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A 47-year-old African American male with endstage kidney disease (ESKD) on home hemodialysis (HD), diabetes, hypertension, and type 2 pulmonary hypertension with preserved ejection fraction was referred for preoperative risk assessment to be listed for kidney transplant. He was evaluated by a video visit given the ongoing coronavirus disease 2019 (COVID19) viral pandemic by his primary care physician late March 2020 and in 1st week of April 2020 by a cardiologist. Review of primary care physician and cardiologist notes highlighted patient had no general or cardiac symptoms, was compliant with his medications and performed his dialysis sessions regularly at home. His medications included low dose aspirin, atorvastatin, metoprolol, and insulin. He was felt to need further risk assessment and subsequently underwent a same day restregadenoson stress Technetium sestamibi SPECT/attenuation correction CT study for preoperative risk assessment on April 8th, 2020. The study quality and perfusion/attenuation correction fusion data were all adequate and of good quality. Review of the myocardial perfusion images (Figures 1a and b) showed a mildly reversible anterior/ anterolateral perfusion defect less obvious after attenuation correction with a summed difference score of 3 and the scan was read as mildly abnormal suggesting mild ischemia but overall low ischemic burden risk. Ejection fraction was 57% with no transient ischemic dilation and no pharmacologic stress electrocardiographic ischemia was noted. Review of CT images done for attenuation correction (Figure 2) with bone window showed scattered 3 vessel coronary calcification. Lung window review of CT showed peripheral bilateral ground glass opacities in both lungs with a pattern suggestive of COVID-19 involvement. Following the scan report, the primary care physician contacted the patient who again expressed no symptoms. He was advised to get COVID-19 testing but given that he was asymptomatic he couldn’t get it done per hospital policy and had to be referred to free testing sites offered at limited locations in Michigan regardless of symptoms. He underwent a viral polymerase chain reaction test for nCOV (COVID-19 RT PCR) which was positive suggesting COVID-19 infection. He was advised to quarantine from family for 2 weeks, updated on COVID-19 symptoms to watch for and to seek medical attention for any new symptoms. He has been currently followed for over a month with no new symptoms as of May 20th and feels well. His wife worked at an outside hospital and was suspected to be the source. She was notified and underwent testing and found to be positive for COVID-19 and their children were quarantined.

journal of nuclear cardiology

Lurking in the shadows: Asymptomatic bilateral lung involvement with novel corona virus 2019 identified on myocardial perfusion SPECT CT: Implications for interpreting physicians