Chest X-ray v CTPA (pulmonary embolus)

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Clinical information - Patient 1

  • 60-year-old female
  • 2-week history of fatigue and shortness of breath
  • Left sided pleuritic chest pain
  • COVID-19 swab positive on the same day as this chest X-ray

Chest X-ray

  • The Chest X-ray shows lung shadowing in a typical distribution for COVID-19 pneumonia – patchy, bilateral, peripheral, basal
  • Classification: Moderate

Chest X-ray v CTPA (pulmonary embolus)

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CTPA (coronal slice)

  • A CT pulmonary angiogram (CTPA) was performed the same day
  • Filling defects of the pulmonary arteries are due to pulmonary embolism (frequently best seen on coronal slices)
  • Areas of peripheral consolidation (roll-over image) have the typical appearance of wedge-shaped pulmonary infarcts seen in patients with pulmonary embolism

Chest X-ray v CTPA (mild shadowing)

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Clinical information - Patient 2

  • 40-year-old male
  • Presented 2 weeks earlier with fever, cough and short of breath (chest X-ray normal at that time and swab for COVID-19 was positive)
  • Returned to hospital with worsening shortness of breath
  • Heart rate 100

Chest X-ray (mild shadowing)

  • The chest X-ray now shows subtle patchy shadowing but this does not appear particularly peripheral
  • Classification: Mild

Chest X-ray v CTPA (mild shadowing)

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CTPA - Mild shadowing

  • A CTPA was performed to exclude pulmonary embolus (not found)
  • Patchy areas of ground-glass opacification are shown to be peripherally located in the lungs
  • These areas of opacification contain prominent vessels

Chest X-ray v CTPA (extreme peripheral sparing)

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Clinical information - Patient 3

  • 72-year-old male
  • Fever, shortness of breath, viral symptoms
  • 72-year-old male
  • D-dimer 4500
  • COVID-19 swab positive on the same day as this chest X-ray

Chest X-ray (extreme peripheral sparing)

  • The presenting chest X-ray shows bilateral patchy shadowing
  • The sub-pleural lungs are spared (arrowheads)
  • This is a finding frequently seen on CT (see image below) but less often seen so clearly on a plain X-ray
  • Classification: Severe

Chest X-ray v CTPA (extreme peripheral sparing)

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CTPA (extreme peripheral sparing)

  • A CTPA was performed on the same day to exclude pulmonary embolism (the scan was positive for small pulmonary emboli in the lung peripheries – not shown)
  • The CT shows peripheral ground-glass opacification but the sub-pleural lung tissue is spared (arrowheads)

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

Last reviewed: June 2020