key: cord-0982097-mpckxs16
authors: Wang, Jing; Shu, Shenglei; Zhang, Tianjing; Zheng, Chuansheng
title: Chest CT findings in a pregnant woman in the second trimester with COVID-19 pneumonia
date: 2020-07-29
journal: Clin Imaging
DOI: 10.1016/j.clinimag.2020.07.021
sha: a1da3f4d0cd6d4f7b40b91171b29781aea5b8e6d
doc_id: 982097
cord_uid: mpckxs16

Pregnant women with 2019 novel coronavirus disease (COVID-19) pneumonia are a special group of patients in the pandemic. We report a case of pregnant woman with COVID-19 pneumonia in the second trimester. Clinical and imaging features of the patient were similar to that reported in the literatures for both perinatal patients and non-pregnant patients.

At the end of December 2019, a new type of infectious pneumonia, 2019 novel coronavirus disease (COVID-19) pneumonia caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2), broke out in Wuhan, China [1, 2] . Most infected people present with respiratory symptoms at disease onset, some may worsen to acute respiratory distress syndrome [3] [4] [5] . Dysfunction of organs other than respiratory system such as hepatic function impairment may occur and indicate higher risk of progression to severe disease [2] . Chest CT scanning is essential for the diagnosis and treatment monitoring of COVID-19 pneumonia. Radiological findings of COVID-19 pneumonia in non-pregnant adults have been extensively described and summarized，ground-glass opacities that progressed to or co-existed with consolidation are common findings in chest CT [6] [7] [8] . Several studies have reported chest CT manifestations of perinatal pregnant patients with COVID-19, with imaging J o u r n a l P r e -p r o o f In late January, 2020, a 26-year-old woman who was 26 weeks pregnant without underlying illness was admitted to fever clinic of Union Hospital (Tongji Medical College, Wuhan, Hubei Province). She presented a history of fever and myalgia for 10 days followed by dry cough and dyspnea for 3 days. The patient is a healthcare worker in the obstetrics department of a secondary hospital in Wuhan. She had contact history with a COVID-19 patient in maternity ward 2 weeks before onset. On admission (day 1), her vital signs were normal except for elevated body temperature (38.4℃). Auscultation revealed reduced breath sounds in both lungs. Blood oxygen saturation detected by pulse oximeter was 95%. Complete blood cell count showed normal white blood cell count (WBC, 6.54×10 9 /L, normal range 3.5-9.5×10 9 /L), mildly elevated neutrophil ratio (76%, normal range 40%-75%) and normal lymphocyte ratio (20%,normal range 20%-50%). Red blood cell count (RBC, 3.43×10 12 /L) and hemoglobin content (106g/L) decreased slightly. Increased level of interleukin-6 (7.98pg/ml, normal range 0.1-2.9pg/ml), was detected. The hypersensitive C-reactive protein level and with the prescription of oral medicine of polyene phosphatidylcholine, and she was asked to stay quarantined at home for another two weeks. By the end of observation, the patient recovered well without any discomfort.

We reported a case of pregnant woman with COVID-19 pneumonia in the second trimester, who had a history of exposure to confirmed cases, positive nucleic acid test results and typical clinical manifestations at admission. The clinical characteristics of pregnant woman in this report were similar to those in late pregnancy and non-pregnant adult patients [4, 9] . The onset symptoms of the patient were fever and myalgia , followed by dry cough and dyspnea. These clinical presentations were among the most common symptoms in pregnant patients with COVID-19 pneumonia [12] . Similar to most pregnant cases reported in Wuhan city, the patient in our report showed mild to moderate clinical symptoms, and responded well to treatment and recovered completely [12] . Hepatic function impairment was common in patients with COVID-19 including perinatal patients, which occurred more often in the severe course of the disease [2, 12] . The liver function abnormality in COVID-19

patients may be result of immune mediated damage due to inflammatory response, direct toxicity to hepatic cells, drug induced liver injury or reactivation of per-existing liver disease [13] . J o u r n a l P r e -p r o o f quickly with thickening of interlobular interstitium and gradually turned to patchy consolidation. With the support of symptomatic treatment, consolidation within the lungs will undergo a gradual process of resolution [6, 8] . Pregnant patients with COVID-19 pneumonia showed similar course in imaging as non-pregnant patients [10] . The initial CT scan of our patient showed multiple subplerual and peribronchovascular areas of air-space disease with various density involving bilateral lower lobes, left upper lobe, and to lesser extent right middle lobe. . The mixed densities of opacities containing ground-glass and consolidation demonstrated the dynamic transition of early phase to peak phase in COVID-19 pneumonia. Imaging manifestations in 10 days after symptom onset of the patient was consistent with characteristics of peak period according to staging system by Pan et al [8] . Follow-up CT chest performed for suspicion of superimposed secondary bacterial infection after 10 days from the initial exam has shown resolving changes of pre-existing areas of air-space disease, with no new areas of lung involvement. Although contradiction between imaging change and clinical condition evolution was reported for a pregnant patient, as described in most studies, the improvement in imaging corresponded to clinical recovery in our report [14] .

In conclusion, the patient in the second trimester with COVID-19 pneumonia in our report showed similar clinical and imaging features as patients in late pregnancy and non-pregnant adult patients.

Chest CT findings corresponded well to clinical condition evolution while hepatic toxicity of antiviral drugs may cause the delayed recovery of liver function in the patient.

A Novel Coronavirus from Patients with Pneumonia in China

Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumonia

Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study

Clinical Characteristics of Coronavirus Disease 2019 in China

Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China

Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study

Emerging Coronavirus 2019-nCoV Pneumonia

Time Course of Lung Changes On Chest CT During Recovery From 2019 Novel Coronavirus (COVID-19) Pneumonia

Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records

Pregnancy and Perinatal Outcomes of Women With Coronavirus Disease (COVID-19) Pneumonia: A Preliminary Analysis

Clinical and CT imaging features of the COVID-19 pneumonia: Focus on pregnant women and children

Clinical Characteristics of Pregnant Women with Covid-19 in

Liver international : official journal of the International Association for the Study of the

Chest CT Findings in a Pregnant Patient with