Download PDF
CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2021; 31(S 01): S128-S133
DOI: 10.4103/ijri.IJRI_368_20
Original Article

Radiographic features of COVID-19 infection at presentation and significance of chest X-ray: Early experience from a super-specialty hospital in India

Amit K Sahu
Department of Radiology, Max Superspeciality Hospital, Saket, New Delhi, India
,
Anandmoyee Dhar
Department of Radiology, Max Superspeciality Hospital, Saket, New Delhi, India
,
Bharat Aggarwal
Department of Radiology, Max Superspeciality Hospital, Saket, New Delhi, India
› Author Affiliations Financial support and sponsorship Nil.
› Further Information
Also available at
   Permissions and Reprints

Abstract

Background: Due to the relative early lockdown in India, relative greater availability of reverse transcription polymerase chain reaction (RT-PCR) testing, and mandate to admit all positive corona virus disease 2019 (COVID-19) patients, the protocol in our hospital is to perform a baseline chest X-ray (CXR) at the time of admission and for follow up. There are currently limited publications demonstrating the radiographic findings and the role of CXR of COVID-19 patients at presentation. Aims: Evaluatethe radiographic findings on CXR in COVID-19 patients at presentation. Recommend a guideline for its judicious use. Settings and Design: Retroprospective study performed on RT-PCR confirmed COVID-19 patients admitted in our hospital between March 31,2020 to May 25, 2020. The study included symptomatic and asymptomatic patients. CXR was performed for218 patients. Materials and Methods: Portable bedside CXR was performed. The CXRs were evaluated by three radiologists to record the findings and grade the disease. All variables were expressed as mean, ranges, counts, and percentages. Results: 157 patients (72%) were symptomatic and 61 (28%) were asymptomatic. 104 CXRs (48%) were abnormal (97 in symptomatic (62%) and fourin asymptomatic (6%)). 74 patients (47%) in the symptomatic group had known comorbidities and of these, 62 (84%) had abnormal CXR. 97 CXRs (93%) had bilateral findings and 87 CXRs (84%) had peripherally predominant abnormalities. The lower zone was the most common area of involvement (73%). Ground glass opacity (GGO) was the most common finding (94%–98 CXRs). Mild disease was seen in 56 (54%). Conclusion: CXR can be used to assess symptomatic COVID-19 patients at presentation and to grade the severity of disease. It may be avoided in asymptomatic patients.

Keywords

Chest X-ray (CXR) - COVID-19 - consolidation - ground glass opacity


Publication History

Received: 13 May 2020

Accepted: 17 July 2020

Article published online:
13 July 2021

© 2021. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India

 

