[Not all ground-glass opacifications reflect COVID-19; the hidden danger of a pandemic]

Area of Science:

• Pulmonology
• Infectious Diseases
• Radiology

Background:

• The COVID-19 pandemic led to a diagnostic fixation on SARS-CoV-2.
• Patients presenting with respiratory symptoms were often presumed to have COVID-19.

Observation:

• Three patients presented with fever, cough, and dyspnea during the pandemic.
• Chest CT scans revealed ground-glass opacities and crazy paving patterns.
• Reverse transcription polymerase chain reaction (RT-PCR) for SARS-CoV-2 was negative in all cases.

Findings:

• A negative SARS-CoV-2 PCR result was insufficient to rule out other serious respiratory conditions.
• Diagnostic delays occurred due to an overemphasis on COVID-19.
• Delayed diagnosis and treatment had significant negative consequences for patient outcomes.

Implications:

• Clinicians must maintain a high index of suspicion for alternative diagnoses when SARS-CoV-2 tests are negative.
• Thorough patient evaluation, including medical history and specialized consultations, is crucial.
• Over-reliance on imaging scores like CT-Radiographic Reporting and Data System (CO-RADS) without considering clinical context can be misleading.