text,entities A 30 year old female patient with a past medical history of asthma morbid obesity BMI 39 5 and hypertension on an angiotensin converting enzyme ACE inhibitor presented with a 6 day history of fever Tmax 38 9°C cough and shortness of breath Laboratory studies were remarkable for lymphopenia 0 6×103 µL normal range 0 9×103 µL – 3 3×103 µL elevated serum creatinine 1 3 mg dL normal range 0 6 mg dL – 1 2 mg dL elevated aspartate aminotransferase 73 IU L normal range 13 IU L – 39 IU L elevated c reactive protein 8 6 mg dL normal range 0 – 1 mg dL elevated procalcitonin 2 39 ng mL normal 0 1 ng mL elevated interleukin 6 197 pg mL normal ≤ 5 pg mL elevated cardiac troponin I 142 ng L normal 15 ng L and mildly elevated d dimer 570 ng mL normal 500 ng mL She reported a history of contact with a COVID positive co worker and no recent travel Influenza A B RT PCR were negative She developed acute respiratory distress and was emergently intubated Prone portable PA chest X ray on second day of admission demonstrates persistent airspace opacities cardiomegaly and haziness of the cardiac borders Fig 3 ,"[[60, 66, 'DX'], [99, 111, 'DX'], [198, 203, 'DX'], [219, 224, 'DX'], [230, 249, 'DX'], [290, 301, 'DX'], [846, 851, 'DX'], [943, 969, 'DX'], [1070, 1099, 'EXIST_WORSEN'], [1101, 1113, 'EXIST_WORSEN'], [1118, 1149, 'EXIST_WORSEN']]" A 29 year old immunocompromised female patient with a 3 day history of cough and fever Past medical history includes severe ulcerative colitis treated with Tofacitinib The patient was admitted to the hospital ward and discharged one week after admission with complete recovery Chest X ray Increase of parenchymal opacity in right lower lobe ,"[[71, 76, 'DX'], [81, 86, 'DX'], [261, 278, 'ABST_RECOVER'], [305, 344, 'EXIST_WORSEN']]" 79 year old woman who presented with chest pain cough and fever for 3 days Coronavirus disease COVID 19 had recently been diagnosed in two of her household members Patient developed acute respiratory distress syndrome within subsequent few days and died 11 days after admission Courtesy of Song F Shanghai Public Health Clinical Center Shanghai China show ground glass opacification GGO on day 1 ,"[[37, 47, 'DX'], [49, 54, 'DX'], [60, 65, 'DX'], [78, 89, 'DX'], [99, 107, 'DX'], [188, 214, 'DX'], [370, 396, 'EXIST_WORSEN'], [398, 401, 'EXIST_WORSEN']]" 79 year old woman who presented with chest pain cough and fever for 3 days Coronavirus disease COVID 19 had recently been diagnosed in two of her household members Patient developed acute respiratory distress syndrome within subsequent few days and died 11 days after admission Courtesy of Song F Shanghai Public Health Clinical Center Shanghai China obtained on day 4 show GGO has progressed to airspace consolidation ,"[[37, 47, 'DX'], [49, 54, 'DX'], [60, 65, 'DX'], [78, 89, 'DX'], [99, 107, 'DX'], [188, 214, 'DX'], [388, 391, 'EXIST_WORSEN'], [410, 432, 'EXIST_WORSEN']]" History 73 year old male with aorta insufficiency and pacemaker was admitted to the hospital with fever and coughing after being in an area with Corona X findings day 1 normal findings day 4 bilateral consolidations intubated day 8 bilateral consolidation day 13 extubation PCR positive Follow up Extubated after 9 days of mechanical ventilation ,"[[98, 103, 'DX'], [108, 116, 'DX'], [195, 219, 'EXIST_WORSEN'], [238, 261, 'EXIST_WORSEN']]" 50 year old man was sent to the fever clinic for fever chills cough fatigue and shortness of breath He reported the travel history of Wuhan from January 8 to 12 and the first symptoms appeared on January 14 the first day of onset manifested as mild chills and dry cough But the patient continued to work until going to the hospital on January 21 Figure 1 The patient underwent a chest radiograph and a pharyngeal swab in the hospital The chest radiograph showed multiple patchy images of both lungs Appendix p2 On January 