Chest Radiographic Findings in COVID-19 patients

Abstract

Background: Coronavirus disease 2019 (COVID-19) is an ongoing global pandemic disease. The chest radiograph (CXR) has been used to evaluate severity of COVID-19 pneumonia. Objective: This study aimed to describe the correlation between CXR findings and clinical symptoms in COVID-19 and the time course of lung changes on the CXR relative to the initial symptoms. Methods: This retrospective study evaluated COVID-19 patients treated at the Bamrasnaradura Infectious Disease Institute during January 1 - April 1, 2020. Patients were divided into 4 groups, namely, asymptomatic, mild disease, moderate disease and severe disease. 158 patients included in the study had initial CXR for review. Of which, 135 patients had follow-up CXR available for review. Results: During the study period, there were 158 COVID-19 patients. 63.3% were males. The average age of patients was 41.8 years. Of 158 patients, 44.3% had abnormal initial CXR. Among 88 patients who had normal initial CXR, 17.0% subsequently showed abnormality on the follow-up CXR. The most common parenchymal opacity was ground glass opacity at 90% of the initial CXR and 73.8% of the peak stage CXR. Lesions were more likely to be multifocal and bilateral involvement, both central and peripheral distribution, and lower zone predominant. Pleural effusion was seen in 1.4% of the initial CXR and 10% of the peak stage CXR. Pleural effusion was only found in severe disease group. The mean duration from initial symptoms to the peak stage CXR was 10.9 + 4.5 days. Conclusion: Patients in moderate and severe disease groups might have normal initial CXR. The most common CXR findings of COVID-19 pneumonia were ground glass opacity, multifocal and bilateral lungs involvement, both central and peripheral distribution and lower lung zone predominant. The duration from initial symptoms to the peak stage CXR was around 11 days.