Evolution of Cavitary Lesion in a Case of COVID-19 Pneumonia: A Rare Entity

Abstract

Abstract Introduction Toward the end of 2019, a novel coronavirus was identified as the causative organism of a cluster of pneumonia cases in Wuhan, China, spreading rapidly resulting in an epidemic throughout China, followed by a global pandemic. The initial radiological findings of coronavirus disease 2019 (COVID-19) pneumonia at the early stage on a computed tomography (CT) scan include multiple small patchy shadows and interstitial inflammation, predominantly distributed in the peripheral one-third of the lungs. Gradually, it develops into multiple ground glass opacities and infiltrates in the lungs. Furthermore, pulmonary consolidation is observed, but pleural effusion is rare. Objective From time of presentation to complete recovery, CT scans show significant morphological changes in the lesions, but very few literatures have reported cavitary lesion in the lungs. We present the case of a 64-year-old patient with COVID-19 pneumonia who had typical manifestations of the disease on a CT scan along with constantly changing small cavity in the lung. Discussion Delayed cavitation is a rarely described radiological manifestation of COVID-19. Atypical presentations of COVID-19 raise possibility of other infections or additional diagnoses. Bacterial and fungal infection should be excluded, as well as cavity-causing organisms. Although the proper mechanism of cavitation in COVID-19 pneumonia is not known, it may be due to intra- alveolar hemorrhage, diffuse alveolar damage, and necrosis of parenchymal cells based on findings of autopsy reports. Early and late complications associated with COVID-19 are yet to be defined. Conclusion Common causes of cavitary lesions must be investigated properly in all patients. Most cases are self-limited hence managed conservatively. The clinical spectrum of disease due to COVID-19 continues to evolve. Physicians must be aware of evolving radiological findings of COVID-19 and must conduct regular follow-up of convalescent patients with COVID-19 to ensure complete recovery.