The British Society of Thoracic Imaging (BSTI) has published clear guidance on the classification of chest X-ray (CXR) findings in coronavirus disease 2019 (COVID-19) patients, which are summarised in four main categories: COVID-classical, COVID-indeterminate, COVID-normal, or non-COVID. We report the case of a 34-year-old lady who is otherwise fit and well. She presented with typical COVID-19 symptoms requiring supplemental oxygen, with normal CXR and COVID-19 reverse transcriptase-polymerase chain reaction (RT-PCR) swab on admission. Her condition deteriorated after 24 hours with severe hypoxia requiring up to 60% oxygen. Repeat CXR was normal, which was followed by computed tomography pulmonary angiogram (CTPA) that ruled out pulmonary embolism; however, CTPA confirmed multi-lobar pneumonia consistent with COVID-19. The patient was admitted to the intensive care unit for non-invasive ventilation (NIV) and ongoing care. Extended respiratory screening confirmed positive COVID-19 antibodies and positive adenovirus swabs. The patient also developed COVID-19 related hepatocellular injury and myocarditis in the absence of other causes. These were treated by a multidisciplinary team, and the patient achieved full recovery after three weeks. This case highlights the fact that normal CXR does not rule out COVID-19 pneumonia even in the severely hypoxic patient requiring NIV. Also, it is important to investigate for other potential causes of hypoxia in a deteriorating patient, such as pulmonary embolism and non-COVID causes of pneumonia.
【저자키워드】 COVID-19, coronavirus, hypoxia, Pneumonia, chest X-ray, 【초록키워드】 coronavirus disease, intensive care, antibody, oxygen, RT-PCR, Adenovirus, Computed tomography, myocarditis, imaging, swabs, Patient, non-invasive ventilation, Swab, Admission, Care, patients, Guidance, Repeat, CXR, CTPA, COVID-19 symptom, Society, causes, full recovery, positive, positive COVID-19, severe hypoxia, NIV, hepatocellular injury, highlight, hypoxic, the patient, treated, absence, cause, 24 hour, Extended, requiring supplemental oxygen, with COVID-19, 【제목키워드】 normal,