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Case Reports
. 2020 Aug 13;383(7):665-674.
doi: 10.1056/NEJMcpc2004977. Epub 2020 Jul 29.

Case 25-2020: A 47-Year-Old Woman with a Lung Mass

Amita Sharma  1 , Jonathan E Eisen  1 , Jo-Anne O Shepard  1 , Adam Bernheim  1 , Brent P Little  1
Affiliations
Case Reports

Case 25-2020: A 47-Year-Old Woman with a Lung Mass

Amita Sharma et al. N Engl J Med. .
No abstract available

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Figures

Figure 1
Figure 1. Imaging Studies of the Chest.
Imaging studies were obtained on the patient’s initial presentation to the emergency department. Posteroanterior and lateral radiographs of the chest (Panels A and B, respectively) show a rounded mass in the right lower lobe (arrows). Computed tomographic (CT) images of the chest (Panels C, D, and E), obtained after the administration of intravenous contrast material, show a rounded mass in the right lower lobe with ground-glass attenuation and a rim of higher attenuation at the periphery of the mass, findings that represent the reversed halo sign (Panel C, arrowhead). Additional, smaller ground-glass nodules are present at the periphery of the right middle lobe (Panel C, arrow) and left upper lobe (Panel D, arrow). There is associated right hilar lymphadenopathy (Panel E, arrow). Additional imaging studies were obtained 3 days later, during the patient’s hospitalization. A portable chest radiograph (Panel F) shows that the discrete mass has evolved into faint patchy opacities in the right lower lobe (arrow).
Figure 2
Figure 2. Causes of Ground-Glass Opacity on Chest CT.
The inset shows a normal secondary pulmonary lobule, which is defined by Miller as a functional unit of lung surrounded by an interlobular septum. The lobular branch of the bronchus and the pulmonary artery divide to supply several acini in the center of the secondary pulmonary lobule. Oxygenated blood returns to the heart through branches of the pulmonary veins that lie, together with lymphatics, in the interlobular septa. Lymphatics also surround the bronchovascular sheath. Ground-glass opacity is seen on chest CT when the air within the acini in the center of the secondary pulmonary lobule is partially displaced, which can be caused by partial filling due to replacement of air by fluid; thickening of the intraalveolar interstitium; increased capillary blood flow; or partial collapse of the alveoli, which leads to a relative loss of aeration.
Figure 3
Figure 3. Radiographic Findings in Patients with Covid-19.
Posteroanterior radiographs obtained from patients with Covid-19 are shown. Images from a 64-year-old woman and a 37-year-old man (Panels A and B, respectively) show typical radiographic findings of Covid-19, including opacities that predominantly involve the peripheral lower lung (Panel A, arrows), which is a pattern that can be seen in organizing lung injury, and extensive bilateral opacities with an overall peripheral predominance (Panel B, arrows). An image from a 41-year-old man (Panel C) shows less common radiographic findings of Covid-19, including bilateral asymmetric opacities without a definite peripheral or lower-lung predominance; the opacities are rounded bilaterally (arrows). An image from a 31-year-old woman (Panel D) is normal, with clear lungs and no evidence of pneumonia.
Figure 4
Figure 4. Patterns of CT Findings in Patients with Suspected Covid-19.
Axial CT images obtained from patients with suspected Covid-19 are shown. An image from a 50-year-old man with SARS-CoV-2 infection (Panel A) shows findings that are classified as typical of Covid-19, including bilateral peripheral ground-glass opacities and consolidation, with reversed halo signs (arrows). An image from a 40-year-old man with SARS-CoV-2 infection (Panel B) also shows bilateral peripheral ground-glass opacities and consolidation; some of the peripheral opacities have a linear and perilobular distribution (arrows). An image from an 88-year-old woman with SARS-CoV-2 infection (Panel C) shows findings that are classified as indeterminate for Covid-19, including bilateral patchy ground-glass opacities without a clear distribution in the axial plane (arrows). An image from a 32-year-old woman who tested negative for SARS-CoV-2 but tested positive for rhinovirus (Panel D) shows findings that are classified as atypical of Covid-19, including bilateral ground-glass opacities with clustered, well-defined centrilobular nodules in a tree-in-bud pattern (arrows). The classifications follow the expert consensus reporting guideline of the Radiological Society of North America, endorsed by the American College of Radiology and the Society of Thoracic Radiology.
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References

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