Abstract
Objective:To determine the pattern of COVID-19 on chest radiograph in patients presenting to Lady Reading Hospital, Peshawar, Pakistan.Methods:This prospective observational study was conducted on 178 consecutive swab positive COVID-19 patients presenting to Lady Reading Hospital, Peshawar, Pakistan from 15th March to 15th June 2020. Patients of all ages and both genders were included. Chest X-rays performed by portable radiography unit were viewed for different patterns by two consultant radiologists independently and results were analyzed using IBM SPSS 20.Results:Out of 178 patients 134 were male. Mean age was 55.67 years. Radiographic patterns observed were ground glass haze without or with reticulation and/or consolidation (45.5 % and 33.2% respectively) and predominant consolidation either alone or in combination with ground glass haze or other findings (27.1% collectively). Peripheral distribution pattern was seen in 69.1% of patients with bilateral findings in 84.3%. Further categorization was based on pulmonary zonal demarcation with changes most commonly involving four zones (33.1%) i.e., the lower and mid zones bilaterally.Conclusion:Portable chest radiography is an essential supporting tool for assessing different patterns in COVID-19 infection. The most common pattern observed is alveolar opacities with predominant peripheral distribution either unilateral or more frequently bilateral, starting from the lower and mid zones extending to the upper zones and becoming diffuse with disease progression.
Highlights
COVID-19, caused by SARS-COV-2, declared a pandemic by world health organization (WHO) in March 2020, has had a global impact since it first emerged in WUHAN, CHINA in late December 2019.1 In Pakistan the first case was reported on 26th February 2020 in Karachi.[2]
Chest radiograph though less sensitive than CT chest, is the first line imaging modality used for COVID-19 patients, with portable chest radiography units used for ease of decontamination and eliminating the need of patient transfer.[5,6,7,8,9]
This prospective observational study were conducted on an initial series of consecutive 178 patients presenting with COVID-19 infection to Lady Reading Hospital (LRH), Peshawar, Pakistan from 15th March to 15th June 2020
Summary
COVID-19, caused by SARS-COV-2, declared a pandemic by world health organization (WHO) in March 2020, has had a global impact since it first emerged in WUHAN, CHINA in late December 2019.1 In Pakistan the first case was reported on 26th February 2020 in Karachi.[2]. Chest radiograph though less sensitive than CT chest, is the first line imaging modality used for COVID-19 patients, with portable chest radiography units used for ease of decontamination and eliminating the need of patient transfer.[5,6,7,8,9] Most of radiological literature focuses on chest CT role and manifestations in COVID -19. According to some studies performed in China, CT has achieved a diagnostic sensitivity even higher than initial RT-PCR swab test[10] but due to infection control issues, decontamination and lack of CT availability in certain parts of the world, portable chest radiography is the most frequently used imaging modality for identification and follow up of lung manifestations of COVID-19. The rationale of the study was to highlight the different radiographic patterns of COVID-19 which is an essential parameter in both disease diagnosis and prognosis
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