ABSTRACT
OBJECTIVE: In the present study, we evaluated the role of portable chest radiographs in critically ill patients with COVID-19 pneumonia in whom computed tomography (CT) of the chest was not feasible. METHODS: A retrospective chest X-ray study of patients under investigation for COVID-19 was performed in our dedicated COVID hospital (DCH) during the exponential growth phase of the COVID-19 outbreak (August-October, 2020). A total of 562 on-bed chest radiographs were examined comprising 289 patients (critically ill who couldn't be mobilized for CT) along with positive reverse transcription-polymerase chain reaction (RT-PCR) tests. We categorized each chest radiograph as progressive, with changes, or improvement in appearance for COVID-19, utilizing well-documented COVID-19 imaging patterns. RESULTS: In our study, portable radiographs provided optimum image quality for diagnosing pneumonia, in critically ill patients. Although less informative than CT, nevertheless radiographs detected serious complications like pneumothorax or lung cavitation and estimated the evolution of pneumonia. CONCLUSION: A portable chest X-ray is a simple but reliable alternative for critically ill SARS-CoV-2 patients who could not undergo chest CT. With the help of portable chest radiographs, we could monitor the severity of the disease as well as different complications with minimal radiation exposure which would help in identifying the prognosis of the patient and thus help in medical management.
ABSTRACT
CONTEXT: Paucity of literature of portable CXR findings in COVID-19. AIMS: Evaluate radiographic findings in COVID-19 patients and calculate sensitivity of radiographs with RT-PCR as gold standard. SUBJECTS AND METHODS: Total 116 COVID-19 patients underwent portable CXR between April-June, 2020. Two radiologists reviewed radiographs with respect to laterality, craniocaudal, mediolateral distribution, shape, density, unifocality/multifocality and number of lung zones. Sensitivity of radiography was calculated with RT-PCR as gold standard. STATISTICAL ANALYSIS USED: IBM SPSS Statistics Subscription software (IBM, New York, USA). RESULTS: Many patients 67.2% (78/116) were asymptomatic. Cough (21.5%, 25/116) and fever (17.6%, 20/116) were the most frequent symptoms. 36.2% (42/116) patients revealed COVID-19 pneumonia-like abnormalities on CXR. Sensitivity of CXR with RT-PCR as gold standard was 36.2% (CI: Confidence interval = 27.46% - 44.95%). More patients in symptomatic group (68.4%, 26/38) had abnormal CXR compared to asymptomatic group (20.5%, 16/78) [P < 0.0001]. Radiographs revealed both unilateral (57.1%, 24/42), bilateral (42.8%, 18/42), GGO (80.9%, 34/42), or consolidation (11/42, 26.1%) in a middle (57.1%, 24/42), lower zone (83.3%, 35/42) and peripheral distribution (78.5%, 33/42). Lesions were commonly patchy (88%, 37/42) and multifocal (59.5%, 25/42). Majority had single (40.4%, 17/42) or two zone (35.7%, 15/42) involvement. CONCLUSIONS: Significant number of COVID-19 patients were asymptomatic. Over 1/3rd of patients showed radiographic abnormalities. Symptomatic patients were more likely to show radiographic findings than asymptomatic patients. If radiographs identify pneumonia in appropriate clinical setting, CT can be avoided. Common radiographic abnormalities among COVID 19 patients were bilateral/unilateral, patchy, multifocal, ground glass opacity or consolidation in peripheral and middle/lower zone distribution.