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 lung disease – 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 as 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 (visible filling defects not found)
- Patchy areas of ground-glass opacification are shown to be peripherally located in the lungs
- These areas of opacification contain prominent vessels
- This phenomenon is thought to be due to disordered vasoregulation in vessels of the lungs
Chest X-ray v CTPA (immeditate subpleural 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 (immediate subpleural sparing)
- The presenting chest X-ray shows bilateral patchy shadowing
- The immediate subpleural 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 immediate subpleural lung tissue is spared (arrowheads)