22 the 9th day of onset He was immediately transferred to the isolation ward and oxygen was given through the mask for oxygen support Interferon alpha 2b aerosol inhalation of 5 million U bid and lopinavir ritonavir 500 mg bid Po were used as antiviral treatment and moxifloxacin 0 4 g qd ivgtt to prevent secondary infections Given its severe shortness of breath and hypoxemia methylprednisolone 80 mg bid Ivgtt was given to reduce lung inflammation The laboratory test results are listed in the appendix p4 After receiving medication the patient's body temperature dropped from 39 0 ° C to 36 4 ° C ,"[[32, 37, 'DX'], [49, 54, 'DX'], [56, 62, 'DX'], [64, 69, 'DX'], [84, 103, 'DX'], [258, 264, 'DX'], [269, 278, 'DX'], [476, 512, 'EXIST_WORSEN'], [899, 925, 'DX'], [930, 939, 'DX']]" chest film normal on admission to hospital,"[[0, 20, 'ABST_RECOVER']]" patient on mechanical ventilation with bilateral consolidations on the chest film,"[[34, 76, 'EXIST_WORSEN']]" Chest film of a 83 year old male with mitral insufficiency pulmonary hypertension and atrial fibrillation with COVID 19 infection Ground glass opacification and consolidation in right upper lobe and left lower lobe arrows ,"[[60, 82, 'DX'], [112, 120, 'DX'], [132, 216, 'EXIST_WORSEN']]" Within a few hours after presentation on the ER the patient became hypoxic and was treated with mechanical ventilation Later that day the patient was transferred to another hospital History 64 year old male with fever and coughing for 2 weeks after a skiing holiday with his family CT findings Widespread GGO in all lobes Crazy paving blue arrows Vascular enlargement black arrow Subpleural bands with retraction yellow arrows Consolidation and bronchiectasis posteriorly in the lower lobes CORADS 5 very high suspicion of COVID 19 PCR positive,"[[67, 74, 'DX'], [215, 220, 'DX'], [225, 233, 'DX'], [299, 326, 'EXIST_WORSEN'], [356, 376, 'EXIST_WORSEN'], [392, 424, 'EXIST_WORSEN'], [460, 505, 'EXIST_WORSEN'], [541, 549, 'DX'], [551, 563, 'DX']]" 83 year old male with mitral insufficiency and pulmonary hypertension was diagnosed with COVID 19 infection The chest film shows consolidation in the right upper lobe green arrow and probably some consolidation in the left lower lobe The patient decided not to be treat with mechanical ventilation and died four days later ,"[[47, 69, 'DX'], [89, 97, 'DX'], [130, 167, 'EXIST_WORSEN'], [200, 236, 'EXIST_WORSEN']]" Day 1 normal findings History 73 year old male with aorta insufficiency and pacemaker was admitted to the hospital with fever and coughing after being in an area with COVID 19 PCR positive Follow up extubated after 9 days of mechanical ventilation ,"[[55, 74, 'DX'], [123, 128, 'DX'], [133, 141, 'DX'], [170, 178, 'DX'], [180, 192, 'DX']]" Day 4 bilateral consolidations intubated History 73 year old male with aorta insufficiency and pacemaker was admitted to the hospital with fever and coughing after being in an area with COVID 19 PCR positive Follow up extubated after 9 days of mechanical ventilation ,"[[7, 31, 'EXIST_WORSEN'], [74, 93, 'DX'], [142, 147, 'DX'], [152, 160, 'DX'], [189, 197, 'DX'], [199, 211, 'DX']]" Day 8 bilateral consolidation History 73 year old male with aorta insufficiency and pacemaker was admitted to the hospital with fever and coughing after being in an area with COVID 19 PCR positive Follow up extubated after 9 days of mechanical ventilation ,"[[7, 30, 'EXIST_WORSEN'], [63, 82, 'DX'], [131, 136, 'DX'], [141, 149, 'DX'], [178, 186, 'DX'], [188, 200, 'DX']]" Day 13 extubation History 73 year old male with aorta insufficiency and pacemaker was admitted to the hospital with fever and coughing after being in an area with COVID 19 PCR positive Follow up extubated after 9 days of mechanical ventilation ,"[[51, 70, 'DX'], [119, 124, 'DX'], [129, 137, 'DX'], [166, 174, 'DX'], [176, 188, 'DX']]" 72 year old female came to