Presumed pulmonary COVID-19 infection detected incidentally on breast MR

Brown, Dr Adam; Dluzewski, Dr Sam; Malhotra, Dr Anmol

COVID-19 is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). A global pandemic was declared by the World Health Organisation on 11 March 2020. Approximately 30% of infected individuals are asymptomatic.(1) We present the case of a 68-year-old female who underwent outpatient breast magnetic resonance (MR) imaging for assessment of a right breast mass. The study demonstrated abnormal subpleural high T2 signal intensity change within in the partially visualised lungs, which showed enhancement following administration of contrast. Concern was raised that the pulmonary changes may represent COVID-19 infection. The patient was urgently contacted and denied any current symptoms but reported suffering mild upper respiratory tract symptoms two weeks earlier. An outpatient chest radiograph demonstrated changes consistent with COVID-19 infection and the patient was treated as COVID-19 positive and advised to self-isolate for seven days as per Public Health England guidance.(2) Due to increasing breathlessness the patient presented to our Emergency Department the next day and underwent a CT pulmonary angiogram which demonstrated segmental pulmonary emboli and subpleural consolidation in keeping with COVID-19 infection. This represents the first case of COVID-19 identified on breast MR imaging that the authors have seen and highlights the importance of prompt identification and flagging of incidental pulmonary findings to minimise further transmission of the virus in asymptomatic carriers.