0:01

In this case, we have a 56-year-old

0:03

who comes in during the pandemic with shortness of breath.

0:07

And what we see here on the portable x-ray,

0:10

bilateral pleural opacities, pleural parenchymal opacities, throughout

0:17

the lungs, they do appear to have a peripheral predominance.

0:23

I don't appreciate necessarily any adenopathy, although the heart does look

0:26

slightly enlarged, the airway is within normal limits.

0:31

The bones and the soft tissues are also within normal limits.

0:36

So given the timing of the presentation,

0:39

the signs and the symptoms, which included shortness of breath,

0:44

this is certainly a finding compatible with COVID pneumonia.

0:47

So, again, the hallmarks,

0:49

and we'll discuss this a little bit more fully, is you have usually bilateral

0:54

patchy opacities with peripheral predominance.

0:58

There can be an upper lobe predominance,

1:00

but you can have all lobes involved, tends not to be unilateral,

1:04

tends to be an absence of adenopathy, and you don't see pleural effusion.

1:08

So, again, here, when I look at the costophrenic angles,

1:11

they're still pretty sharp and crisp.

1:13

So certainly, given the timing, the presentation, I'll be very concerned,

1:18

or say that this is compatible with COVID pneumonia.

1:22

Now, we'll talk a little bit more about

1:23

the opportunities where and when radiographs and CTs are appropriate.

1:31

But really, this is a patient who needs to get tested, not necessarily needs

1:35

to get imaged, as a way to rule in or rule out the diagnosis.

1:39

So this patient also has a CT.

1:41

So we'll move on to that.

1:42

Before we do, I'll just also just show you the enhanced view.

1:46

So, again, you just see the peripheral

1:47

opacities coming into view much more clearly.

1:51

You can see, again, a lot of the patchy and bilateral

1:55

distribution and relatively spared more central portions.

1:59

So when we look at the CT,

2:02

we'll first just move to the lung windows and we'll come back and look at the soft

2:06

tissue and the bony windows, but moving from the inferior portions up.

2:13

Again, what we're seeing bilaterally are ground glass consolidations,

2:18

some of which are forming and coalescing into more nodular opacities.

2:23

They tend to be more peripherally oriented, sparing the central portions.

2:30

We see them in the upper lobes, the middle portions, as well as the lower lobes,

2:36

so it's really distributive. As we're moving through the airway, is patent,

2:43

we're not seeing a lot of secretions within them.

2:45

We're not seeing any mucus plugging.

2:47

We're not seeing thickening, necessarily.

2:51

Again, we're not seeing pleural effusions.

2:54

There's no evidence of pneumothorax.

2:57

So let's take a look at these soft tissues.

3:01

And here we see a normal thyroid.

3:05

The vascular structures are normal.

3:08

And while you do see some small lymph

3:10

nodes here, these are not necessarily enlarged lymph nodes.

3:14

Looking at the subcarinal stations, not a lot of adenopathy.

3:18

Looking in the hilar regions, again, not seeing significant adenopathy.

3:24

We're not seeing pleural effusions.

3:26

And as we're looking at the pulmonary vessels, the opacification is consistent.

3:31

We're not seeing any evidence of pulmonary emboli.

3:34

Although, keep in mind that patients who do have COVID-19 do have a lot

3:39

of vasculopathy and can have a higher propensity toward clotting.

3:44

So pulmonary emboli, stroke, distal ischemic disease.

3:48

We don't see any evidence of that.

3:50

We do see here that the esophagus

3:53

and the gastric stomach has herniated through into the chest.

3:57

And so we're seeing here a hiatal hernia, but that is incidental.

4:01

And so we'll take one last look

4:03

at the bones to make sure that we're not missing anything.

4:06

And scrolling through the bones, nothing looks like an aggressive lesion.

4:13

We don't want to forget about our contents below the diaphragm.

4:18

So again, our liver here looks normal.

4:24

The kidneys look normal.

4:28

The adrenal glands look normal.

4:31

The spleen is normal.

4:35

The visualized portion of the pancreas looks normal, also.

4:40

The aorta and its branches look normal.

4:44

Just really briefly, it's helpful again to take advantage

4:48

of all of the views that you've been provided.

4:51

So I like to take a look at the coronals.

4:54

Againn, it emulates the chest x-ray really nicely.

4:57

So again, what you're seeing is the peripheral patchy and consolidated

5:01

opacities with relative sparing. Centrally, not seeing any pleural effusions.

5:07

We're not seeing significant adenopathy.

5:10

The heart is a little big, but we've already talked about that.

5:15

The benefit of the sagittal, again,

5:17

I really like that for the alignment of the spine and the spinal structures as

5:23

well as the sternum and the appearance of the retrosternal spaces.

5:28

So this was a case of COVID-19 pneumonia.

5:32

And we'll talk about some pearls and pitfalls in a moment.