the hospital with sore throat cough dyspnea anosmia and fever for 5 days Physical exam revealed no pathological findings Biochemistry showed lymphopenia decreased prothrombin activity c reactive protein increase and hypoxemia RT PCR was positive for COVID 19 No co morbidities or risk factors were communicated AP chest X Ray a reticular nodular pattern in both lungs mostly in the right one was observed In addition mild opacities in the superior middle and lower right lobes were depicted ,"[[45, 56, 'DX'], [58, 63, 'DX'], [65, 72, 'DX'], [74, 81, 'DX'], [86, 91, 'DX'], [173, 184, 'DX'], [250, 259, 'DX'], [285, 293, 'DX'], [366, 405, 'EXIST_WORSEN'], [459, 518, 'EXIST_WORSEN']]" A 72 year old female patient with a history of ischaemic stroke ocular myasthenia arterial hyper tension and hypercholesterolaemia was admitted to the emergency department because of dyspnoea She reported having fever and cough for a week At admission her pulse oximeter saturation was 84 the tympanic temperature was 37 6 °C Laboratory findings revealed elevated C reactive protein 19 69 mg dL normal range 0 01 0 5 mg dL and mild lymphopenia 0 7X10 3 mm 3 normal range 1 0 4 0 X10 3 mm 3 The patient also underwent non contrast chest CT AP chest X ray obtained on the second day of admission demonstrated diffuse bilateral opacities tracheal cannula na sogastric tube internal jugular CVC,"[[186, 194, 'DX'], [216, 221, 'DX'], [226, 231, 'DX'], [444, 455, 'DX'], [624, 651, 'EXIST_WORSEN']]" A 74 year old woman with history of hypertension and heart disease who had been discharged 10 days before knee prosthetic surgery was admitted with 4 day history of fever dry cough and dyspnoea She had not left home since discharge and no family member was affected Analysis revealed lymphopenia elevation of C reactive protein and a positive RT PCR The patient was admitted to the intensive care unit with a favourable course Chest X ray at admission showed diffuse reticular pattern with small opacities in both basal regions,"[[36, 48, 'DX'], [53, 66, 'DX'], [167, 172, 'DX'], [174, 183, 'DX'], [188, 196, 'DX'], [289, 300, 'DX'], [468, 536, 'EXIST_WORSEN']]" A 74 year old woman with history of hypertension and heart disease who had been discharged 10 days before knee prosthetic surgery was admitted with 4 day history of fever dry cough and dyspnoea She had not left home since discharge and no family member was affected Analysis revealed lymphopenia elevation of C reactive protein and a positive RT PCR The patient was admitted to the intensive care unit with a favourable course Chest X ray on the second day showed diffuse reticular pattern and increased density in both lungs,"[[36, 48, 'DX'], [53, 66, 'DX'], [167, 172, 'DX'], [174, 183, 'DX'], [188, 196, 'DX'], [289, 300, 'DX'], [473, 534, 'EXIST_WORSEN']]" A 74 year old woman with history of hypertension and heart disease who had been discharged 10 days before knee prosthetic surgery was admitted with 4 day history of fever dry cough and dyspnoea She had not left home since discharge and no family member was affected Analysis revealed lymphopenia elevation of C reactive protein and a positive RT PCR The patient was admitted to the intensive care unit with a favourable course Chest x ray on the eighth day showed improvement with decreased of high density and reticular pattern more evident in the upper left lobe ,"[[36, 48, 'DX'], [53, 66, 'DX'], [167, 172, 'DX'], [174, 183, 'DX'], [188, 196, 'DX'], [289, 300, 'DX'], [473, 574, 'ABST_RECOVER']]" A sixty five year old woman presented to the emergency department with a 5 day history of nausea and diarrhoea and a 2 day onset of non productive cough and asthenia without fever Her husband had similar symptoms and both had no epidemiological context for COVID 19 infection She had type 2 diabetes mellitus arterial hypertension and chronic renal disease Both were positive