Maria Sole Prevedoni Gorone, Francesco Ballati. Radiologia Pediatrica IRCCS Policlinico San Matteo Pavia. Direttore: dott Federico Zappoli Thyrion.

4 pediatric
patients, mean age 4.2 years old (range 3.5 months, 10.9 yo).

At the admission,
clinical features were the following:

• Fever (39°) in 2 out 4 patients
• Malaise and loss of appetite in 1/4
• One of the patients was asymptomatic but he was admitted to take care of him since his parents were both hospitalized for Covid-19 pneumonia.
•  Only one patient with fever also had moderate lymphopenia.
• LDH was increased in the symptomatic patients.

Chest radiography:

Normal findings in
3 out of 4 patients (case 1 – 3)

In 1 patient with
fever (case 4) a blurred ill-defined consolidation with pleural effusion was
seen.  The nasal swab revealed only a low
viral load. This finding may be considered as the end-stage of the Covid-19
pneumonia, since the patient had symptoms for 1 week before coming to the ED.

None of the patient underwent CT The present case series – although the small sample – demonstrates that children may get SARS-CoV-2 infection, but they are usually asymptomatic or paucisymptomatic. In our experience, and as previously reported, pediatric patients may be hospitalized for preventive reasons.

Silvia Lucarini, Chiara Moroni, Antonella Masserelli, Edoardo Cavigli, Lina Bartolini, Alessandra Bindi, Silvia Pradella AOU Careggi, Firenze, Direttore Dr. Vittorio Miele.

61-years-old male
patient admitted to the ED for severe dyspnea, confusion on March 3.  Bedfast after a recent upper respiratory
infection. Medical history: DM type 2, HTA. Non-smoker.

Blood test: WBC
11.2; C-PR 301 (normal values < 5); LDH 738 (normal values 135-225);
Fibrinogen 798 (normal values 200-400); INR 1.4. ABG: PaO2 82; PCO2 32.

A CTA was performed for suspected pulmonary embolism:

Multiple aree di ground-glass estese diffusamente in entrambi i polmoni con inizali aspetti consolidativi nelle regioni basali ove si evidenzia risparmio subpleurico; coesiste moderata riduzione volumetrica di entrambi i polmoni.

Multiple and
diffuse ground-glass opacities involving both lungs, associated with
consolidations at the bases, those sparing the cortex. Lungs volume is also
reduced.

The patient was promptly intubated and a treatment with Lopinavir-Ritonavir and Cloroquine was also started.

Chest film after intubation (March 3):

Chest film on March 6:

comparing to the previous CRX, an improvement of the pulmonary involvement is seen.

On March 12, a chest radiography was required due an increase of the procalcitonin levels (1.96, normal values <0.5):

A new-onset
consolidation in the left base is noted, finding suspected for bacterial superimposed
infection.

Antibiotics are then introduced along with redemsivir.

Alessandro Rosa – Giuliano Gagliardi 

DIAGNOSTICA PER IMMAGINI AORN MOSCATI AVELLINO  

61-years-old male, transferred from another hospital. Onset of symptoms (arthralgia, asthenia) on February 27, 2020. Dyspnea and fever (38.5°) since March 2. Venturi mask with reservoir of 15l e pO2 85%, reaching 98% after positioning Venturi at 60% and 15 l.

CT

Subpleural
consolidations in the lower lobes, especially in the apical segments and in the
posterior segment of the RUL and the apicoposterior segment of the LUL.  Ground-glass opacities predominantly in the
subpleural regions are seen in the spared segments of the upper lobes. No
mediastinal nodes.

RT-PCR positive for SARS-CoV-2.

Bedside chest radiography

Diffuse interstitial marking and band atelectasis.

Cristina Veirana, Alessandro Gastaldo

UOC Radiologia, Ospedale San Paolo, Savona, Direttore dott. Alessandro Gastaldo

79-years-old patient, with cough and fever since February 29; the patient was hospitalized for pneumonia on March 1. 

Medical history: DM, cardiopathy. Potential risk for SARS-CoV-2 exposure (travel by bus from Venice – high-risk area – on February 16).

Chest Radiography:
slight interstitial marking at the left base.

On March 3, a CT was performed for clinical worsening:

Bilateral interstitial
pneumonia.

The patient was intubated and transferred to the infectious disease department.

The patient died on March 4.

Federico Paltenghi, Giuseppe Bandi, Laura Nano, Vellini Silvia
ASST Pavia, presidio Ospedaliero di Vigevano, direttore ff reparto di radiologia Elena Belloni

65-years-old male
patient presented to the ED with fever and cough.

Blood test: C-PR 70,99 (< 5) LDH 326 (< 225).

Portable chest film February 28:

Riscontro di lieve ipotrasprenza dell’emitorace sn in torace ipoespanso. Non altri reperti di rilievo.

Opacities in the
left lung.

The day after a chest radiography (2p) is performed due to the low SpO2 (84%) and discrepancy between clinical-radiological findings:

Blurred consolidations especially in the left lung with atelectasis at the bases.

