2019 Novel Coronavirus (COVID-19) Pneumonia with Hemoptysis as the Initial Symptom: CT and Clinical Features

Abstract

Recently, some global cases of 2019 novel coronavirus (COVID-19) pneumonia have been caused by second- or third-generation transmission of the viral infection, resulting in no traceable epidemiological history. Owing to the complications of COVID-19 pneumonia, the first symptom and imaging features of patients can be very atypical and early diagnosis of COVID-19 infections remains a challenge. It would aid radiologists and clinicians to be aware of the early atypical symptom and imaging features of the disease and contribute to the prevention of infected patients being missed.

Keywords: 2019 novel coronavirus; Atypical imaging features; Atypical symptoms; COVID-19; Hemoptysis.

Fig. 1. CT findings on day of admission.

A. Unenhanced chest CT showed area of localized GGO in apicoposterior segment of left upper lobe (yellow arrow). Distribution of lesions was mainly located in medial lung. B. No lesions were observed in other regions of lungs. GGO = ground-glass opacity

Fig. 2. CT findings on 8th day after admission.

A. Chest CT showed that GGO in left upper lobe had evolved into consolidation (yellow arrow). B. Newly presented GGO in superior lingual segment of left upper lobe and superior segment of left lower lobe were distributed along subpleural regions (yellow arrows).

Fig. 3. CT findings on 18th day after admission.

A–C. Initial GGOs and consolidation in medial aspect of left upper lobe zone decreased on 18th day, while diffuse GGO and consolidation increased in remaining areas of lungs with appearance of diffuse haziness in both lungs and batwing sign (red arrows). Crazy-paving and air-bronchogram sign (yellow arrow) were visible. Some GGO was also distributed along peripheral or subpleural regions.

Fig. 4. CT findings on 24th and 29th day post-admission.

A, B. On day 24, consolidation was clearly absorbed. GGO regions were enlarged but GGO density had decreased. Some GGO was mixed with small patch consolidation. C, D. On day 29, GGO and small patch consolidation continued to absorb. Initial GGO on first CT scan and initial GGO and consolidation on second CT scan in apicoposterior segment of left upper lobe were clearly absorbed.