予了支持治疗以及类固醇和抗生素治疗。他恢复良好，随后连续两次拭子检测均为阴性。34 天后出院。结论 COVID-19 肺炎的 CT 表现中已有间质增厚或网状影的描述，但大多与磨玻璃影或实变相关。本病例显示了在疾病预期最严重的第 14 天，COVID-19 肺炎胸部 CT 上以间质增厚为主的非典型表现。
