PMC:7143583 / 834-2975 JSONTXT

{"target":"https://pubannotation.org/docs/sourcedb/PMC/sourceid/7143583","sourcedb":"PMC","sourceid":"7143583","source_url":"https://www.ncbi.nlm.nih.gov/pmc/7143583","text":"2 Visual case discussion\nA 76 year old male patient presented with his wife for altered mental status and lethargy. The patient's wife stated that for the last three days the patient ``had not seemed himself''. She described some confusion at home and decreased interaction. She reported the patient had not had fevers at home or dry cough, however she had recently experienced a dry cough. The couple spent the previous weekend at a nearby casino after taking public transit. The patient and wife had no recent long distance of international travel and no known sick contacts or known exposure to COVID-19 + patients. The patient had no known history of pulmonary disease.\nWhen vital signs were obtained the patient was found to have an oxygen saturation of 70% on room air. The patient was tachypneic to a rate of 23 but did not appear to be in respiratory distress and was able to answer questions in full sentences. Lung sounds were clear bilaterally. The patient was moved to an isolation room and was placed on 15 L O2 via non-rebreather mask.\nThe patient was then weaned and able to maintain oxygen saturation of 93% on 5 L via nasal cannula. Cell counts and electrolytes were within normal limits. The patient was negative for Flu A/B and had a negative respiratory viral panel. Chest X-ray obtained showed nonspecific bibasilar airspace disease (Fig. 1 ). Of note, the patient's D-dimer was elevated to 2574 and CT imaging was ordered to evaluate for pulmonary embolism. CTA of the chest with PE protocol revealed bibasilar opacities. The patient was admitted to the progressive care unit for respiratory support and COVID-19 rule out.\nFig. 1 Chest Radiograph (AP view): Upper lung emphysematous changes. Nonspecific bibasal airspace disease which could represent atypical infection or pulmonary edema superimposed on chronic inflammatory changes. Stable mediastinal contour and heart size. No large effusion or pneumothorax.\nOn follow-up, patient tested positive for COVID-19 with declining respiratory status over the next 24 h. He was upgraded to the intensive care unit for high flow nasal cannula at 25 L/min with FiO2 of 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