Extensive Nonsegmental Pulmonary Perfusion Defects on SPECT/CT as an Early Sign of COVID-19 Infection

Figures

• 

  Fig. 1. Noncontrast chest computed tomography (CT) obtained as part of the lung perfusion single-photon emission computed tomography/computed tomography scan ( left ) in the sagittal plane ( left ) demonstrating multiple peripheral consolidative opacities ( arrows ) with air bronchograms and reticulations in the left upper lobe. These findings are characteristic of coronavirus disease 2019 pneumonia in the appropriate clinical setting. Notably, contrast-enhanced chest CT ( right ) in the sagittal plane obtained 3 days prior was unremarkable, only demonstrating subsegmental plate-like atelectasis in the left lower lobe.

• 

  Fig. 2. Chest computed tomography (CT) ( upper left ) and single-photon emission computed tomography-computed tomography (SPECT/CT) perfusion images ( upper right ) in the axial plane at the mid lung level demonstrate multiple peripheral consolidative lung opacities with reticulation predominantly in the left upper lobe as well as the right upper lobe ( arrowheads ) with corresponding areas of decreased perfusion. A new small right-sided pleural effusion has been also developed. SPECT perfusion imaging in the axial plane ( left lower ) reveals multiple small peripheral perfusion defects ( thin arrows ) corresponding to peripheral vascular territories on CT reflecting probable small emboli. SPECT perfusion in the coronal plane (right lower) of the posterior lungs demonstrates large areas of central perfusion defects ( wide arrows ) not corresponding to vascular territories (“stripe sign”).

• 

  Fig. 3. Single-photon emission computed tomography (SPECT) ( left ) and SPECT/CT perfusion images ( right ) in the axial plane near the lung bases demonstrate large areas of central perfusion defects ( wide arrows ) not reflecting vascular territories. These may represent areas of inflammation with characteristic 'stripe sign” ( thin arrows ) and without underlying CT abnormalities.