The rising demand of chest imaging during the COVID-19 pandemic has necessitated adaptations to be made to the workflow in radiology departments, particularly in regard to personal protective equipment (PPE) guidelines and operations protocol. The guidelines were implemented to reduce the risk of disease transmission to frontline radiology personnel. With the rising number of COVID cases in the community, suspected COVID patients may present to our hospital’s Emergency Department (ED) even though it is not a COVID-designated hospital. Patients who present to ED are stratified as Severe Acute Respiratory Infection (SARI) cases if they exhibit respiratory symptoms, and non-SARI for those without respiratory symptoms. Imaging examinations performed for SARI patients must adhere to the new workflow. Radiographers and doctors performing Computed Tomography (CT), ultrasound and mobile radiography who come in contact with SARI patients must don full PPE. Prior to mobilization of patients, the routes must be cleared, and the cleaning team will standby for terminal cleaning. For portable examinations, donning and doffing of PPE is done in the department. All appliances must be covered prior to examination and sanitized after. Guidelines for usage of common areas such as pantry and prayer room are also employed to avoid crowding and to maintain adequate physical distancing. Adherence to the new workflow and guidelines is imperative to prevent workplace transmission from patients or other healthcare workers.

Gallbladder torsion is a rare but life-threatening condition. It is commonly seen in the elderly population due to a lack of mesenteric fat, making the cystic duct more mobile and prone to torsion. We are presenting a case of gallbladder torsion in a healthy adult male presented with an acute abdomen. Abdomen ultrasound and CT abdomen showed findings of hydrops gallbladder with acute acalculous cholecystitis. The patient went for emergency cholecystectomy due to severe unresolved pain. Intraoperative findings revealed a gangrenous gallbladder with torsion around the cystic duct. He was discharged well post-operatively. Gallbladder torsion remains a challenge for both surgeons and radiologists to diagnose preoperatively. Therefore, having a high index of suspicion is crucial to come to a diagnosis correctly.

During the pandemic, diagnosis of COVID-19 infection must be excluded in patients presenting with respiratory features, especially in the area where the incidence was high. This case report highlights a man who came with respiratory infection symptoms and the chest radiograph suspicious of COVID-19 pneumonia; however, his swab test for RT-PCR was negative for COVID-19. Later he was found to have a positive anti-HIV antibody and developed advanced HIV infection by multiple opportunistic infections. A 45-year-old man presented with chronic cough and dyspnea for three months which worsened five days before the presentation. It was associated with diarrhoea, dysphagia, weight loss, left lower limb weakness, with bowel and urinary incontinence. Chest auscultation revealed generalized crepitations. The first chest radiograph showed bilateral reticular opacities extending to the lung peripheries when the suspected diagnosis of COVID-19 pneumonia was made. The nasopharynx swab for RT-PCR for COVID-19 was negative, and the sputum was positive for Pneumocystis jirovecii. The contrast-enhanced CT (CECT) brain revealed changes consistent with brain abscess. The cerebrospinal fluid (CSF) examination was consistent with cryptococcal infection. He was initially treated in the Severe Acute Respiratory Infection (SARI) ward because of the initial impression of COVID-19. He was tested positive for Human Immunodeficiency Virus (HIV) rapid test and PCR, RPR and TPHA for syphilis. He was diagnosed with Pneumocystis jirovecii pneumonia, cryptococcal meningitis, brain abscess, oral and oesophageal candidiasis and syphilis. He was treated with co-trimoxazole, Amphotericin B, flucytosine, fluconazole, penicillin G and Nystatin. He initially improved upon treatment but later succumbed to his illnesses. Given the current situation of COVID-19, any patient with acute respiratory symptoms must be tested to rule out COVID-19 pneumonia. However, in a newly diagnosed advanced HIV patient presented with respiratory infection symptoms and extrapulmonary symptoms, opportunistic infections should be excluded along with COVID-19.

Dengue is endemic in over 100 countries worldwide, predominantly in the subtropical and tropical regions and the incidence has been increasing globally. Patients with severe dengue may develop massive bleeding, disseminated intravascular coagulopathy and multi-organ failure. Bleeding may occur in various body cavities and muscles; however, bleeding in the retroperitoneal space is uncommon. We report a case of a 37-year-old gentleman who presented with a 4-day history of fever associated with chills and rigours. On Day 6 of illness, he complained of left lumbar and left iliac fossa pain which was aggravated by movement. A computed tomography angiography scan of the abdomen showed the presence of a retroperitoneal haematoma, left iliopsoas and quadratus lumbarum intramuscular haematoma with active bleeding and left abdominal wall muscles haematoma. His condition gradually improved after multiple blood transfusions and he gained full recovery. Spontaneous retroperitoneal haematoma is an uncommon complication of severe dengue infection. Early diagnosis based on high index of clinical suspicion using appropriate imaging will aid in prompt management of these cases and may prevent deaths.