CTICasesRapidly Progressive Post-COVID Pulmonary Fibrosis
Imaging findings
A lung transplant evaluation patient who developed COVID-19 with ARDS in July has an August CT showing extensive fibrosis with traction bronchiectasis, reticulation, and volume loss, with some basal sparing suggesting residual resolving acute lung injury. Over about 30 days, while on a non-rebreather, the lungs progressed to severe fibrosis with end-stage honeycomb-like holes, anterior-predominant, requiring high oxygen at rest. She had no underlying lung disease.
Key takeaways
Post-COVID lung injury can progress to severe end-stage fibrosis over as little as 30 days, among the fastest fibrotic progressions seen outside anti-MDA5 dermatomyositis, and this degree of honeycomb-like destruction is unlikely to recover. The anterior-predominant distribution is notable and may reflect ventilator-associated diffuse alveolar damage affecting the non-dependent baby lung while the dependent posterior lung is relatively protected by atelectasis, in contrast to the usual upper-lung predominance of post-ARDS fibrosis.
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