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Cerebral fat embolism is a rare and potentially fatal condition that may occur following a long bone fracture. Its characterized by respiratory, neurological, and mucocutaneous signs. Isolated severe brain syndrome remains exceptional. We report a 21-year-old male patient admitted for the cerebral manifestation of a fat embolism syndrome due to a fracture of long bone after a traffic accident injury. Neurological deterioration after a free interval was seen with generalized tonic-clonic seizures. MRI of the brain was indicated which showed numerous multifocal hyperintensities involving the deep white matter of both hemispheres producing a “starfield” appearance. This pattern of cytotoxic cerebral edema, with lesions in the white matter rather than the grey matter, is indicative of the subacute stage of fat embolism. The patient was treated with comprehensive support in the intensive care unit, he returned to normal neurological function and was discharged after 3 weeks of hospitalization.

Objectives: To describe CT imaging features of 4 patients with initial negative RT-PCR results but high suspicion of COVID-19 infection. Materiel and methods: Retrospective study including patients with COVID-19 pneumonia who underwent both CT and RT-PCR at initial presentation in our institution From March 31th, 2020 to april 27 th .The results of both tests were compared. For patients with a final confirmed diagnosis ,clinical , laboratory data and CT imaging findings were evaluated. Results: From 142 laboratory confirmed cases, a total of four patients had an initial negative RT PCR and positive CT findings . 3 patients were diagnosed in early stage (1-5days) and one in progressive stage (5-8 days). The 4 patients had typical imaging findings, including groundglass opacity (GGO) (2 patients) ,crazy paving (1 patient),mixed GGO and crazy paving (1 patient) .All the patients were isolated After for presumed 2019-nCoV pneumonia and they were eventually confirmed with 2019-nCoV infection by repeated swab tests. Conclusion: rRT-PCR may produce false-negative results in the early stages of the disease mostly. We therefore suggest that CT features could be utilized as the immediate reference to screen the highly suspected cases and to take necessary actions, while rRT-PCR serves as a confirmation tool to decide the subsequent action of continuing isolated treatment or discharge. Key points: Typical radiological presentation with high clinical suspicion of 2019-nCov infection should be considered even do negative RT-PCR results .  In these cases,repeat swab testing and patient isolation should be applicable.

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