Differential Diagnosis

  • Adenovirus
  • COVID-19
  • Influenza
  • Multifocal bilateral pneumonia
  • Respiratory syncytial virus



  • This patient was diagnosed with multifocal bilateral pneumonia, which may be bacterial but could represent atypical viral infection such as COVID-19. Note the bilateral peripheral patchy infiltrates in the right upper lobe and right lung base, as well as the left upper lobe and left lung base.


Learnings/Things to Look for

  • COVID-19 presents with often subtle findings on chest x-ray
  • Findings associated with COVID-19 infection include multifocal rounded infiltrates
  • Infiltrates most often are peripheral in distribution


Pearls for Urgent Care Management and Considerations for Transfer

  • When presenting in the urgent care setting it is important to realize that a negative chest x-ray does not preclude COVID-19 infection


Acknowledgment: Image and case provided by Experity Teleradiology (www.experityhealth.com/teleradiology).

A 40-Year-Old Man with Cough and Fever During the COVID-19 Pandemic
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