Correct!
1. The chest radiographic opacity has resolved
The left perihilar opacity seen at the initial chest radiograph (Figure 1) has resolved. No nodules, new opacities, or pleural abnormalities are apparent. The follow up chest radiograph is largely unremarkable. There is subtle relative lucency involving the left hilum compared to the right, possibly reflecting oligemia. The finding is subtle, perhaps better seen on a magnified, detail image (Figure 4), but is questionable both in terms of presence and significance.
Figure 4. Magnified, detail views of the medial lungs (A= right, B= left) from the chest radiograph performed 3 months following the diagnosis of COVID-19 (Figure 2) shows subtle oligemia in the medial left lung compared with the medial right lung. Note how the vessels radiating from the left hilum appear similar in size to their right-sided counterparts, but that the pulmonary parenchyma in the background appears somewhat “sparse” and mildly lucent compared to the medial right lung. Placement of region of interest measurements lateral to the interlobar arteries showed approximately 100 HU lower values on the left side compared to the right side. The finding is quite subtle and usually the presence of oligemia at chest radiography is the result of artifact, particularly patient rotation.
While oligemia on a chest radiograph can be a result of emphysema, airway obstruction, volume loss with overexpansion of remaining aerated lung, and decreased vascularity, most commonly the appearance of oligemia is the result of patient rotation and technical factors affecting the image acquisition.
The patient developed chest pain, worsened headache, facial pain, post-nasal drip, and subjective fever to 101.8°F), and presented to the emergency room. In the emergency room, her physical examination showed a respiratory rate of 81, pulse= 71, blood pressure= 132/85 mmHg, room air oxygenation= 98%, and temperature= 98°F. Physical examination was normal. Serum chemistries, a complete blood count, a liver panel, and troponins were all within normal limits. Influenza testing was negative as was testing for SARS-CoV-2. An ECG showed sinus rhythm with mild ST segment depression of unknown chronicity.
Which of the following represents an appropriate next step for the patient’s management? (Click on the correct answer to be directed to the sixth of 11 pages)