Chest X-ray in new Coronavirus Disease 2019 (COVID-19) infection: findings and correlation with clinical outcome

Abstract

Aim The purpose of this study is to describe the main chest radiological features (CXR) of COVID-19 and correlate them with clinical outcome. Materials and methods This is a retrospective study involving patients with clinical-epidemiological suspect of COVID-19 infection, who performed CXRs at the emergency department (ED) of our University Hospital from March 1 to March 31, 2020. All patients performed RT-PCR nasopharyngeal and throat swab, CXR at the ED and clinical-epidemiological data. RT-PCR results were considered the reference standard. The final outcome was expressed as discharged or hospitalized patients into a medicine department or intensive care unit (ICU). Results Patients that had a RT-PCR positive for COVID-19 infection were 234 in total: 153 males (65.4%) and 81 females (34.6%), with a mean age of 66.04 years (range 18-97 years). Thirteen CXRs were negative for radiological thoracic involvement (5.6%). The following alterations were more commonly observed: 135 patients with lung consolidations (57.7%), 147 (62.8%) with GGO, 55 (23.5%) with nodules and 156 (66.6%) with reticular-nodular opacities. Patients with consolidations and GGO coexistent in the same radiography were 35.5% of total. Peripheral (57.7%) and lower zone distribution (58.5%) were the most common predominance. Moreover, bilateral involvement (69.2%) was most frequent than unilateral one. Baseline CXR sensitivity in our experience is about 67.1%. The most affected patients were especially males in the age group 60-79 years old (45.95%, of which 71.57% males). RALE score was slightly higher in male than in female patients. ANOVA with Games-Howell post hoc showed significant differences of RALE scores for group 1 vs 3 (p < 0.001) and 2 vs 3 (p = 0.001). Inter-reader agreement in assigning RALE score was very good (ICC: 0.92-with 95% confidence interval 0.88-0.95). Conclusion In COVID-19, CXR shows patchy or diffuse reticular-nodular opacities and consolidation, with basal, peripheral and bilateral predominance. In our experience, baseline CXR had a sensitivity of 68.1%. The RALE score can be used in the emergency setting as a quantitative method of the extent of SARS-CoV-2 pneumonia, correlating with an increased risk of ICU admission.

Various radiological findings in Indonesian patients with COVID-19: a case series

“…Additionally, CT scans have a very low speci city to detect the peculiar ndings of pneumonia due to COVID-19 [17,18]. Other advantages of CXR over CT scans are as follows: 1) it is easier to operate the X-rays, particularly the procedure of disinfection that should be performed after each examination, and 2) it can be conducted at the bedside of patients, therefore minimizing the cross-infection risk in the radiology department [9]. In conclusion, CXR shows various abnormality ndings in patients with COVID-19, including the type, location, and degree of pneumonia.…”

“…Therefore, CXR is considered more effective and useful for the initial screening and follow-up of patients with COVID-19 [7,8]. Moreover, radiological evaluation of suspected COVID-19 patients is required for early detection of thoracic involvement, particularly in emergency units, while waiting for de nitive diagnosis by real-time reverse transcription polymerase chain reaction (RT-PCR) [9]. In Indonesia, there is no consensus on the use of chest CT scans for COVID-19 cases, but it depends on the availability of tools, facilities, and human resources in most hospitals.…”

Chest CT in the emergency department for suspected COVID-19 pneumonia

“…Moreover, the turnaround time for results may be long in overwhelmed laboratories, as during epidemic growth [ 3 ]. Chest imaging showed good performance in COVID-19 pneumonia diagnosis [ 4 – 6 ], with chest X-ray representing the first line due to wide availability and portability [ 6 ], and CT outperforming RT-PCR sensitivity even in the early stages of the disease [ 5 ].…”

Radiologische Manifestationen von Lungenerkrankungen bei COVID-19

“…Abb. 1; [12,18,19]). Diffuse Parenchymverdichtungen im Thoraxröntgenbild im Rahmen von COVID-19 können Ausdruck eines akuten Lungenversagens ("acute respiratory distress syndrome", ARDS) sein [19].…”