Hilar Lymphadenopathy, a Novel Finding in the Setting of Coronavirus Disease (COVID-19)

A Case Report

Mohsin Sheraz Mughal; Rameez Rehman; Ramy Osman; Nathan Kan; Hasan Mirza; Margaret H. Eng

Disclosures

J Med Case Reports. 2020;14(124) 

In This Article

Discussion

Chest CT has been used extensively not only to diagnose but also to characterize the distinguishing radiological findings associated with viral pneumonia. SARS-CoV-2 is diagnosed by COVID-19 symptomatology and RT-PCR with NP swabs. As the outbreak of COVID-19 has progressed, CT alongside RT-PCR has been used broadly to diagnose COVID-19.[9] There is convincing evidence that viral load is high in NP samples, and RT-PCR can have false-positive and false-negative results. If there is a high clinical suspicion, then repeat RT-PCR with resampling from another site is recommended.[10] There have been patients with a negative result of RT-PCR but whose CT scan was suggestive of viral pneumonia. Later, those patients had positive test results for SARS-CoV-2.[11,12] Yan Li and Liming Xia suggested that CT scans can be used as a rapid diagnostic tool to diagnose COVID-19 on the basis of a low rate of missed diagnoses.[13] This argues in favor of chest imaging earlier in the course with clinical suspicion of viral pneumonia. Frequently encountered imaging findings include peripheral airspace consolidations and bilateral ground-glass opacities; less common associations include cavitation and air bronchograms. To our knowledge, hilar lymphadenopathy has not been reported in the setting of COVID-19. RT-PCR of the NP swab sample is the preferred and recommended screening test worldwide. However, false-negative results may occur because of inadequate viral load or impaired sampling techniques. In these circumstances, chest CT scans and SARS-CoV-2 immunoglobulin M antibody testing can significantly aid in the diagnostic workup. CT scan findings can vary on the day of imaging, and some studies even suggested obtaining a repeat CT scan to rule out worsening of the disease.[14] Clinicians must be aware of rare clinical and radiological findings in order to diagnose this entity. In the absence of effective antiviral therapy and persistent evidence-based guidelines, HCQ and zinc were initially used for COVID-19. Interleukin-6 inhibitors are used against the hyperinflammatory state because of the proposed cytokine storm syndrome. Immunoglobulin G antibodies against SARS-CoV-2 start developing after 2 weeks of disease onset, and convalescent plasma from the recovered patient population is being studied in compassionate trials at different centers. The efficacy of these medications and therapeutic interventions is yet to be established. Calcified lymph nodes have been reported in the late stages of alphaherpesvirus pneumonia.[15] However, bilateral hilar lymphadenopathy has not been reported in the setting of COVID-19. Reporting and recognizing the rare imaging findings will help clinicians to understand their frequency and association with the disease. Follow-up imaging should be pursued to evaluate the persistence or resolution of hilar lymphadenopathy. More information with long-term follow-up is required to establish the importance and clinical implications of our findings.

processing....