Correct!
5. The chest CT shows findings typical for those reported in patients with COVID-19
The unenhanced chest CT shows patchy, multifocal, somewhat rounded or oblong areas of ground-glass opacity preferentially distributed in the subpleural lower lungs bilaterally. The areas of ground-glass opacity show internal mild interlobular septal thickening and intralobular interstitial thickening. This imaging features, while ultimately rather non-specific, are those commonly reported in patients with COVID-19 pulmonary infection. Areas of consolidation may also occur, and both the “crazy paving” and the “reverse (ground-glass opacity) halo” signs have been reported at chest CT as well. While bacterial pneumonias may take multiple forms and is difficult to entirely exclude bacterial infection in this circumstance, the presence of ground-glass opacity alone would be unusual for a bacterial pulmonary infection. Rather, bacterial infections commonly present as areas of consolidation with air bronchogram formation, centrilobular nodules (often with branching configurations) and airway thickening. No bronchiectasis is present, and the morphology of the lung parenchymal opacities is not suggestive of metastatic malignancy; the latter typically appears as multiple nodules or masses, with or without cavitation.
The patient continued to spike fevers to approximately 102 °F, although his dyspnea and cough had improved mildly. The patient had become frustrated with his care and felt he could take care of himself at home, and left the hospital against medical advice.
He was subsequently readmitted to another hospital due to worsening shortness of breath with minimal activity accompanied by chest heaviness, now 12 days after his initial diagnosis. He felt he had been improving somewhat after he initially left the hospital, but now his symptoms were worsening. His oxygen saturation was now 94% on 3L oxygen, decreasing to 90% with walking. In the Emergency Room, laboratory data showed a mildly elevated white blood cell count of 9.9 x 109 / L (normal, 3.4 – 9.6 x 109 / L), but without fever. His heart and respiratory rates were 86 / minute and 18 / minute, respectively. Frontal chest radiography (Figure 4) was performed.
Figure 4. Frontal chest radiograph at second Emergency Room presentation (now 12 days after his initial diagnosis).
Which of the following statements regarding the chest radiograph is most accurate? (Click on the correct answer to be directed to the tenth of twelve pages)