  • References

  • 1 Ge H, Wang X, Yuan X, Xiao G, Wang C, Deng T. et al. The epidemiology and clinical information about COVID-19. Eur J Clin Microbiol Infect Diseases 2020; 39: 1011-9
    CrossrefPubMedGoogle Scholar
  • 2 Yang W, Sirajuddin A, Zhang X, Liu G, Teng Z, Zhao S. et al. The role of imaging in 2019 novel coronavirus pneumonia (COVID-19). Eur Radiol 2020. doi: 10.1007/s00330-020-06827-4. 2020 Apr 15 : 1-9
  • 3 National registration of Indian citizens. Office of the Registrar General & Census Commissioner. India: Ministry of Home Affairs, Government of India; Available from: https://censusindia.gov.in. [Last updated on 2020 Jul 16].
    Google Scholar
  • 4 Adhikari SP, Meng S, Wu YJ, Mao YP, Ye RX, Wang QZ. et al. Epidemiology, causes, clinical manifestation and diagnosis, prevention and control of coronavirus disease (COVID-19) during the early outbreak period: A scoping review. Infect Dis Poverty 2020; 9: 29
    CrossrefPubMedGoogle Scholar
  • 5 Zhu N, Zhang DY, Wang WL, Li X, Yang B, Song J. et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med 2020; 382: 727-33
    CrossrefPubMedGoogle Scholar
  • 6 Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J. et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 2020; 323: 1061-9
    CrossrefPubMedGoogle Scholar
  • 7 Ai T, Yang Z, Hou H, Zhan C, Chen C, Lv W. et al. Correlation of chest CT and RT-PCR testing in coronavirus disease 2019 (COVID-19) in China: A report of 1014 cases. Radiology 2020. doi: 10.1148/radiol.2020200642. [Published on 2020 Feb 26. Last accessed on 2020 May 29].
  • 8 Caruso D, Zerunian M, Polici M, Pucciarelli F, Polidori T, Rucci C. et al. Chest CT features of COVID-19 in Rome, Italy. Radiology 2020. doi: 10.1148/radiol.2020201237. [Published 2020 Apr 03. Last accessed on 2020 Apr 25].
  • 9 Hope MD, Raptis CA, Henry TS. Chest computed tomography for detection of coronavirus disease 2019 (COVID-19): Don’t rush the science. Ann Intern Med 2020. doi: 10.7326/M20-1382. Online ahead of print April 8, 2020. [Last accessed on 2020 Apr 26].
  • 10 Wong HYF, Lam HYS, Fong AH, Leung ST, Chin TW, Lo CSY. Frequency and distribution of chest radiographic findings in COVID-19 positive patients. Radiology 2020. doi: 10.1148/radiol.2020201160. [Published on 2020 Mar 27. Last accessed on 2020 Apr 25].
  • 11 Salehi S, Abedi A, Balakrishnan S, Gholamrezanezhad A. Coronavirus disease 2019 (COVID-19): A systematic review of imaging findings in 919 patients. AJR Am J Roentgenol 2020:1-7.doi: 10.2214/AJR.20.23034. Ahead of print. [Last accessed on 2020 Apr 30].
  • 12 Jacobi A, Chung M, Bernheim A, Eber C. Portable chest X-ray in coronavirus disease-19 (COVID-19): A pictorial review. Clin Imaging 2020; 64: 35-42
    CrossrefPubMedGoogle Scholar
  • 13 Revised Guidelines on Clinical Management of COVID-19. Government of India Ministry of Health & Family Welfare Directorate General of Health Services. Available from: https://www.mohfw.gov.in/pdf/RevisedNationalClinicalManagement Guideline for COVID19. [Published on 2020 Mar 31. Last accessed on 2020 Apr 25].
  • 14 Hansell DM, Bankier AA, MacMahon H, McLoud TC, Müller NL, Remy J. Fleischner Society: Glossary of terms for thoracic imaging. Radiology 2008; 246: 697-722
    CrossrefPubMedGoogle Scholar
  • 15 Guidance for the Reporting Radiologist British Society of Thoracic Imaging. Available from: https://www.bsti.org.uk/media/resources/files/BSTI_COVID-19 Radiology Guidance version 2_16.03.20.pdf. [Published on 2020 Mar 16. Last accessed on 2020 Mar 30].
  • 16 Shi H, Han X, Jiang N, Cao Y, Alwalid O, Gu J. et al. Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: A descriptive study. Lancet Infect Dis 2020; 20: 425-34
    CrossrefPubMedGoogle Scholar
  • 17 Song FX, Shi NN, Shan F, Zhang ZY, Shen J, Lu H. et al. Emerging 2019 novel coronavirus (2019-nCoV) pneumonia. Radiology 2020; 295: 210-7
    CrossrefPubMedGoogle Scholar
  • 18 Koo HJ, Lim S, Choe J, Choi SH, Sung H, Do KH. Radiographic and CT features of viral pneumonia. Radiographics 2018; 38: 719-39
    CrossrefPubMedGoogle Scholar
  • 19 Lee EY, Ng MY, Khong PL. COVID-19 pneumonia: What has CT taught us?. Lancet Infect Dis 2020; 20: 384-5
    CrossrefPubMedGoogle Scholar
  • 20 Novel Corona disease (COVID 19) Situation update report-13. World Health Organization; India: Available from: https://www.who.int/docs/default-source/wrindia/situation-report/india-situation-report-13.pdf. [Published on 2020 Apr 26. Last accessed on 2020 Apr 30].
    Google Scholar