Temporal Lung Changes on Chest X-ray in COVID-19 Patients at Thabo Crown Prince Hospital

Abstract

Background and objective: Coronavirus disease 2019 (COVID-19), a novel worldwide pandemic, is a highly infectious disease, causing pathological lung changes that can result in severe pneumonia progressing to acute respiratory distress syndrome (ARDS). In Thailand, portable chest x-ray (CXR) machines are the most commonly used modality for assessment and follow-up of lung abnormalities in COVID-19 positive patients. This study aimed to describe CXR findings and temporal lung changes in COVID-19 patients.

Methods: A retrospective, descriptive study of patients with positive reverse transcription polymerase chain reaction (RT-PCR) tests for COVID-19 who were admitted from July 1 to August 31, 2021. Patients’ demographics and CXR findings were reviewed. The lung finding scores were summed to produce a total severity score (TSS).

Results: A total of 487 patients were included in the study: 48.3 % male and 51.7 % female. The ages of the patients ranged from three months to 89 years with a mean of 36.22 ± 16.57 years. A total of 1,764 chest x-rays were obtained of the 487 patients. Three hundred and thirty-five baseline CXRs and the serial CXRs of 92 patients with abnormalities were analyzed to examine temporal lung changes. The most common findings from CXRs were peripheral ground-glass opacities (GGO) affecting the lower lung zones. In the course of illness, the GGOs progressed into consolidations affecting the middle and lower lung lobes at around 1-9 days, peaking at day 1-4 after the initial CXR (GGOs 48%, consolidations 44%). The consolidations regressed and reticulations were developed after day 10 from the initial CXR, indicating a healing phase.

Conclusion: Chest x-rays are good for assessing and monitoring patients with COVID-19 pneumonia; the CXR scoring system provided a good method to predict disease severity.