肺に小さな空洞を認めるCTスキャン上のCOVID-19肺炎のまれな所見。症例報告

An uncommon manifestation of COVID-19 pneumonia on CT scan with small cavities in the lungs: A case report.

• Jinqing Chen
• Song Peng
• Bangjun Zhang
• Zhifeng Liu
• Lang Liu
• Wendy Zhang

抄録

ラショナル:

胸部CT（Computed Tomography）スキャンはCOVID-19肺炎の診断と管理に重要な役割を果たしています。胸部CTスキャン上のCOVID-19肺炎の典型的な症状は、ガラス地状の不鮮明さ、圧密、結節、線状の不鮮明さである。狂い敷き」パターン、気管支炎、胸膜肥大、胸水を伴うことがある。しかし、肺に空洞を認めた症例は報告されていない。

RATIONALE: Chest computed tomography (CT) scans play a key role in diagnosing and managing of COVID-19 pneumonia. The typical manifestations of COVID-19 pneumonia on a chest CT scan are ground glass opacities, consolidation, nodules, and linear opacities. It can be accompanied by a "crazy-paving" pattern, air bronchograms, pleural hypertrophy, and pleural effusion. However, no literature has reported a case with cavities in the lungs.

患者の悩み:

34歳の男性患者が2週間前から発熱、咳、倦怠感、筋肉痛、下痢、頭痛、めまいを訴えた。この患者は武漢近郊の都市Xiaoganに在住しており、発熱の14日前に武漢からCOVID-19肺炎の患者と接触していた。

PATIENT CONCERNS: A 34-year-old male patient complained of fever, cough, fatigue, myalgia, diarrhea, headache, and dizziness for 2 weeks. This patient is living in Xiaogan, a city around Wuhan, and he had contact with a patient with COVID-19 pneumonia from Wuhan <14 days before he had fever.

ダイアグノシス:

咽頭スワブでrRT-PCRによる核酸検査が陽性となり、COVID-19肺炎の診断が確定した。

DIAGNOSIS: A nucleic acid test by rRT-PCR returned positive on a pharyngeal swab, confirming the diagnosis of COVID-19 pneumonia.

介入:

隔離抗ウイルス治療を行った。

INTERVENTIONS: Isolation antiviral treatment.

アウトカム:

19日間の隔離と抗ウイルス治療の結果、体温が平熱に戻り、症状が緩和された。検査結果も正常値に戻っていた。胸部CT検査では急性炎症はかなり沈静化していた。2回連続の新規コロナウイルス核酸検査が陰性であったため、退院して政令指定ホテルで検疫観察となった。本症例の特徴的な胸部CT所見は、本疾患の吸収期に両肺に小さな空洞が認められたことである。これらの小空洞は端部が明瞭な連結結節に発展し、徐々に縮小・消失していった。

OUTCOMES: After 19 days of isolation and antiviral treatment, his temperature returned to normal and the symptoms were relieved. The laboratory results also were returning to normal levels. The chest CT scan showed that the acute inflammation had subsided significantly. With 2 consecutive novel coronavirus nucleic acid tests had returned negative, the patient was discharged from the hospital and sent to a government designated hotel for quarantine observation. The unique chest CT manifestation in this case was the small cavities in both lungs during the absorption phase of this disease. These small cavities developed into consolidated nodules with clear edges and gradually shrank or disappeared.

レッスン:

この患者は2回連続の核酸検査で陰性となったが、肺に小さな空洞変化が認められたため、14日間の隔離が行われた。しかし、最初の14日間の隔離後のフォローアップCTで肺に新たな小さな空洞変化が認められたため、さらに14日間の隔離が推奨された。そのため、COVID-19の一部の症例では、核酸検査が陰性になっても肺病変の消失には長い時間がかかることがあります。繰り返しの胸部CTスキャンは、COVID-19の回復の診断と評価において重要な役割を果たしている。

LESSONS: Although 2 consecutive nucleic acid tests returned negative in this patient, the small cavity changes in the lungs were observed, so the patient was quarantined for 14 days. However, follow-up CT after the first 14 days' quarantine showed new small cavity changes on the lungs, a further 14 days of quarantine was recommended. Therefore, in some COVID-19 cases, even if the nucleic acid tests turns negative, the disappearance of lung lesions may take a long time. The repeated chest CT scan plays an important role in the diagnosis and evaluation of the recovery of COVID-19.