on RT PCR test for COVID 19 Anteroposterior chest x ray of a patient infected with COVID 19 that shows consolidations,"[[90, 96, 'DX'], [101, 110, 'DX'], [132, 152, 'DX'], [157, 165, 'DX'], [175, 180, 'DX'], [260, 268, 'DX'], [401, 409, 'DX'], [466, 474, 'DX'], [480, 500, 'EXIST_WORSEN']]" showing interstitial alveolar hypodiaphania of the middle basal field on the left and basal seat on the right which is associated with pleural veiling on the left ,"[[30, 81, 'EXIST_WORSEN'], [136, 163, 'EXIST_WORSEN']]" Softened confluent densities with peripheral distribution with associated interstitial weft thickening No pleural effusion Thickening with frosted glass with peripheral distribution and associated thickening of the interlobular septa absence of pleural effusion and in the absence of significant ilo mediastinal lymphadenopathies characterize the TC pattern highly suggestive of CoViD 19 then found later with pharyngeal swab ,"[[9, 57, 'EXIST_WORSEN'], [74, 102, 'EXIST_WORSEN'], [104, 123, 'ABST_RECOVER'], [199, 235, 'EXIST_WORSEN'], [237, 264, 'ABST_RECOVER'], [276, 314, 'ABST_RECOVER'], [315, 332, 'EXIST_WORSEN'], [383, 391, 'DX']]" posterior bilateral interstitial engagement at the base of the alveolar consolidation area with air bronchograms and moderate concomitant pleural effusion The X ray examination shows nuanced parenchymal thickening in the middle and lower field in the right hemithorax and in the middle field on the left ,"[[64, 86, 'EXIST_WORSEN'], [97, 113, 'EXIST_WORSEN'], [118, 155, 'EXIST_WORSEN'], [185, 215, 'EXIST_WORSEN']]" Fever cough and shortness of breath on arrival patient saturation of oxygen was 75 There is peripheral patchy air space opacification seen in both lung lower zones with diffuse ground glass haze bilaterally This is the initial plain film raising suspicion of COVID 19 pneumonia RT PCR was sent which turned out to be positive The patient was referred to a COVID 19 dedicated center for further treatment ,"[[0, 5, 'DX'], [7, 12, 'DX'], [17, 36, 'DX'], [95, 160, 'EXIST_WORSEN'], [264, 272, 'DX'], [273, 282, 'DX'], [363, 371, 'DX']]" Fever dry cough and dyspnea for few days Multiple peripheral opacifications throughout both lungs ,"[[0, 5, 'DX'], [7, 16, 'DX'], [21, 28, 'DX'], [44, 101, 'EXIST_WORSEN']]" Moderate amount of mid zone airspace opacification in both mid zones with a peripheral predominance ,"[[19, 68, 'EXIST_WORSEN']]" just stepped down from HDU New oxygen requirements Extensive bilateral airspace opacification in both lungs more pronounced on the right and with relative sparing of the left upper lobe The airspace opacification has a peripheral distribution No pleural effusions ,"[[63, 109, 'EXIST_WORSEN'], [195, 247, 'EXIST_WORSEN'], [250, 270, 'ABST_RECOVER']]" ITU admission Endotracheal tube nasogastric tube and right internal jugular lines suitable sited Bilateral airspace opacification persists but it has partially regressed since the prior radiograph ,"[[101, 174, 'ABST_RECOVER']]" Lines and tubes suitably sited Minor regression in the appearances of the lungs from the radiograph of 2 days earlier ,"[[33, 81, 'ABST_RECOVER']]" increasing oxygen requirements Extubated Positive pressure ventilation mask in use Widespread bilateral airspace opacification in both lungs No longer is the distribution peripheral or sparing the apices No pleural effusions or lobar consolidation ,"[[88, 145, 'EXIST_WORSEN'], [213, 256, 'ABST_RECOVER']]" Extubated since the prior radiograph Partial regression of the diffuse lungs changes however air bronchograms are now evident in both upper lobes ,"[[39, 78, 'ABST_RECOVER'], [96, 148, 'EXIST_WORSEN']]" Remarkable improvement in appearances since the radiograph 4 days earlier The current appearances of the lungs are nearly normal and better than the day 1 admission appearances ,"[[0, 37, 'ABST_RECOVER'], [105, 132, 'ABST_RECOVER']]"