C4) Acute respiratory distress

Review the Learning Outcomes, Hx, PE and Labs, and begin the module with your Provisional Diagnosis. Keep hitting "Next" to move through the module.

Learning Outcomes

  1. Articulate your relationship with the consulting diagnostic radiologists in the evaluation of a patient with fever and cough.
  2. Review the DDx considerations in fever and cough.
  3. Identify the spectrum of imaging findings in appropriate modalities for evaluating patients with fever and cough.

History

Physical Exam

Labs

Provisional Diagnosis

Select the Dx you believe is most appropriate
It is likely that the patient has COVID pneumonia considering the fever, shortness of breath, lymphopenia, and thrombocytosis. Pulmonary embolism and ARDS are both sequelae of COVID infections and may contribute to worsening shortness of breath. However, pulmonary embolism is more likely considering the acute onset shortness of breath and pleuritic chest pain.
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Potential Acuity

What is your assessment of the likely acuity for this patient?

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The patient requires urgent workup for their respiratory distress.

First Imaging Study

What is the first imaging study you will order?

A chest X-ray is a good initial test to evaluate acute onset shortness of breath.
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Pertinent Imaging Observations

Click on the links below to view images from the study, and assess these key findings as best you can.

View Report

Watch our video

View the full study if you'd like to take a look yourself.

Second Imaging Study

What is the next imaging study you will order?

A chest CT can further evaluate the pulmonary findings. Specifically, a chest CTA can detect the presence of pulmonary emboli.
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Pertinent Imaging Observations

Click on the links below to view images from the study, and assess these key findings as best you can.

View Report

Watch our video

View the full study if you'd like to like a look yourself

Third Imaging Study

What is the next imaging study you will order?

No further imaging is required.
View ACR Appropriateness Criteria

What is your Diagnosis now that you have seen the imaging results?

The patient likely has COVID-19 pneumonia and pulmonary emboli secondary to the hypercoagulable state from their COVID-19 infection.

Current Acuity

Initially, you selected and we suggested acuity.

Has your concern for this patient changed?

The patient requires urgent management to prevent respiratory decompensation.

Assessment and Plan

Please provide your assessment and plan for this patient

The patient has COVID-19 pneumonia and pulmonary emboli secondary to the resultant hypercoagulable state. This can be confirmed with a COVID-19 test. He will require admission with supportive care and anticoagulation.

Lessons Learned: The hypercoagulable state secondary to COVID-19 infection can lead to a pulmonary embolism. COVID-19 pneumonia can appear on chest x-ray as multifocal pneumonia with numerous airspace consolidations. CT findings characteristic for COVID-19 pneumonia include diffuse ground glass opacities with basilar and peripheral predominance, air space consolidations, bronchovascular thickening, and traction bronchiectasis.

Socioeconomic Factors: Patients with high clinical suspicion for COVID-19 infection should be immediately tested and placed under droplet precautions prior to imaging, if possible. Portable imaging for the initial chest x-ray is preferable to minimize infection spread.

That's the end of the module! Once you've reviewed the video(s), you can click here for another case challenge.

Contributors:
Kevin Pierre, MD - Editor
Robbie Slater, MD - Supervising Editor
Bayar Batmunh, MS - Coordinator

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