Though acute pulmonary manifestations of COVID-19 infection are well documented, the long-term sequelae from this viral infection are unclear. We report a case of a patient presenting with persistent respiratory failure after recovery from COVID-19 infection with imaging showing evidence of new onset pulmonary fibrosis. CASE PRESENTATION: 56 year-old Hispanic male with Diabetes Mellitus presents to ED for shortness of breath on exertion after recent hospitalization 16 days ago for Covid-19 infection. He reports progressive dyspnea since discharge, interfering with daily activities including walking to the bathroom and preparing food. He denies dyspnea at rest, cough, constitutional symptoms, or exposure to sick contacts. On his last visit, he was hospitalized for 24 days for Covid-19 pneumonia, and finished a course of antibiotics, hydroxychloroquine and steroids. PaO2/Fio2 ratio was 250, and oxygen requirements were met with nasal cannula, with gradual improvement to 95% saturation on room air. He denied previous hospitalizations, family history, occupational exposures and substance abuse. Vital Signs showed blood pressure 137/91 mmHg, Pulse 116 BPM, RR 22 Temperature 98.4 F. Physical exam was pertinent for fine velcro-like inspiratory and expiratory crackles auscultated at lung bases, saturating 94% on room air at rest but desaturating to 85% after walking 5 steps. Labs revealed chest x-ray showed patchy opacities diffusely worsened from previous visit. CTPE showed no pulmonary embolism, but diffuse bilateral patchy infiltrates with ground glass opacities and bronchiectasis. WBC was 8.64 [K/mm3], absolute lymphocyte count 1.73 K/mm3. BNP, procalcitonin, lactate, autoimmune workup and Echocardiogram were normal. Inflammatory markers were elevated but decreased from last admission. Quantiferon Gold was positive with three negative AFB smears suggesting latent tuberculosis. PFTs showed a moderate restrictive pattern. He was treated with methylprednisolone and oxygen to prevent further fibrosis in areas of active inflammation and isoniazid for latent TB. After symptomatic improvement, he was discharged on home oxygen and steroid taper with outpatient follow up.

No abstract

Hepatocellular carcinoma (HCC) is the most common primary malignancy of liver. Distant metastasis to various organs is well known. Skeletal metastasis is also reported to various locations. Vertebral metastasis has been reported mostly to thoracic spine. However, cervical spinal cord involvement leading to cord compression has been reported very rarely in literature. We present a case of 58-year-old male with liver cirrhosis presenting as neck pain. Further work-up revealed metastatic HCC to cervical spinal cord resulting in acute cord compression. Patient has been treated with neurosurgical intervention.

We report on the MR imaging of an anomalous medial meniscus with a tear in a 41-year-old man. Anomaly of the medial meniscus is rare and difficult to diagnose clinically. The MR images contributed to the pre-arthroscopic diagnosis and arthroscopy confirmed the lesion. The anomalous meniscus was not related to the symptoms.