Secondary Logo

Journal Logo

Letters to the Editor

Multidetector computed tomography chest findings of coronavirus disease 2019 pneumonia in patient with hepatocellular carcinoma

El-Badrawy, Adel

Author Information
European Journal of Gastroenterology & Hepatology: September 2020 - Volume 32 - Issue 9 - p 1265-1266
doi: 10.1097/MEG.0000000000001823
  • Free

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 [1].

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.

Fig. 1.
Fig. 1.:
57-year-old man with coronavirus disease (COVID-19) and history of hepatocellular carcinoma. Multidetector CT scan of the chest [a–c (axial cuts), d and e (coronal reformates), f (sagittal reformate)] shows hepatic focal lesion (HCC) (arrow head), bilateral pleural effusions (white arrows), ascites (asterisks), ground glass opacities (black outlined arrows), bronchial dilatation (all-black arrows), consolidation (curved black arrow), and interlobular septal thickening (white outlined arrows). CT, computed tomography; HCC, hepatocellular carcinoma.

Discussion

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 [2]. Bilateral lung involvement was observed in early patients (28%), intermediate patients (76%), and late patients (88%) [1]. 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 [3]. 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.

Acknowledgements

Conflicts of interest

There are no conflicts of interest.

References

1. Bernheim A, Mei X, Huang M, Yang Y, Fayad ZA, Zhang N, et al. Chest CT findings in coronavirus disease-19 (COVID-19): relationship to duration of infection. Radiology. 2020; 295:200463
2. Zhou S, Wang Y, Zhu T, Xia L. CT features of coronavirus disease 2019 (COVID-19) pneumonia in 62 patients in Wuhan, China. AJR Am J Roentgenol. 2020; 214:1287–1294
3. Henry BM, de Oliveira MHS, Benoit S, Plebani M, Lippi G. Hematologic, biochemical and immune biomarker abnormalities associated with severe illness and mortality in coronavirus disease 2019 (COVID-19): a meta-analysis. Clin Chem Lab Med. 2020; 58:1021–1028
Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.