Lung Manifestations of COVID-19 on Chest Radiographs—Indian Experience in a High-Volume Dedicated COVID center

Nagarajan, Bhagyam; Autkar, Gayatri; Monga, Aarav; Toshniwal, Nikhil

Chest imaging, which includes X-ray imaging and CT scan, is the main modality for assessing lung involvement in patients affected with the COVID-19 virus. Although CT is more sensitive, due to ease and affordability issues, X-rays are the preferred first-line study. The aim of this article is to familiarize the treating physician with the imaging spectrum of the coronavirus lung infection on X-ray and to discuss the frequency of these findings. A total of 593 radiographs of admitted COVID-19 patients (RT-PCR proven) were retrospectively assessed in the study. Demographics of admitted patients and COVID manifestations on chest radiographs were assessed. Male to female ratio of patients in our study was 2.1:1. The largest number of patients was in the 50 to 60-year age bracket (29%). Forty percent of the X-rays in our study were negative. No X-ray showed findings exclusively in the upper zones, and 88% showed findings in the mid-lower zones. Ground glass opacification was the commonest finding (75% of cases) in abnormal X-rays. The next most common findings were peripheral lung opacities and confluent consolidation. Confluent consolidation, which indicates more severe disease, was observed in 15% of the abnormal X-rays. The proportion of patients showing confluent consolidation was seen more in the older age groups (> 50 years old) with a peak in the 60–70-year age bracket. Small reticular opacities, pneumothorax, pneumomediastinum, and pleural effusions were uncommon findings in our study.