Covid-19 (case n. 2) with mediastinal lymphadenopathies
Female patient, 61 years old, cardiopathic, hypertensive and diabetic following an oral hypoglycemic treatment. The patient is resident in Fabrizia, a "red zone" in the province of Vibo Valentia (Italy). Positive pathological history due to proximity for being in contact with Covid-19 patient: her sister had a unilateral disease (1). For this reason, an oro- and nasopharyngeal swab was taken from the patient and the test result was positive to Covid-19. On 10/4, the patient was transported by ambulance to the Emergency Room of Serra San Bruno due to the onset of a persistent cough, low-grade fever (37.3°) and diarrhoea. Laboratory tests showed no significant alterations, except for the hyperglycemia related to the already reported diabetes. Saturation and blood gas analysis were within the normal range. Chest HRCT showed some ground glass parenchymal clusters with prevalent subpleuric patches (fig. 1, 2, 3, 4, 5, 6, 10), more numerous on the left side (anterior and posterior segment of the upper lobe, lingula, lateral segment of the lower lobe) compared to the right side (lateral segment of the middle lobe and, pseudonodular, in the lateral basal segment of the lower lobe). In mediastinal filter reconstructions (fig. 7, 8, 9, 11) several lymphadenopathies were also detectable in the upper paratracheal and prevascular space, the largest of which had a short axis of about 17 mm and caused compression on the adjacent pulmonary parenchyma (anterior segment of the left upper lobe, fig. 10, arrow). Another more circumscribed lymphadenopathy was found in the lower paracaval site. The patient was admitted to the Unit of Infectious Diseases of "G. Jazzolino" Hospital in Vibo Valentia, where she was treated with an antiviral therapy, levofloxacin and lactic ferments. Thanks to the improvement of her clinical conditions, the patient (negative swab) was discharged on 25/4.
The above case represents a rare manifestation of the Covid-19 disease: according to Shi H. et al, only 6% of patients with Coronavirus infection have mediastinal lymphadenomegaly (2). It has also been suggested that this finding may be related to the severity of the disease, since it is more frequent in patients admitted to intensive care (3,4). However, the case presented above does not fall within the latter types due to its clinical course. 1. Gismondo Velardi G, Bova A, Trecroci IV, Greco GE, Militano L, Lico M et al. COVID-19: caso 104 https://www.sirm.org/2020/05/27/covid-19-caso-104/ 2. Shi H, Han X, Jiang N, Cao Y, Alwalid O, Gu J et al. Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study. Lancet Infect Dis 2020; 20: 425–34. 3. Li K, Wu J, Wu F, Guo D, Chen L, Zheng F et al. The clinical and chest CT features associated with severe and critical COVID-19 pneumonia. Invest Radiol 2020; published online Feb 29. DOI:10.1097/RLI.0000000000000672. 4. Colombi D, Bodini FC, Petrini M, Maffi G, Morelli N, Milanese G et al. Well-aerated Lung on Admitting Chest CT to Predict Adverse Outcome in COVID-19 Pneumonia. Radiology 2020 Apr 17:201433. doi:10.1148/radiol.2020201433.