Di Girolamo Marco, Muscogiuri Emanuele, Zucchelli Alberto, Laghi Andrea
Department of Radiology, Sant'Andrea Hospital - Sapienza University of Rome, Roma, ITA.
Cureus. 2020 Dec 16;12(12):e12115. doi: 10.7759/cureus.12115.
The Coronavirus disease 2019 (COVID-19) is caused by the human severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) virus. The most common clinical findings related to COVID-19 are fever and cough, with the proportion of patients developing interstitial pneumonia. Other symptoms include dyspnea, expectoration, headache, anosmia, ageusia, myalgia and malaise. To date, the diagnostic criteria for COVID-19 include nasopharyngeal and oropharyngeal swabs. Computed tomography (CT) scans of the thorax showing signs of interstitial pneumonia are important in the management of respiratory disease and in the evaluation of lung involvement. In the literature, there are few cases of COVID-19 pneumonia diagnosis made using magnetic resonance imaging (MRI). In our report, we describe a case of accidental detection of findings related to interstitial pneumonia in a patient who underwent abdominal MRI for other clinical reasons. A 71-year-old woman was referred to our department for an MRI scan of the abdomen as her oncological follow-up. She was asymptomatic at the time of the examination and had passed the triage carried out on all the patients prior to diagnostic tests during the COVID-19 pandemic. The images acquired in the upper abdomen showed the presence of areas of altered signal intensity involving asymmetrically both pulmonary lower lobes, with a patchy appearance and a preferential peripheral subpleural distribution. We considered these features as highly suspicious for COVID-19 pneumonia. The nasopharyngeal swab later confirmed the diagnosis of SARS-CoV-2 infection. There are limited reports about MRI features of COVID-19 pneumonia, considering that high-resolution chest CT is the imaging technique of choice to diagnose pneumonia. Nevertheless, this clinical case confirmed that it is possible to detect MRI signs suggestive of COVID-19 pneumonia. The imaging features described could help in the evaluation of the lung parenchyma to assess the presence of signs suggestive of COVID-19 pneumonia, especially in asymptomatic patients during the pandemic phase of the disease.
2019冠状病毒病（COVID-19）由人类严重急性呼吸综合征冠状病毒2（SARS-CoV-2）引起。与COVID-19相关的最常见临床症状是发热和咳嗽，部分患者会发展为间质性肺炎。其他症状包括呼吸困难、咳痰、头痛、嗅觉丧失、味觉丧失、肌痛和不适。迄今为止，COVID-19的诊断标准包括鼻咽拭子和口咽拭子。胸部计算机断层扫描（CT）显示间质性肺炎迹象对于呼吸系统疾病的管理和肺部受累情况的评估很重要。在文献中，很少有使用磁共振成像（MRI）诊断COVID-19肺炎的病例。在我们的报告中，我们描述了一例因其他临床原因接受腹部MRI检查的患者意外发现与间质性肺炎相关的表现。一名71岁女性因肿瘤随访被转诊至我科进行腹部MRI扫描。检查时她没有症状，并且在COVID-19大流行期间诊断检查前通过了对所有患者进行的分诊。上腹部获取的图像显示双侧肺下叶不对称出现信号强度改变区域，呈斑片状外观，且优先分布于外周胸膜下。我们认为这些特征高度怀疑为COVID-19肺炎。后来的鼻咽拭子证实了SARS-CoV-2感染的诊断。考虑到高分辨率胸部CT是诊断肺炎的首选成像技术，关于COVID-19肺炎MRI特征的报道有限。然而，这个临床病例证实了有可能检测到提示COVID-19肺炎的MRI征象。所描述的成像特征有助于评估肺实质，以评估是否存在提示COVID-19肺炎的征象，特别是在疾病大流行阶段的无症状患者中。
