Mobile X-rays are highly valuable for critically ill COVID patients

Abstract

Dear Editor,The diagnostic value of CT for SARS-CoV-2 infection has been widely reported [1,2]. However, performing CT is very difficult in critically ill patients in ICU, whereas mobile Xrays serve as an alternative. From Feb. 20 to Mar. 20, 542 mobile chest X-rays were performed in 229 COVID patients who were under assisted ventilation. Table 1 summarizes the main characteristics of the cohort.Among the 229, a significant underlying disease existed in 165 (72%): hypertension in 31%, chronic heart disease in 13%, chronic pulmonary disease in 12%, and malignancy in 11%. As of Mar. 30, 95 (41%) of 229 patients had died, and 134 (59%) survived. Among them, 58 were discharged and 76 still in hospital. Table 1 shows the number of X-rays performed per patient. There were 229 initial examination and 313 were follow-ups. The image quality was diagnostic for all these X-rays.Extensive pneumonia was seen on the initial X-rays in all patients. Other findings were pneumothorax (7%) and pleural effusion (23%). Subcutaneous emphysema, hiatal hernia, and intrapulmonary cavity were rare findings ( Table 1). All patients with pneumothorax died. Compared to previous X-rays, increase of pneumonia was seen in 119 (38%) of 313 followup X-rays, while no changes were seen in 57 (18%), and improvement in 137 (44%).Among non-survivors (n = 95), 61 patients did not have follow-up X-rays and died 1~4 days after the initial examination; 34 patients had 55 follow-up X-rays. Pneumonia progress was seen in 53 (96%) out of 55 follow-up X-rays when compared to previous radiograph (Fig. 1).Among survivors (n = 134), 111 patients had 258 followup X-rays. Pneumonia progress was seen in 66/258 radiographs (26%) of follow-up X-rays in 37 survivors; however, improvement was seen later.We found mobile X-rays provided adequate image quality for diagnosing pneumonia, at least in this population of severely ill patients. Although obviously less informative than CT, X-rays can nevertheless detect serious complications like pneumothorax or lung cavitation, and estimate the evolution of pneumonia. Therefore, it is a simple but reliable alternative in critically ill SARS-CoV-2 patients who could not undergo chest CT.

Chest X-Ray Findings and Temporal Lung Changes in Patients with COVID-19 Pneumonia

“…Our ndings are in consensus with previous studies on chest x-ray and chest CT scans (4,8,(11)(12)(13)18,(21)(22)(23)(24)(25)(26). Only two patients had pleural effusion which is not a common nding on chest imaging (14,27). Two patients developed reticulations in the second week from the onset of symptoms, this nding was reported on chest CT scan (7,23,25,28).…”

“…Also, in our study there was a signi cant association between symptoms and chest x-ray ndings. This nding should encourage the health professionals to utilize chest x-ray in the diagnosis and follow up of patients with COVID-19 which is in agreement with a study conducted by Toussie et al who reported that chest xray severity score was found to be a predictive index of risk for hospital admission and intubation (29), and mobile chest x-rays were found to be bene cial in the follow up of critically ill COVID-19 patients in another study (27).…”

Chest x-ray findings and temporal lung changes in patients with COVID-19 pneumonia

“…Chest x-ray severity score was found in a previous report to be a predictive index of risk for hospital admission and intubation in patients with COVID-19 pneumonia [29], and mobile chest x-rays were found to be beneficial in the follow up of critically ill COVID-19 patients in another study [27]. In our study, the radiographic findings on chest x-ray in COIVD-19 pneumonia patients are consistent with the radiographic findings detected on chest CT scans and on chest x-rays in previous reports.…”

An unusual course of disease in two patients with COVID-19: pulmonary cavitation

“…[8][9][10][11][12][13][14][15][16][17] Sun et al 18 describe formation of pneumomediastinum, a giant bulla and multiple smaller bullae in the subpleural lung zone in a non-smoker without prior lung disease. Wu and Li 7 show a growing right-sided cavity. In contrast to our cases, these patients received high flow nasal cannula oxygen therapy or invasive ventilation and there was no air-fluid level either.…”