Chest X-ray findings in COVID-19 patients: a descriptive study

Abstract

Background: Early suspicion and diagnosis remains the cornerstone for the better outcome of patients and to decrease cross infection in cases of COVID-19 pneumonia. In a country like Nepal X-ray facilities are readily available radiological tool in most of the centers and can be important screening tool. There is a lack of studies detailing the chest XR (C-XR) findings in these patients when compared to that dedicated to the CT features. Study aims to describe the patterns of the lung opacities in CXR in these patients.Methods: This is retrospective descriptive study conducted at NMCTH in COVID-19 patients from 12 September to 17 October 2020. Demographic characteristics, symptoms, co-morbidities and C-XR findings were studied. CXR findings were categorized according to BSTI classification.Results: Among 111 COVID-19 RT-PCR positive cases admitted 102 (91.9%) belonged to age group 18-65 years, 89 (80.2%) were males. Cough and fever were the commonest symptoms present in 109 (98.2%) patients. Ischemic heart disease and hypertension in 32 (28.8%) patients were the commonest co morbidities. According to British society of thoracic imaging (BSTI) COVID-19 CXR classification, six patients (5.4%) had normal chest X-rays. Classic/probable COVID-19 picture was present in 79 (71.17%) patients while (7.2%) had intermediate for COVID-19 X-ray findings. Among 79 patients with classic/probable COVID-19 CXR findings 71 (89.8%) had bilateral consolidation/ground glass haze, 72 (91.1%) had peripheral lung involvement while 66 (83.5%) had middle and lower zone involvement.Conclusions: Ground glass opacities/consolidations with bilateral location, peripheral distribution and middle- lower zone predominance were the commonest X-ray findings in our study.

Mean Brixia Severity Scores among Symptomatic COVID-19 Patients in a Tertiary Care Centre: A Descriptive Cross-sectional Study

“… 6 Mid and lower-zone involvement was seen in 83.5% and midzone in only 16.5% in the above study whereas our study showed 72.0% had mid and 65.0% had lower zone involvement. 6 …”

“…However, 22.2% of our patients showed diffuse bilateral lung involvement compared to 10.1% in theirs. 6 When comparing distribution, peripheral opacities were seen in 63.6% and both peripheral and central opacities in 35.6% of our patients compared to 91.1% and 10.0% respectively in theirs. 6 Mid and lower-zone involvement was seen in 83.5% and midzone in only 16.5% in the above study whereas our study showed 72.0% had mid and 65.0% had lower zone involvement.…”

“… 8 In our study, only 52 (22.12%) out of 235 positive CxRs showed classic abnormalities of bilateral mid and lower zone peripheral grade 1, 2, or 3 opacities without pleural effusion whereas CXR findings in COVID-19 are described in the literature, but the data are relatively scant as compared to CT. A sole study of CxR in COVID-19 conducted in Nepal as early as May 2021, showed that among 111 RT-PCR positive cases, six patients (5.4%) had normal chest X-rays, classic/probable COVID-19 picture was present in 79 (71.1%) patients while eight (7.2%) had intermediate for COVID-19 X-ray findings. 6 …”

“…This may be the reason our study showed only 22.12% of abnormal CxRs to have a classic appearance compared to 71.1% in the above study because our study limited classic appearances exclusively to bilateral opacities and to the absence of pleural effusion. 6 Moreover, upper zone involvement was excluded from the classic appearance in our study. Our study showed a comparable frequency of bilateral (92.7% compared to 89.8%) and unilateral (7.3% compared to 7.2%) disease.…”

“…4,5 There is only one published study on CxR findings of COVID-19 in Nepal. 6 Typical abnormal chest X-ray findings in COVID-19 include bilateral peripheral mid and lower zones ground glass opacities (GGO) and/or consolidation/ air space opacities (ASO) with pleural effusion being uncommon. 5,7 The aim of this study was to find out the mean Brixia severity scores among symptomatic COVID-19 patients in a tertiary care centre.…”