Chest X-Rays Findings and Correlation to Clinical Severity in COVID-19 Patients

Background: The manifestations of COVID-19 infection show a wide range of respiratory symptoms. Chest X-ray (CXR) is helpful for assessment, treatment, and monitoring hospitalization.

Objective: To describe and distinguish CXR findings of patients confirming COVID-19 with correlation to clinical severity.

Material and Methods: Between March and May 2020 all patients at Pattani provincial and field hospitals in Pattani Province with positive RTPCR results for COVID-19 were retrospectively reviewed. Patients’ demographics and clinical characteristics were evaluated and clustered in two groups based on clinical severity. Baseline CXRs were reviewed and correlated with clinical severity.

Results: Forty-eight patients, including 31 males (64.6%) males and 17 females (35.4%), were admitted with confirmed COVID-19. Their age ranged from 3 to 91 years (48.7±18.4 years). Fifteen (31.3%) of the cases had comorbidities. Forty-eight baseline CXRs were obtained, in which 25.0% (12) of CXRs showed abnormalities. The most common pattern and distribution on CXRs was patchy and/or confluent ground-glass opacities and peripheral subpleural distribution in 10/12 (83.3%). The non-severe group showed predominance in the lower lung zone in 4/5 (80%), while in the severe group, they showed multiple zones of lung involvement in 6/7 (85.7%). Bilateral lung involvement in 5/7 (71.4%) was most frequent in the severe group (p<0.001).

Conclusion: The most frequent abnormal pattern on CXRs in COVID-19 were patchy and/or confluent ground-glass opacities with peripheral subpleural distribution. The severe group showed bilateral and multiple lung zones involvement. The CXR findings of lung consolidation, perihilar distribution, bilateral, and multiple lower lung zone opacities, in conjunction with other zones of lung involvement suggested a higher risk of a patient developing severe manifestations of COVID-19.

Keywords: Chest X-ray; Coronavirus; COVID-19; SARS-CoV-2; Severity