Introduction:The management of COVID-19 patients requires efficiency and accuracy in methods of detection, identification, monitoring, and treatment feasible in every hospital. Aside from clinical presentations and laboratory markers, chest x-ray imaging could also detect pneumonia caused by COVID-19. It is also a fast, simple, cheap, and safe modality used for the management of COVID-19 patients. Established scoring systems of COVID-19 chest x-ray imaging include Radiographic Assessment of Lung Edema (RALE) and Brixia classification. A modified scoring system has been adopted from BRIXIA and RALE scoring systems and has been made to adjust the scoring system needs at Dr. Soetomo General Hospital, Indonesia. This study aims to determine the value of scoring systems through chest x-ray imaging in evaluating the severity of COVID-19. Methods: Data were collected from May to June of 2020 who underwent chest x-ray evaluation. Each image is then scored using three types of classifications: modified score, RALE score, and Brixia score. The scores are then analyzed and compared with the clinical conditions and laboratory markers to determine their value in evaluating the severity of COVID-19 infection in patients. Results: A total of 115 patients were males (51.1%) and 110 were females (48.9%). All three scoring systems are significantly correlated with the clinical severity of the disease, with the strengths of correlation in order from the strongest to weakest as Brixia score (p<0.01, correlation coefficient 0.232), RALE score (p<0.01, correlation coefficient 0.209), and Dr. Soetomo General Hospital score (p<0.01, correlation coefficient 0.194). All three scoring systems correlate significantly with each other. Dr. Soetomo General Hospital score correlates more towards Brixia score (p<0.01, correlation coefficient 0.865) than RALE score (p<0.01, correlation coefficient 0.855). Brixia to RALE score correlates with a coefficient of 0.857 (p<0.01). Conclusion:The modified scoring system can help determine the severity of the disease progression in COVID-19 patients especially in areas with shortages of facilities and specialists.

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Situs inversus with a coronary artery defect is an extremely rare congenital anomaly, which is often only incidentally detected during cardiac imaging studies, particularly when the patient is complaining of chest pain. We present a case study of a 37-year-old man who presented with a 3-month history of chest pain. A chest X-ray revealed dextrocardia with stomach gas in the lower right diaphragm. A CT examination showed that the right lung had 2 lobes, and the left lung had 3 lobes. This confirmed that the patient had dextrocardia with situs inversus, where the heart, organs and coronary arteries are inverted to the opposite side of the body. It is also known as a mirroring image, as the arrangement of the anatomy is unaffected. The patient's right coronary artery was prominently inversed to the left side, while the left main coronary artery was inversed to the right side and continued toward the anterior interventricular sulcus, eventually becoming the left anterior descending (LAD) artery. The left circumflex artery was absent in the atrioventricular groove. There was also a plaque in the right-sided LAD with no significant stenosis. The patient received conservative medical therapy and had frequent follow-ups to check for potential complications.

A real-time reverse transcriptase polymerase chain reaction (RT-PCR) is the gold standard in diagnosis for infection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), but the false-negative result is the problem in the prevention and control the pandemic of coronavirus disease 2019 (COVID-19). A false-negative of RT-PCR test needs to be evaluated when the patient showed a high clinical suspicion for COVID-19. We report a 36-year-old man with four times negative RT-PCR results, but clinical, radiological (chest X-ray and chest CT scan), and serological examinations showed a high suspicion of COVID-19. History of close contacted with COVID-19 confirmed patient was reported, and the wife of our case was also RT-PCR tested positive for SARS-CoV-2 in the next few days strengthen the COVID-19 diagnosis of our case patient. It is important to use the combination of RT-PCR, chest X-ray, chest CT scan, clinical manifestations, antibodies test, and exposure history of patients to diagnose COVID-19 and decide the early isolation and appropriate treatment.

Background Pulmonary sequestration is a mass of lung tissue disconnected from the bronchial tree, which derives its blood supply from one or more systemic vessels. Case presentation 3 participants were diagnosed with intra-lobar pulmonary sequestration (IPS) where the diagnosis was obtained using CT-Scan. The diagnosis is also supported by the results of Thoracal CT-Angiography and other examinations. Discussion The CT-Scan image of the IPS thorax needs to be considered carefully, especially in low research settings. Conclusion This report is expected to help in diagnosing IPS which is a rare case so that misdiagnosis can be minimized.