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Delay of COVID-19 diagnosis due to aspiration pneumonia
Yutaka Matsushita1, Sho Kurihara1, Kazuhiro Omura2
1Department of Otorhinolaryngology, The Jikei University School of Medicine, Tokyo, Japan.
Insights
This case highlights how aspiration pneumonia can mask COVID-19 diagnosis. Early COVID-19 pneumonia may not show on CT scans, delaying critical care.
Area of Science:
- Medicine
- Infectious Diseases
- Pulmonology
Background:
- Coronavirus disease 2019 (COVID-19) diagnosis can be challenging due to asymptomatic cases and overlapping symptoms with other conditions.
- The global spread of COVID-19 necessitates accurate and timely diagnostic strategies.
Observation:
- A 64-year-old male presented with swallowing difficulties and subsequently developed fever after aspirating during an examination.
- Initial diagnosis was aspiration pneumonia based on clinical presentation and CT imaging.
- The patient's respiratory condition worsened, leading to a positive COVID-19 polymerase chain reaction (PCR) test.
Findings:
- Early-stage COVID-19 pneumonia may present with normal CT findings, with abnormalities typically appearing 6-11 days post-onset.
- Common CT findings in COVID-19 pneumonia include consolidation, ground-glass opacities, and peripheral bilateral lung lesions.
- Differentiating COVID-19 pneumonia from other pneumonias based solely on imaging can be difficult.
Implications:
- COVID-19 should be considered in the differential diagnosis of pneumonia, especially during the pandemic.
- Delayed diagnosis of COVID-19 can lead to adverse patient outcomes.
- Awareness of atypical presentations is crucial for effective COVID-19 management.
Abstract:
COVID-19 was first confirmed in December 2019 in Wuhan, China and is now spreading worldwide. Diagnosis of COVID-19 is sometimes difficult due to the absence of symptoms and its tendency to be masked by other diseases. In this paper, we report a COVID-19 case in which diagnosis was delayed due to aspiration pneumonia. A 64-year-old man visited our department for evaluation of swallowing function. However, during the examination, the patient aspirated testing food and subsequently developed a fever. Based on his medical history and computed tomography (CT) images, he was diagnosed with aspiration pneumonia and admitted to the hospital to begin treatment. However, after admission, his respiratory condition deteriorated, and the result of a COVID-19 polymerase chain reaction (PCR) test was positive. Previous reports have shown that CT images in cases of COVID-19 pneumonia were normal in the early phase, and abnormalities usually appeared approximately 6-11 days after onset. Common findings of COVID-19 are consolidation, ground-glass opacities, and a distribution of lesions predominantly in the bilateral inferior lung field periphery. It is difficult to differentiate COVID-19 pneumonia from other types of pneumonia; it should therefore be listed as a differential diagnosis during the current pandemic.
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