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Lung CT Segmentation to Identify Consolidations and Ground Glass Areas for Quantitative Assesment of SARS-CoV Pneumonia
08:05

Lung CT Segmentation to Identify Consolidations and Ground Glass Areas for Quantitative Assesment of SARS-CoV Pneumonia

Published on: December 19, 2020

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COVID-19 Pneumonia Resembling an Acute Exacerbation of Interstitial Pneumonia

Takaaki Kitayama1, Hideya Kitamura1, Eri Hagiwara1

  • 1Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan.

Internal Medicine (Tokyo, Japan)
|October 22, 2020
PubMed

Insights

This study highlights that coronavirus disease 2019 (COVID-19) pneumonia can mimic interstitial pneumonia exacerbations. Early corticosteroid and anticoagulant therapy improved patient outcomes, even with persistent hypoxemia.

Area of Science:

  • Pulmonary Medicine
  • Infectious Diseases
  • Radiology

Background:

  • Distinguishing coronavirus disease 2019 (COVID-19) pneumonia from acute exacerbations of interstitial pneumonia is clinically challenging.
  • Computed tomography (CT) findings like ground-glass opacities, traction bronchiectasis, and fibrosis can overlap between these conditions.
  • Hypoxemia and elevated D-dimer levels are critical indicators of disease severity and potential complications in COVID-19 pneumonia.

Observation:

  • An 84-year-old male presented with hypoxemia and characteristic CT findings suggestive of interstitial pneumonia.
  • Initial treatment with methylprednisolone pulse therapy showed partial improvement in radiological findings but not hypoxemia.
  • Diagnosis of COVID-19 pneumonia was confirmed, prompting the initiation of anticoagulant therapy due to persistent hypoxemia and elevated D-dimer.

Findings:

  • Corticosteroid therapy alone partially resolved ground-glass opacities in the patient's lungs.
  • Persistent hypoxemia and increased plasma D-dimer levels indicated ongoing disease activity or complications.
  • The addition of anticoagulant therapy led to significant improvement in hypoxemia, suggesting a thrombotic component.

Implications:

  • COVID-19 pneumonia can present with radiological features indistinguishable from acute exacerbations of interstitial pneumonia.
  • Prompt diagnosis and combined treatment with corticosteroids and anticoagulants may be crucial for managing severe COVID-19 pneumonia.
  • This case underscores the importance of considering COVID-19 in patients with interstitial lung disease-like presentations and managing potential thrombotic complications.
Keywords:
COVID-19 pneumoniaacute exacerbation of interstitial pneumoniacorticosteroidcytokine stormsmicrothrombi

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