Typical distribution

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Clinical information

  • 30-year-old woman
  • Non-smoker
  • Shortness of breath, increased heart rate, coryzal symptoms with a dry cough
  • COVID-19 swab positive 24 hours after this chest X-ray

Typical distribution

  • COVID-19 pneumonia typically causes bilateral, peripheral shadowing of the mid and lower zones of the lungs
  • Lung shadowing is subtle
  • Classification: Mild

Perihilar shadowing

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Clinical information

  • 45-year-old woman
  • Dry cough for 7 days
  • Low grade fever
  • COVID-19 swab positive 24 hours after this chest X-ray

Perihilar shadowing

  • Bilateral shadowing of the mid and lower zones - more central in distribution than in the previous example
  • This is a less specific distribution of lung shadowing in patients with acute COVID-19 pneumonia
  • Classification: Moderate
  • Note: In some patients with a perihilar distribution of disease CT demonstrates the lung changes are in fact peripheral, usually posterior within the lungs - see this example on the CT appearances page

Patchy shadowing

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Clinical information

  • 65-year-old woman
  • Cough and fever for several days
  • Short of breath
  • O2 saturation of 90% on air
  • COVID-19 swab positive 4 days after this chest X-ray (first swab negative)

Patchy shadowing

  • Minor patchy shadowing is bilateral and affects the lower zones
  • The pattern is asymmetric with only minor peripheral shadowing
  • Classification: Mild

Asymmetric shadowing

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Clinical information

  • 70-year-old male
  • Previous stroke
  • Obesity
  • 4 days of fever and cough
  • O2 saturation of 82% on air
  • Bibasal crackles
  • COVID-19 swab positive 3 days after this chest X-ray
  • This patient died 10 days after this chest X-ray

Asymmetric shadowing

  • Shadowing is bilateral
  • The distribution is typical on the left - lower zone and peripheral
  • On the right the shadowing is central
  • Classification: Mild

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

Last reviewed: June 2020