Unenhanced CT on February 29:

Diffuse ground-glass attenuation in the dependent regions of the lungs, with consolidations in the subpleural posterior regions. The antero-posterior extension in 6 -9 cm, sparing the apex. Emphysematous bullae in the left lung base. No pleural or pericardial effusion.

A nasopharyngeal swab was performed: positive.

Federico Paltenghi, Federica Lucev, Elena Belloni
ASST Pavia, presidio Ospedaliero di Vigevano, direttore ff Elena Belloni

82-years-old female patient, admitted to the ED with dyspnea and fever for 7 days. Medical history: HTA and kidney cancer. Blood test: C-PR 106,93 (< 5); ESR 45 (<15); LDH 314 (< 214).

Chest film (supine) March 5:

Interstitial markings with diffuse opacities in the left lung, particularly in peripheral regions, with probable pleural effusion.

CT March 5:

Ground-glass opacities with reticulations, particularly in the posterior and lateral regions of the LUL; subpleural consolidations in the LLL. Findings are consistent with unilateral interstitial pneumonia.

RT-PCR positive
for SARS-CoV-2.

The authors highlights that, unlike the majority of Covid-19 pneumonia, in this case the abnormalities were unilateral.

Bozzalla Cassione Francesca, Demaria Paolo, Baralis Ilaria, Negri Alberto, Cerutti Andrea , Priotto Roberto, Violino Paolo

S.C.  Radiodiagnostica – A.O. “S. Croce e Carle” – Cuneo

87-years old male
patient with HTA, chronic cardiomyopathy was hospitalized from February 27 to
March 1, 2020 for right-sided heart failure successfully treated with diuretic
therapy. 

On March 7, the
patient was readmitted for dyspnea and cough. SpO2

Chest radiography:

Diffuse bilateral consolidations, particularly in the right lung.

SpO2: 95%; C-PR: 160 mg/dl; LDH: 747 U/L.

The patient was hospitalized in pneumology. Due to the worsening of his clinical conditions, HRCT was performed.

HRCT

Diffuse ground-glass opacities with consolidations in the posterobasal segments of the lower lungs. No pleural effusion.

A nasopharyngeal swab was performed (which was positive) and the patient was transferred in the infectious disease department. The disinfection of the CT suite was promptly activated.

Federico Paltenghi, Lucia Volpato, Giuseppe Bandi

ASST Pavia, presidi Ospedalieri di Vigevano e Mortara, direttore f/f Elena Belloni

73-year-old male patient presented to the ED with fever for 10 days, not responding to paracetamol.

Chest radiography:

Consolidation with
interstitial distribution in the right paracardial area, findings suspicious
for pneumonia.

Five days after, the onset of dyspnea occurred and a nasal swab was performed ( which turned positive).

CT

Confluent consolidations and ground-glass opacities with crazy-paving pattern, predominantly in the upper lobes, with a relative sparing of the subpleural regions. Bilateral atelectasis bands. Low amount of bilateral pleural effusion. Findings are consistent with Covid-19 pneumonia.

Marco Di Serafino, Francesca Iacobellis, Giovanna Russo, Luigia Romano.

AORN “Antonio Cardarelli” – Napoli

53-year-old patient with history of HTA and coronary
artery disease recently detected at cardiac CT, waiting for coronarography,
admitted to ED for syncope with no chest pain, dyspnea, lower limbs edema or
fever (36°). No potential risk for SARS-CoV 2 exposure.

Blood tests: WBC (3,47 x10^3/ul, normal values. 4,5 –
10,0), Fibrinogen 650 mg/dL (normal values 150-450), troponin and ESR in the
normal ranges.

In the evening, body temperature increased (37°C).

Chest film

The day after, the body temperature reached 38.5°C.

CT

Multiple and bilateral confluent ground-glass
opacities with consolidations with subpleural distribution, particularly in the
apical segment of the RUL, apicoposterior of the LUL, lingula segment, and at
the bases. No pleural effusion.

RT-PCR from nasopharyngeal swap was positive.

Federica Pirro, Marco Parillo, Bruno Beomonte Zobel, Carlo Cosimo Quattrocchi

Dipartimento di Diagnostica per Immagini e Radiologia Interventistica – Policlinico Universitario Campus Biomedico di Roma

62-years-old
female patient with headache, cough and fever not responding to antibiotics, in
absence of dyspnea. Nausea and loss of appetite was also reported. Blood tests
were unremarkable, and nasal swab negative for SARS COV
2

The patient was
then hospitalized 10 days after the onset of symptoms. Blood test: LDH:
352.00(*) UI/L; Fibrinogen 627(*)mg/Dl; 
C PR 7.95(*)mg/dL; ESR 110.00(*)mm/h. ABG test: pH 7.52 (. 7.35 – 7.45),
PaCO2 36 mmHg, PaO2 64 mmHg, SaO2 96.2%, HCO3– 29.4mmol/L.

CT

Multiple ground-glass opacities associated with consolidations predominantly in peripheral-subpleural distribution, especially in the posterior regions of the lower lobes where bronchiectases are also noted.

In the suspicious of Covid-19 pneumonia, the patient underwent nasopharyngeal swab confirming the diagnosis. The patient was then transferred to the referral center “Spallanzani” hospital in Rome.