A 69-year-old man with a history of nephrolithiasis presented to the Emergency Department (ED) on March 6, 2020 complaining of generalized body aches and suprapubic pain. He had returned from a trip to Egypt 10 days earlier and developed these symptoms a week prior to presentation. The patient denied sick contacts, fever, chills, fatigue, cough, or shortness of breath.
A contrast-enhanced CT of the abdomen and pelvis was performed and in addition to multiple stones in the left kidney and left ureterovesical junction measuring up to 1.0 cm, the lung bases showed new development of bilateral ground-glass and nodular opacities (Fig. 1). Because of the imaging features and the patient’s travel history, COVID–19 was suggested by radiology despite the lack of fever and respiratory symptoms.
After consultation with the Department of Health (DOH), there was a low suspicion for COVID–19, but COVID–19 RT-PCR viral swabs were sent to the DOH lab for testing.
The patient was deemed stable for discharge with tamsulosin, pain medication, and an outpatient urology appointment. Instructions were also given for the patient to self- quarantine until the results for COVID–19 came back.
On March 9, 2020, the patient was found to be infected with COVID–19 and told to isolate himself as best he could in his home.
A 67-year-old man presented to the ED on March 8, 2020 with a chief complaint of increased urinary frequency and right lower quadrant abdominal pain radiating to the pelvis for the past week. The patient’s son and niece were sick with unknown illnesses. He had not had any recent travel or exposure to patients with known COVID–19.
A contrast-enhanced CT of the abdomen and pelvis was performed to assess for appendicitis and diverticulitis. Imaging showed no acute abdominal or pelvic pathology, but there were round ground-glass opacities at the lung periphery in the visualized lung bases (Fig. 2). The radiologist suggested COVID–19 as an etiology and the patient was tested and sent home to quarantine in his home with the approval of the DOH.
Two days later the patient was notified that he had tested positive for COVID–19 and was directed to remain isolated and to return to the emergency room if any acute respiratory symptoms developed.
A 30-year-old man was transferred to our ED from an outside hospital for neurologic consultation on March 11, 2020. The patient had presented with dysarthria, right hemiparesis, and a right facial droop. A non-contrast head CT performed at the outside hospital showed a 1.7 cm acute left basal ganglia hemorrhage (Fig. 3a). The patient was admitted to the Stroke Service who managed the patient by obtaining a CT angiogram of the head and neck. There was no vascular malformation or other etiology for the hemorrhage, but there were sub-centimeter ill-defined nodules in both upper lobes of the lung and a 1.8 cm nodule at the periphery of the left upper lobe (Figure 3b and 3c) and COVID–19 was suggested by the interpreting neuroradiologist.
The patient had no fever, known underlying medical conditions, sick contacts, or recent travel. After additional imaging, including a Brain MRI, Brain MRA, Chest CT and echocardiogram, the patient tested positive for COVID–19 and was placed in isolation.