PMC8826107_01
Anterior-posterior portable chest radiograph shows a right lower lobe patchy density (red arrow) and blunting of the left costophrenic angle (red arrow) suggestive of early pneumonia.
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Initial chest X-ray on presentation (see Figure 1) showed a right lower lobe patchy density with blunting of the left costophrenic angle suggesting early COVID-19 pneumonia.
Axial non-enhanced CT. (a) Image through the right mastoid shows mild opacification of the mastoid air cells (red circle). (b) Image through the left mastoid shows mild opacification of the mastoid air cells (red circle). (c) Image through the sinuses shows bilateral nearly complete opacification of the sphenoidal sinuses (red rectangle). (d) Image through the brain shows a mild hypodensity of the white matter (white rectangle) surrounding the left basal ganglia and thalamus with apparent mass effect on the left lateral ventricle (green arrow) which is lower than the right. These findings could be secondary to early ischemia or encephalitis.
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CT without contrast (see Figure 2) during day 7 revealed near-complete bilateral opacification of the sphenoid sinuses and several ethmoid air cells consistent with a sinus infection and a mild hypodensity of the white matter surrounding left basal ganglia and thalamus with apparent mass effect on the left lateral ventricle. Cerebrospinal fluid (CSF) testing was contraindicated due to the mass appearing lesion on initial head CT.
Axial IV contrast-enhanced CT image through the chest. (a-c) Images show bilateral lower lung filling defects; opacification of the arterial system was limited due to poor timing bolus.
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A chest CT angiography (see Figure 3) demonstrated suboptimal pulmonary arterial opacification for probable bilateral pulmonary embolism (PE).
Axial head MRI T2-FLAIR weighted. (a-c) Images through the brain show nonspecific bilateral ill-defined confluent high T2-FLAIR signal lesion in the deep and subcortical white matter of both cerebral hemispheres (blue arrows).
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MRI of the head without contrast (see Figure 4) on day 3 of current stay revealed an ill-defined confluent high T2 FLAIR signal lesions in the deep and subcortical white matter of both cerebral hemispheres which are nonspecific, although no restricted diffusion or acute infarct was seen.