Woman with cough and shortness of breath

Abstract

A 47-year-old woman with a history of being overweight was admitted to the ICU with 5 days of symptoms of headache, fever, myalgia, dry cough, odynophagia, and dyspnea. Physical examination revealed fever (38C), tachypnea (40 breaths per minute), oxygen desaturation (77%), and tachycardia (110 beats per minute). Pulmonary auscultation revealed crackles in the right hemithorax and decreased breath sounds and mild wheezing in the left hemithorax. Initial laboratory tests showedelevated inflammationmarkers. ACOVID-19polymerase chain reaction test was positive. The chest radiograph showed a diffuse interstitial-alveolar pattern in the right hemithorax. The left hemithorax showed an apical region without infiltrates; but with the presence of an area of atelectasis and retraction of the cardiac silhouette (Figure 1A). Because of the worsening of the respiratory pattern and hypoxemia, orotracheal intubation was necessary. A bronchoscopy was performed finding an intraluminal and highly vascularized tumor in the left main bronchus at 1.5 cm from the carina, which occluded 100% of the bronchial lumen (Figure 1B and C), and a bronchoscopic decompression was practiced. Then a chest tomography was performed, showing diffuse ground-glass opacities from apical to basal in the right lung and irregular interlobular septal thickening in relation to COVID-19 pneumonia. Surprisingly, the left lungwas foundwithout anyopacity suggestive of COVID-19 pneumonia (Figure 1D–F).