Chest X-ray findings monitoring COVID-19 disease course and severity

Abstract

Background Coronavirus related respiratory illness usually manifests clinically as pneumonia with predominant imaging findings of an atypical or organizing pneumonia. Plain radiography is very helpful for COVID-19 disease assessment and follow-up. It gives an accurate insight into the disease course. We aimed to determine the COVID-19 disease course and severity using chest X-ray (CXR) scoring system and correlate these with patients’ age, sex, and outcome. Results In our study, there were 350 patients proven with positive COVID-19 disease; 220 patients (62.9%) had abnormal baseline CXR and 130 patients (37.1%) had normal baseline CXR. During follow-up chest X-ray studies, 48 patients (13.7%) of the normal baseline CXR showed CXR abnormalities. In abnormal chest X-ray, consolidation opacities were the most common finding seen in 218 patients (81.3%), followed by reticular interstitial thickening seen in 107 patients (39.9%) and GGO seen in 87 patients (32.5%). Pulmonary nodules were found 25 patients (9.3%) and pleural effusion was seen in 20 patients (7.5%). Most of the patients showed bilateral lung affection (181 patients, 67.5%) with peripheral distribution (156 patients, 58.2%) and lower zone affection (196 patients, 73.1%). The total severity score was estimated in the baseline and follow-up CXR and it was ranged from 0 to 8. The outcome of COVID-19 disease was significantly related to the age, sex, and TSS of the patients. Male patients showed significantly higher mortality rate as compared to the female patients (P value 0.025). Also, the mortality rate was higher in patients older than 40 years especially with higher TSS. Conclusion Radiographic findings are very good predictors for assessing the course of COVID-19 disease and it could be used as long-term consequences monitoring.

Case report and systematic review suggest that children may experience similar long‐term effects to adults after clinical COVID‐19

“…Although it was not explicitly stated, the median age of the 48 patients in the pre‐print study by Savarraj et al 28 was 50 years and children were not mentioned. Yasin et al reviewed respiratory symptoms and x‐ray results 22 in subjects with a mean age of 42 years, which included an unspecified number of children aged 12–17. It is unclear if any of the documented abnormalities at more than 15 day persisted for two or more months and were seen in children.…”

Challenges and optimization strategies in medical imaging service delivery during COVID-19

“…On the other hand, some countries such as South Korea uses reverse transcription polymerase chain reaction (RT-PCR) for initial screening instead of relying on diagnostic imaging studies[ 19 ]. Nevertheless, chest radiography is a fundamental tool in the diagnosis, management and monitoring of disease[ 20 - 22 ]. Moreover, chest radiography is widely available (less resource intensive), coupled with features of rapid execution, low cost and function of bedside radiography.…”

Modified Chest X-Ray Scoring System in Evaluating Severity of COVID-19 Patient in Dr. Soetomo General Hospital Surabaya, Indonesia

“…8 The lack of CT-scans and radiologists, especially in developing countries such as Indonesia, makes CXR a great substitute to diagnose and determine the severity and progression of lung abnormalities in COVID-19 patients. 9 The currently established CXR scoring systems are Brixia and Radiographic Assessment of Lung Edema (RALE) scoring systems. Brixia scoring system has been widely used as a tool to monitor the severity and progression of COVID-19 pneumonia in Tongji Hospital, Wuhan and Azienda Socio Sanitaria Territoriale, Spedali Civili of Brescia, Italy.…”