A thoracic CT scan demonstrated that a linear shape in a transverse plane can be seen as a rounded nodule in a frontal plane. The round opacity misled us, and the first negative RT-PCR did not correct the first erroneous assessment. Given that the patient presented with no further symptoms, our first suspicion was a pulmonary neoplasm, either primary or metastatic. In our patient, COVID-19 pneumonia resembled a solitary pulmonary nodule. In such cases, a complete laboratory blood panel, including blood cultures, serology, and nasopharyngeal smears for RT-PCR, is required . Any viral, fungal, or atypical bacterial infection can mimic ground glass lung opacities . COVID-19 pneumonia findings are nonspecific. Hence, thoracic CT or ultrasound can be used in early diagnosis, even if an initial RT-PCR is negative. However, during the early stages of the disease, chest X-rays may have limited usefulness due to the possibility of false-negative results. RT-PCR is the gold standard for diagnosis, and several imaging techniques, such as chest X-ray, thoracic CT scan, and ultrasound, are useful for the diagnosis and assessment of COVID-19 pneumonia .īilateral multifocal ground glass opacities in the mid- or lower lobes are the most common initial findings in chest X-rays . Its symptoms include fever, dry cough, myalgia, and dyspnea , but an asymptomatic course is not uncommon. SARS-CoV-2 was first identified in 2019, and the disease it causes was named COVID-19 by the WHO in 2020 . Hence, clinicians should be aware of symptoms and signs that can be misleading. Some clinical and radiological features of COVID-19 are relatively new and can mimic other entities. Given the relatively recent onset of the COVID-19 pandemic, some of its clinical features are not yet well understood, especially in asymptomatic patients. In such cases, a systematic diagnostic workup should be performed for the final diagnosis. However, atypical pneumonia can also resemble a pulmonary neoplasm. Since its course is mild, most patients recover with no antibiotic therapy. Therefore, atypical pneumonia can be asymptomatic, and a chest X-ray is usually used to diagnose ground glass opacities, although reticular, nodular, or patchy opacities can be also seen. There is no pathognomonic sign, and even chest auscultation can be normal. Dyspnea is less common when compared with pneumonia caused by other pathogens such as Streptococcus pneumoniae. Its onset is gradual and can be accompanied by headache, dry cough, malaise, or even low-grade fever. Atypical pneumonia is often community acquired and mild to moderate, although signs and symptoms vary. Atypical pneumonia, caused by atypical bacteria (such as Mycoplasma pneumoniae), viruses, or fungi, is uncommon but tends to have subacute courses or milder symptoms than typical pneumonia. Some pulmonary diseases may be elusive when diagnosed via plain chest X-ray as they can mimic other entities.
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