Role of chest radiography in the management of COVID-19 pneumonia: An overview and correlation with pathophysiologic changes

Abstract

Background: Chest radiography (CXR) is a widely available baseline radiological modality in evaluating symptomatic patients with suspected or confirmed Covid-19 disease. Serial changes can help in monitoring the patients in conjunction with the clinical status of these patients in a hospital setting. Purpose: The purpose of this study was to analyse the patterns of radiological findings on chest radiograph (CXR) for suspected and confirmed COVID-19 patients on initial presentation to the emergency medical services (EMS) on admission and to assess the progression and resolution. Materials and Methods: In this study, patients who presented to EMS of a multispeciality hospital as suspected or confirmed Covid-19 on consecutive reverse transcriptase polymerase chain reaction (RT-PCR). CXR was examined for findings of haziness, patterns and distribution of opacities. Progression and regression of findings in serial CXR were studied and evaluated with the clinical and laboratory parameters. High resolution CT (HRCT) chest was performed initially for some patients. Results: 756 RT-PCR confirmed COVID-19 patients were included in our study who had initial CXR. 510 (67.46%) of our patients with positive initial RT-PCR showed abnormal baseline CXR. The abnormal findings were described as haziness akin to ground glass opacities (GGO) on CT, peripheral opacities, patchy parenchymal opacities and consolidation. Peripheral opacities and lower zone distribution were the commonest pattern of CXR abnormalities with bilateral involvement. The severity of findings on serial CXR and radiographic regression was studied along with follow-up to assess response to treatment. Forty-six patients showed features of acute lung injury (ALI). Complications and new CXR findings were reported for patients who were given ventilator support. Conclusion: CXR is a valuable baseline radiological investigation on hospital admission in symptomatic patients with suspected or confirmed Covid-19 presenting to the EMS as it helps to monitor the progress and regression of the disease in conjunction with clinical findings.

Rama Co-RADS: Cutting-edge tool for improved communication in management and treatment of COVID-19 patients in Thailand

“…Ramathibodi hospitels as alternative healthcare facilities for COVID-19 multiple countries are still using chest X-ray, particularly portable chest X-ray, as a first-line triage tool for diagnosis, assessing the severity of the COVID-19 infection, and excluding an alternative diagnosis. It is also helpful for disease monitoring and detecting complications, especially in critical care settings [5,15,19,20].…”

“…Rama Co-RADS category 4 (Figures 2B and 4A) requires the presence of single or multifocal poorly defined ground-glass opacities, consolidations, or both in the unilateral lung. These findings are considered suspicious for early/mild COVID-19 pneumonia [15,19,26,28,29] and, therefore, implies a high likelihood of COVID-19 pneumonia.…”

“…Rama Co-RADS category 5 (Figure 5) requires the presence of typical findings for COVID-19 pneumonia, i.e., multifocal, peripheral opacities (ground-glass opacities, consolidations, or both), including those with rounded morphology, in bilateral lungs. This category implies a very high likelihood of COVID-19 pneumonia [15,19,26,28,29]. Timely treatment with antivirals (± corticosteroids if indicated) and close follow-up, especially in a high-risk patient, are mandatory [4,12].…”

“…Nevertheless, it is essential to note that categories 4 and 5 do not reflect the overall disease extent or severity of pneumonia, which may vary differ among patients. As the disease progresses or regresses, a dynamic or temporal change is inevitable (Figures 2, 4, and 5) [13][14][15]19,20].…”

“…Therefore, onduty physicians can follow the workflow without consulting ID specialists (Figure 1). Since a negative chest X-ray may result from a lack of pulmonary involvement, an early course of infection, or subtle pulmonary involvement beyond the resolution of plain radiography, follow-up chest X-ray is required for disease monitoring, especially in high-risk or symptomatic patients [19].…”