Progression and Resolution of COVID-19 Pneumonia on Chest Radiograph

Abstract

Objective: To evaluate the temporal changes on serial chest radiographs (CXRs)of hospitalised COVID-19 positive patients till their outcome(discharge/death); to determine the severity of CXR score and its correlation with clinical outcome (hospital stay, chest intubation and mortality). Study Design: Descriptive study. Place and Duration of Study: Shifa International Hospital (SIH), Islamabad from March to June 2020. Methodology: After IRB approval, 112 patients were consecutively enrolled, having laboratory-confirmed SARS-CoV-2 and hospitalised in SIH. Patients' demographics and clinical data were retrieved from Radiology Information System (RIS). Chest radiographs (CXR) were retrieved from picture archive and communication system (PACS). CXR severity scoring was determined by three radiologists, and results were analysed. Results: Lung opacities (98.2%), involvement of both lungs (96.4%), both peripheral and central region involvement (62.5%) and upper/mid/lower zone distribution (61.6%) were the most frequent findings. Males affected more than females with a mean age of 58.9 ± 13.1 years. Zonal involvement, density and extent of opacities peaked on 10-13 th day of illness. In the last CXR, opacities showed decrease in extent as well as density, reduction in zonal involvement, and few having mixed interstitial thickening/fibrosis. One hundred and five out of 112 (93.8%) patients had residual radiographic abnormalities on discharge. Conclusion: Serial chest radiography can be used to monitor disease progression and temporal changes after initial HRCT. Patients who have CXR severity score of 4 or more at the time of admission, is a red flag for prolonged hospital stay and possible intubation. Severity of CXR findings peaked at 10-13 days. It is recommended to repeat CXRs every 3-4 th day during hospital stay. Majority of the patients has residual radiographic abnormality on discharge.

Late-onset pulmonary complications among survivors of Coronavirus Disease 2019

“…17 We assessed the radiological severity of the disease using CXR rather than HRCT to reduce expenses as Masood et al describe X-Ray findings in COVID Pneumonia. 19 Similarly Rashid et al elaborate the role of CXR in COVID-19 pneumonia, discouraging the wastage of resources. 20 The patients having normal SpO 2 at rest after recovery from COVID-19 develop dry cough of variable intensity, aggravated at night or early morning and similar in character to bronchial asthma.…”

Spectrum of HRCT Scan Chest Findings in COVID-19 Patients as Categorized by Modified CO-RADS Classification

“…It has been reported in many studies involving imaging modalities. Asghar MS et al 4 and Masood L et al 5 described lung involvement on X-ray chest. Asghar et al 4 reported "bilateral lower zone patchy infiltrates as frequent chest X-ray finding" Regarding modality of CT scan chest Asefi H et al commented that "at least in earlier stages of the disease, CT may not be valuable as a screening test for COVID-19".…”

A study of the chest imaging findings of adult patients with COVID-19 on admission to a tertiary hospital in Johannesburg, South Africa

“…In addition, considering that only the first or admission chest radiograph was included in this study, it is possible that the pattern of disease may have shifted towards consolidation predominance on later, serial images given the authors’ subsequent understanding of the temporal changes of COVID-19 pneumonia on imaging. 32 …”

“…Architectural distortion, subpleural lines and septal thickening were also identified in one study in the lower lobes predominantly, all of which are signs seen more commonly in the resorptive stage of the disease, indicating local inflammatory absorption with residual fibrosis and associated bronchus distortion. 31,32,40 Diffuse bronchiectasis with background emphysema was found in one patient with COPD. There were no pleural or pericardial effusions, lung nodules or tree-in-bud pattern to suggest other acute comorbid lung diseases; however, the small number of CTs makes it difficult to determine the significance of these findings.…”

“…In addition, considering that only the first or admission chest radiograph was included in this study, it is possible that the pattern of disease may have shifted towards consolidation predominance on later, serial images given the authors' subsequent understanding of the temporal changes of COVID-19 pneumonia on imaging. 32 The most commonly affected lung zone was the right lower zone (49.6% ground glass opacities and 17.7% consolidation), which is concordant with the findings of Toussie et al 19 and Zhou et al 33 In this cohort, despite only one-fifth of patients being admitted to ICU, the left upper zone was relatively spared with only 7.0% ground glass opacities and 1.8% consolidation, corroborating the unusual local findings of Buckley et al 21 A few postulates for these specific disease patterns have been proposed, one of which is that anatomically the bronchus of the right lower lobe of the lung is steeper and straighter than other bronchial branches, with a smaller angle between the right lower lobe and the long axis of the trachea. Therefore, the virus is more likely to enter the branches of the right inferior lobar bronchus and cause infection in this distribution rather than in other lobes.…”