Main Text
A 30-year-old man presented with a 2-day-history of fatigue, fever (39.0℃) and cough without sputum and respiratory failure. 6 days ago, he had participated the banquet and meeting in Tokyo, in which COVID-19 had been spreading. Laboratory tests showed elevated C-reactive protein (4.23mg/dL) without the specific findings about any pathogen. Chest CT revealed only tree-in-bud appearance on the right upper-lobe (Fig.1B) and centri-lobular nodules with unclear edge on the left lower lobe without typical ground-glass opacity (GGO) as COVID-19 (Fig. 1A-C). Diagnosis of COVID-19 was made by RT-PCR from nasopharyngeal swab. He has received supportive care and the symptoms have improved.
COVID-19 usually demonstrates the specific pattern of Chest CT-findings, such as GGO, inverted-halo sign, and so on [1,2]. However, it had been reported that several cases showed only atypical findings or no significant findings in Chest CT [1,2]. Although the role of CT images for COVID-19 is extremely high, it is also important to recognize that some cases show only atypical findings in CT, especially at a diagnosis. We should not decide whether or not to carry out PCR test based on CT findings alone. At the time, we physicians should make comprehensive judgement for this pandemic situation.