Can we diagnose it as COVID-19?

44-year-old male, stigmata of HIV, presented with shortness and respiratory distress. Patient was intimated and sedated. The patient is a known MDR-TB patient, on further investigation found to have completed treatment in 2015. Other history was not obtained. On arrival patient x/ray reviewed (attached - Image 1) and bilateral infiltrates noted as well as ? right lung mass. The patient sent for urgent non-contrast CTB (NAD) and chest. CT findings: ‘Basal infiltrates bilaterally, no cavities, faint effusions with no gross adenopathy. Active TB is very unlikely. Cardiomegaly with PAH. Paraseptal emphysema - mild degree only. Right pericardiac mass (mediastinal).” Patient management is ongoing. What are your valuable suggestions?

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Rt paracardiac lobulated opacity seen. Cardiomegaly LVH seen. Left sided crowding of ribs noted ETT in situ. CT thorax showing bil min pleural effusion. Left postermedial consolidation. Adv Sputum examination Swab test for influenza typing. May start antibiotics bronchodilators mucolytics oxygen support . Antibiotics choice as per sensitivity test. Add antiviral therapy.

Excellent discussion Sir thanks a lot I want to add one thing is the history of travel and eddiction
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First take care of urself with proper protection at this time unless strongly suspect covid 19. X-ray of covid may presented mostly 3 patterns.it looks like one of them. Refferd him to near covid 19 government hospital is best. Ask for travel history,or contact with person who had from abroad Check his FBS,PPBS at this pandemic time better test for corona should be there

PATIENT SHOWS MASSIVE CARDIOMEGALY WITH. CAVITIES AND MARKED VASCULARITY ON RIGHT SIDE, SHOWING PLEURAL EFFUSION.... C-P ANGLES ARE NOT CLEAAR..... IF THERE IS POSTIVITY OF COVID VIRUS SAMPLE... THEN HE SHOLD BE TREATED ACCORDINGLY AS HE IS TREATED FOR COVID INFECTION , AS IT'S CLEAR FROM THE X-RAY FILM.... DR. RAJESH GOPAL. MBBS PMC REGD. NO. 35726...LUDHIANA..

Cardiomegaly with PAH with HIV with past History of MDR - TB - the following D/D of these signs , symptoms and basal infiltrates bilateral are 1.Pulmonary Koch's. 2..Viral pneumonia-can be due to a , Influenza, b , COVID 3.Malignancy 4.ARDS 5.CCF

The images are suggestive of bilateral pl thickeng with adjacent collapse The opacity is within a fat plane. Can be mediastinal or pericardium. Attenuation is almost same of heart. Needs further evaluation

Koch's chest sequelae with cardiomegaly and periodical effusion. Reduced immunity due to HIV . NEEDS FURTHER INVESTIGATION AND EVALUATION TO CONCLUDE SPECIALLY COVID 19 AND TREATMENT PLAN.

Thanks Dr Vipin Bihari Jain
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Cardiomegaly with pericardial effusion ?tubercular (old sequelae of koch's) Reduced immunity due to HIV Better to test for COVID-19

? cardiomegaly with R paracardiac mass.ett seen.bilateral pleural effusion.?lymphoma,? Koch's.

Massive cardiomegaly , with basal infiltration suggestive of covid 19

Massive cardiomegaly Lt lung volume loss? Pericardial effusion ARDS

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