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放射線科での偶発的なCOVID-19。乳がんのCT病期分類を受けた無症候性患者におけるCOVID-19の放射線所見
Incidental COVID-19 in the radiology department: Radiographic findings of COVID-19 in asymptomatic patient undergoing CT staging for breast cancer.
PMID: 32685081 PMCID: PMC7287467. DOI: 10.1016/j.radcr.2020.05.080.
抄録
2016年に浸潤性管腔癌と診断された59歳の監禁女性が乳癌の評価のために運ばれてきた。乳がん再診断のために胸部CT検査を行ったところ，非定型ウイルス性肺炎を疑う両側のびまん性地中硝子体混濁と右下葉に逆ハローサインが認められた．症状は熱感があり，酸素飽和度は100％で，胸痛，息切れを認めなかった．健康診断では両側の呼吸音の低下と呼気喘鳴を認めた。その後，COVID-19検査を受けたが陽性であった．新型重症急性呼吸器症候群コロナウイルス2（SARS-CoV-2、COVID-19としても知られている）への感染は、初期段階では無症状のままであることがあり、標準的な臨床適応では過少認識や偶発的な発見につながる。病院、特に画像診断サービスは、臨床所見と結果としての放射線学的パターンとの間に潜在的な相違があることを念頭に置きながら、健康上の注意事項に関してそれに応じた準備をしなければならない。このような意識は、リスクの高い患者（例えば、受刑者）ではより高められるべきである。さらに、初期の段階でこのウイルスが偶発的に検出された場合に対処することで、その後の措置がウイルスの拡散を防ぐのに役立つ可能性があります。
A 59-year-old incarcerated woman who was diagnosed with invasive ductal carcinoma in 2016 was brought in for evaluation of the breast cancer. Upon evaluation of the computed tomography chest for breast cancer restaging, diffuse bilateral ground glass opacities and a reverse halo sign in the right lower lobe concerning for atypical viral pneumonia were discovered. The patient was afebrile, had an oxygen saturation of 100%, and denied chest pain as well as shortness of breath. On physical exam, she exhibited decreased breath sounds bilaterally and expiratory wheezing. She later received a COVID-19 test, which came back positive. Infection with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, also known as COVID-19) may remain asymptomatic in the initial phase, leading to under-recognition and incidental detection on procedures for standard clinical indications. Hospitals, in particular diagnostic imaging services, should prepare accordingly in regard to health precautions while keeping in mind the potential discrepancies between clinical presentation and resultant radiologic patterns. This awareness should be heightened in patients at higher risk (ie, prisoners). Furthermore, by acting upon the incidental detection of this virus during its early stages, subsequent steps could help prevent the spread of the virus.
© 2020 The Authors. Published by Elsevier Inc. on behalf of University of Washington.