Imagenological Evolution of Pulmonary Secuelae after SARS CoV2 Infection

ABSTRACT

INTRODUCTION: due to the fact that lung disease due to SARS COV 2 infection is of recent appearance and the lack of knowledge about its natural history, it is not clear the moment of adequate follow-up by diagnostic images, this being suggested after 3 months of the onset of the symptoms according to the evolution of the patient. We present the variation of image findings of a patient with severe COVID-19 pneumonia. DESCRIPTIONwe present the case of a 56-year-old male patient who required initial hospitalization of 14 days because of symptoms secondary to multilobar severe pneumonia due to SARS-COV-2 infection with initial tomographic findings of classic pattern given by ground glass opacities of subpleural distribution predominantly in the lower lobes. The patient was discharged with low flow oxygen supplementation and attended the pulmonology consultation a month later reporting improvement in dyspnea with medical research council score grade 1 and complete withdrawal of oxygen support. A control chest computed tomography was taken 6 weeks since initial evaluation reporting subpleural bullae of recent appearance in the upper and lower right lobe with diameters of up to 80 mm. It was also described a small residual laminar pneumothorax adjacent to the lingula with pleural effusion with apparent septae. Given these findings, an intervention by thoracic surgery was requested who decided to schedule a surgical procedure and performed a new control image corresponding to 8 weeks from the initial one with findings of complete and spontaneous resolution of the pneumothorax as well as the pleural effusion although persistence of the bullas. It was decided there was not required further interventions and patient was discharged from follow-up.DISCUSSION: SARS-CoV2 infection manifests itself in different patterns of lung damage and can have long term pulmonary sequelae that are only identified with judicious and strict follow-up during the first months after infection. Nevertheless, the British Thoracic Society (BTS) has recommended the first image follow-up to be preformed after 3 months of the initial symptoms because of the high incidence of image alterations in that period of time and lesser probability of occult malignancy. This case described a rare presentation of lung damage with equally spontaneous resolution of the complications confirming the timeframe proposed by the BTS.