Background: South Africa has experienced multiple waves of the coronavirus disease 2019 (COVID-19) with little research documenting chest imaging features in an human immunodeficiency virus (HIV) and tuberculosis (TB) endemic region.Objectives: Describe the chest imaging features, demographics and clinical characteristics of COVID-19 in an urban population.Method: Retrospective, cross-sectional, review of chest radiographs and computed tomographies (CTs) of adults admitted to a tertiary hospital with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, between 01 May 2020 and 30 June 2020. Imaging was reviewed by three radiologists. Clinical parameters and laboratory data were analysed.Results: A total of 113 adult patients with a mean age of 46 years and 10 months were included. A total of 113 chest radiographs and six CTs were read. Nineteen patients were HIV-positive (16.8%), 40 were hypertensive and diabetic (35.4%), respectively, and one had TB (0.9%). Common symptoms included cough (n = 69; 61.6%), dyspnoea (n = 60; 53.1%) and fever (n = 46; 40.7%). Lower zone predominant ground glass opacities (58.4%) and consolidation (29.2%) were most frequent on chest radiographs. The right lower lobe was most involved (46.9% ground glass opacities and 17.7% consolidation), with relative sparing of the left upper lobe. Bilateral ground glass opacities (66.7%) were most common on CT. Among the HIV-positive, ground glass opacities and consolidation were less common than in HIV-negative or unknown patients (p = 0.037 and p = 0.05, respectively).Conclusion: COVID-19 in South Africa has similar chest imaging findings to those documented globally, with some differences between HIV-positive and HIV-negative or unknown patients. The authors corroborate relative sparing of the left upper lobe; however, further research is required to validate this currently unique local finding.