The novel coronavirus disease 2019 (COVID-19) is a highly infectious and rapidly spreading disease. Typical radiological findings on computed tomography (CT) are bilateral and peripheral ground glass and consolidative pulmonary opacities, ‘crazy paving’ pattern and linear opacities .
A 57-year-old male with a history of hepatocellular carcinoma. He had recently been in close contact with patient who confirmed with COVID-19. He had fever, myalgia, and dyspnea for 7 days. He was admitted in hospital for treatment. Laboratory tests showed a low percentage of lymphocytes (13.6%), a low lymphocyte count (0.8 × 109/L), a normal white blood cell count (6.8 × 109/L), red blood cell count (3.1 × 1012/L), hemoglobin concentration (9 g/dL), platelet count (70 × 109/dL), serum creatinine (1.7 mg/dL), serum albumin (1.9 g/dL), serum total bilirubin (17.67 mg/dL), serum direct bilirubin (12.1 mg/dL), aspartate transaminase (AST) (629.02 iu/L), alanine transaminase (ALT) (267.37 iu/L), prothrombin time (31.8 s), INR (2.66), and C-reactive protein (48 mg/l). Anti-HCV was positive and HBs Ag was negative.
The patient underwent CT chest examination using multidetector CT (MDCT) scanner: SOMATOM go.Now (Siemens Healthcare, Germany, Forchheim Siemens CT Factory). Nonenhanced chest CT scans were performed within 8 days from illness onset. MDCT showed extensive ground glass opacities in both lungs. All five lung lobes were affected. There are associated interlobular septal thickening, consolidation, bronchial dilatation, and mild bilateral pleural effusions (Fig. 1). The presence of mild bilateral pleural effusions was either due to liver cell failure or COVID-19 infection. CT features suggesting the possibility of COVID-19. Therefore, the patient underwent upper respiratory tract swab. The swab was positive for COVID-19 with real-time PCR, and the diagnosis of COVID-19 pneumonia was confirmed. The patient was deteriorated and died after 10 days of CT scanning.
COVID-19 pneumonia is a new, highly contagious viral pneumonia caused by a novel coronavirus (COVID-19). The CT features of COVID-19 pneumonia included lung changes (ground glass opacities, consolidation, vacuolar sign, and interlobular septal thickening), bronchial changes (bronchial thickening and/or dilatation), and pleural effusion . Bilateral lung involvement was observed in early patients (28%), intermediate patients (76%), and late patients (88%) . According to this classification, our patient is considered as late patient with extensive involvement of all five lung lobes. The previous study showed that in patients with severe or fatal COVID-19; there is a decrease in lymphocyte count, platelet count, hemoglobin, and albumin. As regard biochemical findings, there is an increase in the alanine aminotransferase, aspartate aminotransferase, total bilirubin, and creatinine levels. Also, there is increase prothrombin time, INR, and C-reactive protein . This coincides with our findings, as we found a severe pattern of COVID-19 pneumonia with these abnormal laboratory changes.
In conclusion, there is a severe pattern of COVID-19 pneumonia in patient with HCC. Radiologists should be familiar with these findings to help with timely and accurate management of COVID-19 pneumonia.
Conflicts of interest
There are no conflicts of interest.
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