Key points

  • Understanding of the imaging features of COVID-19 pneumonia is evolving
  • Chest X-ray and CT features are described in this gallery
  • This resource is intended as a point of reference for healthcare professionals caring for patients with proven or suspected COVID-19 pneumonia

Introduction

This image gallery is intended as a reference source for healthcare professionals caring for patients with suspected or proven COVID-19 pneumonia. First principles of image interpretation are highlighted in the context of the COVID-19 global pandemic.

COVID-19 pneumonia - typical pattern

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Clinical information

  • 30-year-old male non-smoker
  • Presented with arthralgia and mild dry cough
  • Patient well enough to be discharged and instructed to self-isolate
  • No swab sample was taken
  • The diagnosis of Covid-19 was made on the basis of clinical and radiological features

COVID-19 pneumonia - typical pattern

  • PA chest
  • The pattern of shadowing is typical for COVID-19 pneumonia
  • Patchy, peripheral, bilateral and basal (mid and lower zones)
  • Classification: Mild (see classification page)

Chest X-ray (CXR) v Computed Tomography (CT)

CT has been used for the purpose of diagnosis in certain clinical settings - such as when swab testing is not available - but currently is not used routinely for diagnosis in most health care settings. Most patients can be managed acutely on the basis of chest X-ray findings. For this reason the plain chest X-ray is the main focus of this gallery. CT appearances are discussed briefly.

Note: Many patients do not require imaging which is usually limited for assessment of patients ill enough to be admitted to hospital. Although the diagnosis of COVID-19 remains based on rRT-PCR (real-time reverse transcription polymerase chain reaction) the diagnosis can be made before swab testing is positive on the basis of the combination of typical clinical and imaging features.

Disclaimer: Clinical decisions should be made on the basis of wider medical knowledge and based on local healthcare pathways. Please see our full terms and conditions before proceeding.

Acknowledgements

Special thanks to Dr Charles Peebles and Dr Georgina Adam of University Hospitals Southampton UK for submission of cases for this gallery.

Submit to this resource

To submit your case(s) please see our submission page HERE. Limited time only.

References

Frequency and Distribution of Chest Radiographic Findings in COVID-19 Positive Patients

Wong et al, Radiology, Mar 27 2020.

https://pubs.rsna.org/doi/10.1148/radiol.2020201160

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Portable chest X-ray in coronavirus disease-19 (COVID-19): A pictorial review

Jacobi et al, Clinical Imaging, Apr 8 2020.

https://www.sciencedirect.com/science/article/pii/S0899707120301017

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Imaging Profile of the COVID-19 Infection: Radiologic Findings and Literature Review

Ng et al, Radiology, Feb 13 2020.

https://pubs.rsna.org/doi/10.1148/ryct.2020200034

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Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study

Shi et al, Lancet, Feb 24, 2020.

https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30086-4/fulltext

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Temporal Changes of CT Findings in 90 Patients with COVID-19 Pneumonia: A Longitudinal Study

Wang et al, Radiology, Mar 19 2020.

https://pubs.rsna.org/doi/10.1148/radiol.2020200843

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Clinical Characteristics of Coronavirus Disease 2019 in China

Guan et al, New England Journal of Medicine, Feb 28 2020.

https://www.nejm.org/doi/full/10.1056/NEJMoa2002032

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Clinical, laboratory and imaging features of COVID-19: A systematic review and meta-analysis

Rodriguez-Morales et al, Travel Medicine and Infectious Disease, Mar 13 2020.

https://www.sciencedirect.com/science/article/pii/S1477893920300910?via%3Dihub

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Epidemiology of COVID-19 and grading of CXR changes

M Rodie, British Institute of Radiologists, Web Presentation, Apr 3 2020.

https://www.bir.org.uk/media/421269/covid_advice_sheet_1.pdf

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Page author: Salisbury NHS Foundation Trust UK (Read bio)

Last reviewed: June 2020