Admission Chest X-ray

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Clinical information

  • 50-year-old male smoker
  • Fever and cough
  • Tested positive for COVID-19 the previous day
  • Returned to hospital with increasing shortness of breath
  • Maintaining O2 saturation on 15 litres of O2

Admission Chest X-ray

  • PA chest X-ray (patient able to stand)
  • Distribution of shadowing is asymmetric - predominantly affecting the right lung
  • Classification: Mild

Admission to ITU

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Clinical information

  • Day 6
  • Worsening respiratory failure
  • Admitted to ITU

Admission to ITU

  • Supine image - requested to assess tube position
  • The endotracheal (ET) tube tip is located approximately 3.5 cm above the carina
  • A nasogastric tube is in situ
  • The right internal jugular catheter is misplaced - instead of passing into the superior vena cava the catheter has passed laterally into the right subclavian vein
  • Comparison with the previous image shows worsening of lung shadowing
  • Classification: Moderate

Tubes repositioned

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Clinical information

  • Later on Day 6
  • The right internal jugular catheter and the ET tube were repositioned
  • Chest X-ray requested to check position and to exclude a pneumothorax

Tubes repositioned

  • The ET tube tip is located approximately 6 cm above the carina
  • The internal jugular catheter is now positioned over the SVC
  • Classification: Moderate

Discharge from ITU

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Clinical information

  • Day 16
  • Continued stay in ITU uneventful
  • Patient extubated
  • Chest X-ray requested to see if shadowing had resolved

Discharge from ITU

  • PA chest (patient able to stand again)
  • Marked reduction in extent and density of lung shadowing
  • The pattern of shadowing remains typical of COVID-19 pneumonia - patchy, peripheral, bilateral and basal
  • Classification: Mild

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

Last reviewed: May 2020