Review previous images (admission chest X-ray)
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Clinical information - Patient 1
- 50-year-old female (never smoked)
- 2 days ago presented with a fever and was swabbed
- Returned with worsening shortness of breath
- Bronchial breathing at the lung bases
- O2 saturation of 75% on 4 litres of O2
- COVID-19 swab positive prior to this X-ray
Review previous images (admission chest X-ray)
- Anterior-Posterior (AP) image - too unwell to stand
- Shadowing is typical for COVID-19 lung disease - patchy, peripheral, bilateral and basal
- Inspiration is suboptimal - the diaphragm should be intersected by the 5th to 7th anterior ribs in the mid-clavicular line - which may make the interpreter think the lung markings are exaggerated
- Poor inspiration is a common feature of COVID-19 lung disease
- Classification: Severe (see next page)
Review previous images (2017 chest X-ray)
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Clinical information - Patient 1
- (Same patient as image above)
- Chest X-ray acquired three years ago as part of a septic screen
- The patient had no chest symptoms at the time
Review previous images (2017 chest X-ray)
- Posterior-Anterior (PA) image - well enough to stand
- Inspiration is only just adequate even though this is otherwise a good quality chest X-ray (the 5th rib crosses the diaphragm at the point of intersection with the mid-clavicular line)
- Comparison with this previous image highlights the extent of lung shadowing at the time of admission
- Review of the previous chest X-ray (if available) provides useful insight and is a mandatory part of chest X-ray interpretation
Assessing progress (admission chest X-ray)
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Clinical information - Patient 2
- 60-year-old male
- Ex-heavy smoker with COPD
- Travel to Eastern Europe in March 2020
- Productive cough and sweats
- Crackles at right lung base
Assessing progress (admission chest X-ray)
- PA chest
- Shadowing is bilateral, peripheral and mainly affects the lower lungs
- Shadowing extends more superiorly on the right
- Classification: Moderate (see next page)
- Note: If shadowing due to COVID-19 lung disease is asymmetric it is frequently more extensive on the right than on the left
Assessing progress (2 days later)
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Clinical information - Patient 2
- Increasing shortness of breath
- Maintaining O2 saturation of 95% on 15 litres of O2
- Chest X-ray requested as part of consideration for admission to ITU
- ITU was not required, the patient recovered and was discharged
Assessing progress - (2 days later)
- AP chest X-ray
- At first the shadowing appears worse on this chest X-ray when compared with the previous image
- AP and PA images cannot be directly compared - an AP image can exaggerate lung markings
- Careful assessment shows similar distribution and extent of shadowing
- Shadowing is still classified as moderate (see next page)