Margarita Kirienko1, Barbara Padovano2, Gianluca Serafini2, Alfonso Marchianò3, Alessandro Gronchi4, Ettore Seregni2, Alessandra Alessi2. 1. Nuclear Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, Milan, Italy. margarita.kirienko@icloud.com. 2. Nuclear Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, Milan, Italy. 3. Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. 4. Melanoma and Sarcoma Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
The incidence of Covid-19 is rapidly growing worldwide. In Italy, as of April 3,, 119,827 cases have been reported with a toll death of 14,681 [1]; in Lombardy, the number of cases was 47,520, with 8311 deaths [2].Early identification of SARS-CoV-2 infection is important for the safety of patients and health workers. Imaging can play a role in the diagnosis of Covid-19 [3, 4].A 73-year-old male from Bergamo (Italy) was admitted to the National Cancer Institute of Milan, for curative surgery of a 22.5 × 14.2 × 19 cm vascular tumour, intermediate risk, of the right retroperitoneum. At admission, he was asymptomatic, and during hospitalization, he progressively developed fever (up to 38 °C) and hypoxemia. Temporal track of clinical data, laboratory tests and imaging findings (both computed tomography (CT) and [18F]fluoro-deoxyglucose ([18F]FDG) positron emission tomography (PET)/CT), retrospectively retrieved, are reported in the Figure. Imaging suggested viral infection. Diagnosis was obtained by means of reverse transcription polymerase chain reaction on rhino pharyngeal swab. Subsequently, the patient was transferred to a Covid-19 dedicated hospital; surgery was postponed. We could not reach the patient for consent; local ethics committee approved the publication.Epidemiological data, worldwide and at local level, need to be considered when approaching a patient with respiratory symptoms. Neoplastic disease may constitute a risk factor and also a confounding factor. It is important to recognize Covid-19 as early as possible for optimal patient management and ensure hospital staff and patient’s safety. Imaging demonstrated Covid-19 even in the presence of mild symptoms. In view of its high sensitivity, imaging may be considered for anticipating diagnosis and safety interventions. Early after image acquisition, scans should be reviewed to identify suspected Covid-19 cases. High-resolution CT of the thorax during PET acquisition could improve lung abnormalities detection.