Admission Chest X-ray
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Clinical information - day 1
- 50-year-old male smoker
- Fever and cough
- Tested positive for COVID-19 the previous day
- Returned to hospital with increasing shortness of breath
- Maintaining O2 saturation on 15 litres of O2
Admission Chest X-ray
- PA chest X-ray (patient able to stand)
- Distribution of shadowing is asymmetric - predominantly affecting the right lung
- Classification: Severe
Admission to ITU
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Clinical information - day 6
- Worsening respiratory failure
- Admitted to ITU
Admission to ITU
- Supine image - requested to assess tube position
- The endotracheal (ET) tube tip is located approximately 3.5 cm above the carina
- A nasogastric tube is in situ
- Misplaced right internal jugular catheter - instead of passing into the superior vena cava the catheter has passed laterally into the right subclavian vein
- Comparison with the previous image shows worsening of lung shadowing
- Classification: Severe
Tubes repositioned
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Clinical information - later on day 6
- The right internal jugular catheter and the ET tube were repositioned
- Chest X-ray requested to check position and to exclude a pneumothorax
Tubes repositioned
- The ET tube tip is located approximately 6 cm above the carina
- The internal jugular catheter is now positioned over the SVC
- Classification: Severe
Discharge from ITU
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Clinical information - day 16
- Continued stay in ITU uneventful
- Patient extubated
- Chest X-ray requested to see if shadowing had resolved
Discharge from ITU
- PA chest (patient able to stand again)
- Marked reduction in extent and density of lung shadowing
- The pattern of shadowing remains typical of COVID-19 lung disease - patchy, peripheral, bilateral and basal
- Classification: Moderate
- (The patient went on to make a full clinical and radiological recovery)