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Einstein (São Paulo)

versão impressa ISSN 1679-4508versão On-line ISSN 2317-6385

Einstein (São Paulo) vol.18  São Paulo  2020  Epub 13-Nov-2020

https://doi.org/10.31744/einstein_journal/2020ai5891 

Learning by Images

COVID-19 on resonance magnetic: an incidental but important finding in times of pandemic

José Vitor Rassi Garcia1 
http://orcid.org/0000-0001-5241-1651

Eduardo Kaiser Ururahy Nunes Fonseca1 
http://orcid.org/0000-0002-0233-0041

Rodrigo Caruso Chate1 
http://orcid.org/0000-0002-4193-7647

Daniel Giunchetti Strabelli1 
http://orcid.org/0000-0002-0526-5775

Lucas de Pádua Gomes de Farias1 
http://orcid.org/0000-0001-5195-9818

Bruna Melo Coelho Loureiro1 
http://orcid.org/0000-0002-7270-2664

Lorena Carneiro Ferreira1 
http://orcid.org/0000-0003-3960-1375

Márcio Valente Yamada Sawamura1 
http://orcid.org/0000-0002-9424-9776

1Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.


A 34-year-old woman with a personal history of ulcerative rectocolitis for 5 years who were using sulphasalazine and mesalazine. The patient was admitted to the emergency unit presenting asthenia, dyspnea, fever, cough with hemoptoic sputum for 8 days, and oxygen saturating by 97% in room air. The computed tomography (CT) (Figure 1) showed sparse ground-glass opacities, although more evident in the posterior contour of lower lobes. She was hospitalized and tested positive for coronavirus infection identified through real-time reverse-transcription-polymerase-chain-reaction (RT-PCR) test. During the hospitalization she presented diffuse abdominal pain with liquid, dark, and foul-smelling stools, and underwent an upper abdominal magnetic resonance.

Figure 1 Axial chest computed tomography without contrast showing bilateral ground-glass opacities in lung bases, with peripheral and posterior predominance, suspected of being affected by COVID-19 

Magnetic resonance imaging cuts (Figure 2) showed bilateral ground-glass opacities in lung bases with posterior and subpleural predominance with similar aspects to those showed in the CT.

Figure 2 (A) axial upper abdominal computed tomography in T2 sequence ground-opacities showing subpleural and posterior predominance, suspected by COVID-19; (B) changes in the frame of the same resonance T2-weighted image, making findings more evident, similar to the one expected in computed tomography; (C) chest computed tomography of the patient at the same level showing a great similarity featured changes in magnetic resonance cuts 

A viral infection when presenting lung manifestations often can be similar and indistinguishable pattern among them. In case of COVID-19, we know the typical pattern is peripheral and bilateral ground-glass, or round and multifocal, associated with or not to consolidation and septal lines, often predominant in the posterior aspect of the lower lobes.(1) The signal of reversed halo can appear more lately in time.

Although chest magnetic resonance (MR) is seldom-used method and often not indicated for lung pulmonary assessment in suspected cases of COVID-19, this method can be adopted to analyze radiological signs in the lung parenchyma that indicate the presence of this disease in patients who conducted a study for other reasons. The radiologist needs to understand these findings and be alert to recognize them in cases with confusing respiratory picture. In our case, we observed ground-glass opacities with intermediate signal in T2 in lung bases, such as the one already reported(2) in a tomography study with similar aspects and distributions. In cases that similar findings of the present report are detected in patients without diagnostic and who would be conducting MR for other reasons, i.e., to investigate abdomen and dorsal spine, there is a need to inform the physician assistant about patterns in the lungs as markers of COVID-19 infection, especially in times of pandemic. This would help to establish rapid therapeutic approach, immediate isolation of the infected individual, and consequently, reduction in person-to-person transmission and organization of close monitoring.

REFERENCES

1. Simpson S, Kay FU, Abbara S, Bhalla S, Chung JH, Chung M, et al. Radiological Society of North America Expert Consensus Statement on Reporting Chest CT Findings Related to COVID-19. Endorsed by the Society of Thoracic Radiology, the American College of Radiology, and RSNA - Secondary Publication. J Thorac Imaging. 2020;35(4):219-27. [ Links ]

2. Fonseca EK, Chate RC, Sasdelli Neto R, Ishikawa WY, Silva MM, Yokoo P, et al. Findings of COVID-19 on magnetic resonance imaging. Radiology: Cardiothoracic Imaging. 2020;2(2):1-3. [ Links ]

Received: June 24, 2020; Accepted: October 08, 2020

Corresponding author: José Vitor Rassi Garcia, Rua Dr. Ovídio Pires de Campos, 75 – Cerqueira César Zip code: 05403-010 – São Paulo, SP, Brazil Phone: (55 61) 98130-8487 E-mail: josevitorrg@gmail.com

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