Viral Pneumonia

-
This is just a refresher of how lungs look like in cases of a severe viral pneumonia. Findings on both X-ray and CT are nonspecific for COVID-19 but those are the findings we can see. The important factor is progression of the lung changes and diffuse distribution in both lungs. There is some predilection for the peripheral and lower parts of the lungs. Opacities are more diffused of type "ground glass" compared to more dense in bacterial pneumonia. Increased interstitial pattern can be seen. The end result in severe cases is diffuse lung edema or ARDS that leads to death.


85 years old patient with heart failure. Note diffuse, mostly interstitial opacities in both lungs especially in the right upper lobe and apical segment of the left lower lobe.


57 years old patient, shortly on respirator that died with cause of death officially announced as heart failure. Note diffuse predominantly interstitial "ground-glass" opacities most prominent in the left upper lobe.



Same 57 years old patient later on showing advanced diffuse pneumonia in both lungs. In such cases lungs are filled with fluid. The oxygenation capacity is markedly reduced.

I do not have official confirmation of COVID-19 in those two patients. I reported those cases in the early stages of COVID-19 pandemy when not all patients were screened for virus. In both cases onset of symptoms and death in second case were rapid. I do not have follow-up on the first patient.

Popular posts from this blog

Huntington Disease

-
Image
10 years old boy from parents being cousins to each other presents with progressive rigidity and dystonia. Initial MR showing significant bilateral atrophy in caudate nuclei and putamina with high signal on FLAIR and T2 consistent with gliosis. Note striking symmetric atrophy of the putamina and caudate nuclei on T2 and IR. Huntington disease (HD) is also known as Huntington chorea. HD is an autosomal dominant chronic hereditary neurodegenerative disorder with complete penetrance [Osborn].  Aggregates of huntingtin protein accumulate in axonal terminals, which eventually leads to the death of medium spiny neurons. Autopsy shows generalized cerebral atrophy with an average of 30% reduction in brain weight. Both the cortex and hemispheric WM are affected. The most characteristic gross abnormality is volume loss with rarefaction of the caudate nucleus, putamen, and globus pallidus [Osborn].  Microscopically, HD features neuronal loss with huntingtin nuclear inclusions, astr
Read more

Dilated Perivascular Spaces in the Brain

-
Image
Above images (tra T2, tra FLAIR, cor T2 and sag T1) show enlarged Perivascular Spaces (PVS) in the right frontal lobe of the elderly patient with dementia. Note that signal follows that of the CSF (see FLAIR). Moreover note moderate general cortical atrophy. PVS, also known as Virchow-Robin spaces are considered normal finding although perhaps in the future we should know more about the exact patophysiology and possible relations till dementia and other conditions.
Read more

Hemorrhagic Choroid Plexus Cyst

-
Image
Transversal Diffusion Weighted sequence shows high signal in the left choroid plexus with corresponding low signal on ADC (restricted diffusion). Finding represents acute Hemorrhagic Choroid Plexus Cyst . It is also known as Choroid Plexus Xanthogranuloma . Gradient Echo sequence (third image) shows low signal in the right choroid plexus representing hemosiderine deposits after previous hemorrhage. Coronal T1 shows intermediate to high signal in the plexus cyst. Note also low signal in the right plexus on T2 (old hemorrhage) and high signal on FLAIR in the left plexus (acute hemorrhage). Choroid Plexus Cysts are very common normal finding. Those often show restricted diffusion. However in our case of patient with hypertension this finding is of interest to the clinicians as a requirement to more closely monitor patient's blood pressure. There were no signs of intraventricular hemorrhage.
Read more