PMC8252158_01
A normal CT of the chest performed before the patient's access to the Emergency Department (a). A CT scan of the same patient performed 10 days after the last Bacillus Calmette-Guerin instillation, showing 1 mm - 2 mm diameter nodules disseminated throughout the lung and distributed randomly with respect to the lobular structures in a miliary pattern (b). After two weeks of antibiotic therapy, CT imaging revealed a numerical and dimensional increase in the multiple micronodules (c). Despite the administration of anti-tubercular therapy, the patient's clinical condition deteriorated again, requiring a new CT scan that revealed the presence of bilateral ground-glass opacities localised mainly in the middle and lower parts of the lungs, partially superimposed on the previously seen multiple lung micronodules, compatible with coronavirus disease 2019 superinfection (d).
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Upon suspicion of atypical lung infection, a chest CT scan was requested, the result of which was compared with previously obtained normal chest CT findings of the same patient performed a year before his access to the Emergency Department (Figure 1a). The CT scan demonstrated signs of severe centrilobular and paraseptal emphysema, and innumerable lung micronodules (1 mm - 2 mm in size) distributed in the non-emphysematous lung parenchyma as a random pattern (Figure 1b). Given the persistence of fever and dyspnoea after two weeks, Meropenem was administered in the place of the previous antibiotic, and a radiological re-evaluation was carried out with another chest CT, which demonstrated a numerical and dimensional increase in the multiple micronodules (Figure 1c). A contrast-enhanced chest CT excluded pulmonary embolism but revealed the presence of diffuse ground-glass opacities localised mainly in the middle and lower zones of the lungs, partially superimposed on the previously seen multiple lung micronodules (Figure 1d).