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Case Reports
. 2020 Jun:167:105951.
doi: 10.1016/j.rmed.2020.105951. Epub 2020 Apr 6.

Coronavirus Disease 2019-related dyspnea cases difficult to interpret using chest computed tomography

Shuke Nie  1 , Shoumeng Han  2 , Huangqing Ouyang  3 , Zhan Zhang  4
Affiliations
Case Reports

Coronavirus Disease 2019-related dyspnea cases difficult to interpret using chest computed tomography

Shuke Nie et al. Respir Med. 2020 Jun.

Abstract

Patients with Coronavirus Disease 2019 (COVID-19) often have clinical characteristics, such as chest tightness and dyspnea. Continuous, unresolved dyspnea often indicates the progression of lung lesions. The mechanism that underlies the chest distress and dyspnea in patients with COVID-19 is still unclear. Chest CT has a higher sensitivity and can play an essential role in the diagnosis and treatment of the disease. However, our clinical observations showed that although some patients had significant chest distress and dyspnea, the lesions that were observed in the lungs during computed tomography were milder and not completely consistent with clinical symptoms. We analyzed the clinical characteristics, laboratory test results, and imaging findings of these patients. We found that extensive inflammation of the bilateral and respiratory bronchioles in patients with COVID-19 due to excessive activation of proinflammatory cytokines and chemotactic aggregation of T-lymphocytes at the site of inflammation are possible mechanisms underlying chest distress and dyspnea in patients with COVID-19. Short-time and lose-dose use of corticosteroid may be helpful to treat chest tightness and dyspnea in mild COVID-19 patients. Through this study, we aimed to improve our understanding of the pathogenesis of COVID-19.

Keywords: COVID-19; Chest CT; Chest tightness; Corticosteroid use; Dyspnea.

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Conflict of interest statement

Declaration of competing interest All authors had no conflict of interests to declare.

Figures

Fig. 1
Fig. 1
Chest CT images of patient 1. (A) A little thin shadow in the posterior basal segment of the double lower lobe (blue arrow). (B) Reduced lesions in the bilateral inferior lobes compared with the previous image on February 22. (C) Thickening of subsegmental bronchial walls, no gradual luminal narrowing (blue arrow). (D) Thinning of subsegmental bronchial walls compared with before, gradual luminal narrowing (blue arrow). (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
Fig. 2
Fig. 2
(A) Subsegment bronchial wall thickening (blue arrow). (B) Sparse lesion in the left inferior lobe (blue arrow). (C) Flaky sparse opacity in the right inferior lobe (blue arrow). (D) Sparse, diffuse opacities in the bilateral inferior lobes (blue arrow). (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
Fig. 3
Fig. 3
(A) Subsegmental bronchial wall thickening, expanded lumen. (B) Recovery of subsegmental bronchial wall and lumen to normal condition.
See this image and copyright information in PMC

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