Background: The objective of our study was to investigate the location, extension and type of novel coronavirus-induced disease 2019 (COVID-19) infection involvement and hepatic steatosis on initial chest computed tomography (CT). The relationship between fatty liver and severity of the disease was also investigated by measuring the liver attenuation index (LAI). Methods: This study evaluated the chest CT images of 343 patients (201 male, mean age 48.43 years) who were confirmed to have COVID-19, using nasopharyngeal swab. The chest CTs were analyzed for laterality, number of involved lobes, diffuseness, number of lesions, and lesion types. The CT attenuation values of liver and spleen were measured, and LAI was calculated for the detection of hepatic steatosis. Univariate and multivariate logistic regression analysis were used to identify the independent early predictors for severe COVID-19. Results: There was no significant difference between genders in terms of clinical course. Liver density and LAI were significantly lower in the intensive care unit (ICU) patients. The prevalence of severe disease was higher in the patients with hepatic steatosis than in the non-steatotic group (odds ratio [OR] 3.815, 95% confidence interval [CI] 1.97–7.37, P < 0.001). After adjusting for age and comorbidities including hypertension, diabetes mellitus, coronary artery disease, chronic obstructive pulmonary disease, and chronic kidney disease, multivariate logistic regression analysis showed that non-alcoholic fatty liver disease (NAFLD) was an independent risk factor for COVID-19 severity (OR 3.935, 95% CI 1.77-8.70, P = 0.001). The optimal cut-off value for LAI was calculated as 0.5 for predicting patients who required ICU treatment. Conclusions: On the initial chest CT images of COVID-19 patients, presence of fatty liver is a strong predictor for severe disease.

Altered consciousness and accompanying neurological symptoms are both complex and challenging cases for emergency physicians. These are not specific and may be a sign of a variety of medical conditions including stroke and delayed neurological sequelae (DNS) is a recurrent transient neuropsychiatric consequence of CO intoxication. DNS produces a spectrum of varying symptoms and the diagnosis is primarily made on the basis of clinical features and radiological findings from CT and conventional MRI. In clinical practice, serious CO intoxication is treated only with oxygen therapy although no effective treatment exists. Emergency physicians play a major role in managing patients presenting with CO intoxication and preventing DNS.

Background. Spontaneous orbital haemorrhage is a very rare condition and vision-threatening event. It may occur due to trauma, orbital surgery/injections, orbital vascular anomalies, and a variety of systemic predisposing factors. Signs of retrobulbar hemorrhage include proptosis, ophthalmoplegia, increased intraocular pressure, loss of pupillary reflexes, and optic disc or retinal pallor. Both Computed Tomography scan and Magnetic Resonance Imaging may be performed in the diagnosis. Case Report. A 31-year-old woman was referred to our hospital with a complaint of headache and blurred vision following a strong sneeze. Ophthalmological examination revealed mild Relative Afferent Pupillary Defect in left eye. Computed Tomography revealed left hyperdense retrobulbar mass and displaced optic nerve. T1 weighted hypointense, T2 weighted hyperintense and non-enhanced round shape, sharply demarcated lesion measuring 18 × 15 × 14 × mm in diameter compatible with haematoma was detected by MRI. Surgically Caldwell-Luc procedure was performed. Histological examination confirmed haematoma. Follow-up Magnetic Resonance Imaging revealed a small reduction in the size of lesion but not complete resolution. The patient's complaint was regressed. She is now free of symptoms and is still under surveillance. To our knowledge, this is the first reported case of retrobulbar haematoma caused by sneeze.

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