Imaging changes of severe COVID-19 pneumonia in advanced stage.

We recently reported in Intensive Care Medicine the imaging changes of acute stage from a case of 75-year-old male patient with severe COVID-19 pneumonia combined acute respiratory distress syndrome (ARDS), septic shock, and multiple organ disfunction syndrome (MODS) who had a history of 10-year hypertension and 1-year diabetes. He presently received advanced life support treatment including respiratory support (invasive mechanical ventilation) and circulatory support (vasoconstrictor assistance), as well as intermittent renal replacement therapy (IRRT) in intensive care unit (ICU) of our hospital—a tertiary teaching hospital of medical university. Because his MODS still existed on the day 20 after symptom onset, we had to re-examine the chest computed tomographic (CT). The results showed that early changes of reticular pulmonary fibrosis appeared in Panels D, E, and F (marked by green arrows), compensatory emphysema occurred in Panels D and E (marked by blue arrows), and pulmonary cavity formation appeared in Panel F (marked by blue arrows), compared with acute stage of the day 5 after symptom onset, inflammatory lesions and ground glass shadow of Panels A and B (marked by red arrows), as well as septal line of Panel C (marked by yellow arrows). Presently, this patient is still under the condition of advanced life support therapy (Fig. 1).

Fig. 1

Chest computed tomographic image changes of a 75-year-old patient infected with 2019 Coronavirus Disease (COVID-19) in advanced stage