Correct!
5. The patient should remain isolated
The sensitivity for the RT-PCR nasal swab for COVID-19 infection varies according to the source cited, but recent data suggest the test may be at least 90% sensitive, perhaps greater, for the qualitative detection of nucleic acid from SARS-CoV-2 in upper and lower respiratory specimens. This test is not infallible, however, with false negative results reported. This observation has led a number of investigators to suggest that CT scanning may prove useful for detecting lung abnormalities indicative of COVID-19 infection. Nevertheless, the CT findings of COVID-19 infection, while often suggestive in the proper context [one of high pre-testing probability due to a combination of typical symptoms, recent exposure to an infected individual, and/or a relatively high prevalence of COVID-19 infection in the community are non-specific and can be seen with other infectious and non-infectious disorders. Furthermore, negative CT results have been encountered in the presence of proven infection. Finally, CT scanning for COVID-19 infected patients exposes transport personnel and CT technologists- these exposures could lead to additional infections- and at least one hour is required for decontamination of the CT suite following scanning of an infected individual, which curtails CT availability for other patients who need this resource. Bronchoscopy is not required either- this procedure will needlessly expose staff when the proper course of management still remains supportive care and isolation. Repeat chest radiography would be indicated for a change in respiratory status, but is not necessarily required at this point.
The patient was still stable and was sent home to self-quarantine. He returned to the Emergency Room 2 days later with complaints of worsening shortness of breath and continued fever. Chest radiography (Figure 2) was repeated.
Figure 2. Frontal chest radiography performed several days following presentation chest radiography (Figure 1).
Which of the following statements regarding the chest radiograph is most accurate? (Click on the correct answer to be directed to the seventh of twelve pages)