Severe shadowing (admission image)

Hover on/off image to show/hide findings

Tap on/off image to show/hide findings

Click image to align with top of page

Clinical information

  • 60-year-old male
  • Cough, fever and increasingly short of breath
  • 60-year-old male
  • O2 saturation of 80% on air
  • COVID-19 swab positive 5 days after this chest X-ray (2 negative swabs)

Severe shadowing (admission image)

  • PA chest
  • Bilateral lung shadowing spares only the upper zones
  • Classification: Severe

Severe shadowing (admission to ITU)

Hover on/off image to show/hide findings

Tap on/off image to show/hide findings

Click image to align with top of page

Clinical information

  • Worsening of O2 requirement over several hours
  • Patient admitted to ITU

Severe shadowing (admission to ITU)

  • The endotracheal tube (ET tube) tip is located at the level of the carina and entering the right main bronchus - the tube was subsequently withdrawn a few centimetres
  • A nasogastric tube has also been inserted
  • Distribution of shadowing appears worse when compared with the previous PA image
  • Direct comparison is not possible - this is an AP supine image with incomplete inspiration (intubated patients cannot hold their breath in deep inspiration)

CT Chest - lung apices (axial slice)

Hover on/off image to show/hide findings

Tap on/off image to show/hide findings

Click image to align with top of page

Clinical information - day 14 after admission

  • Worsening respiratory failure and raised D-dimer

CT Chest - lung apices (axial slice)

  • A CT Pulmonary Angiogram (CTPA) was requested to exclude pulmonary embolus (no PE was found)
  • A non-contrast CT was acquired first (intravenous contrast required for a CTPA can lead to misinterpretation of subtle lung changes)
  • This axial image passes through the lung apices - see the (red line) on the 'scout image' (top right)
  • Multiple 'ground-glass opacities' are shown

CT Chest - anterior lungs (coronal slice)

Hover on/off image to show/hide findings

Tap on/off image to show/hide findings



Click image to align with top of page

CT Chest - anterior lungs (coronal slice)

  • This slice (mid-axillary line) shows areas of ground glass opacification superiorly with denser areas of consolidation in the lower lungs
  • Ground glass opacification is more dominant in non-dependent areas of the lungs (anteriorly in a patient nursed in the supine position)
  • Ground-glass opacification is a typical feature of COVID-19 pneumonia seen on CT

CT Chest - lower lungs (axial slice)

Hover on/off image to show/hide findings

Tap on/off image to show/hide findings



Click image to align with top of page

CT Chest - lower lungs (axial slice)

  • Lower in the lungs there is dense consolidation in the dependent part of the lungs posteriorly
  • Ground glass opacities are seen more anteriorly
  • Consolidation is a sign of disease severity in COVID-19 pneumonia

CT Chest - posterior lungs (coronal slice)

Hover on/off image to show/hide findings

Tap on/off image to show/hide findings

Click image to align with top of page

CT Chest - posterior lungs (coronal slice

  • This slice (posterior to the mid-axillary line) shows dense consolidation of the dependent (posterior) parts of both lungs
  • Air bronchogram is the characteristic feature of consolidation
  • Consolidation is more dominant in dependent areas of the lungs (posterior in a patient nursed in the supine position)

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

Last reviewed: May 2020