Early observational studies discussing characteristic patterns of radiographic findings have focused predominantly on the use of computed tomography (CT) imaging. However, to date, there is little evidence describing the utility of CXR in identifying patients with suspected COVID-19. Plain film radiography of the chest (CXR) is a relatively inexpensive and widely available diagnostic modality in urgent care (UC) centers. 1,2 During this outbreak, acute care clinicians have been striving to accurately diagnose and define its clinical features in order to provide the best care for afflicted patients and limit the spread of the disease. Pleural effusions and lymphadenopathy were uncommon.ĬOVID-19, a novel disease caused by the SARS-CoV-2 virus, rapidly became a pandemic in early 2020, resulting in considerable worldwide morbidity and mortality. When abnormal, the most common findings were present in the lower lobes and the pattern was interstitial and/or multifocal. The vast majority of patients (566/636) had either normal or only mildly abnormal CXRs (89%), despite being symptomatic enough to warrant imaging as determined by the treating UC provider.ĬXRs obtained from confirmed and symptomatic COVID-19 patients presenting to the UC were normal in 58.3% of cases, and normal or only mildly abnormal in 89% of patients. This is the first study to specifically explore CXR findings of patients with confirmed COVID-19 evaluated in a UC setting. Effusions and lymphadenopathy were uncommon. Location of the abnormalities were in the lower lobe in 215 (33.8%), bilateral in 133 (20.9%), and multifocal in 154 (24.2%). Interstitial changes and ground glass opacities (GGO) were the predominant descriptive findings in 151 (23.7%) and 120 (18.9%) of the total, respectively. Of the 265 abnormal cases (41.7%), 195 demonstrated mild disease, 65 demonstrated moderate disease, and five demonstrated severe disease. There were 371 CXRs re-read as normal (58.3%). Patient ages ranged from 18 to 90 years of age, with most (493 patients, or 77.5%) being 30─70 years old. Of the 636 CXRs reviewed among patients with confirmed COVID-19, 363 were male (57.1%) and 273 were female (42.9%). Lastly, overreads were compared with the initial CXR reading. They subsequently characterized specific findings. Their readings were classified as normal, mild, moderate, or severe disease. Eleven board-certified radiologists, with knowledge that they were only reading imaging studies of COVID-19 patients, were each given a subset of the CXRs with oral and written instructions to re-read the films while disregarding the initial reading. Secondarily, we aim to describe specific imaging characteristics and the frequency of each abnormal findings on plain film radiography (CXR).Ī database of a large UC company in the greater New York City (NYC) area was reviewed for patients with positive SARS-CoV-2 PCR tests who also underwent CXR in UC between March 9 and March 24, 2020. Our primary objective was to determine what percentage of UC patients with confirmed COVID-19 had normal vs abnormal chest x-rays (CXR). Patients with COVID-19 commonly present to Urgent Care (UC) centers. Cohen, MD, Stephen Waite, MD, Allen Frye, NP, and Frank A. Russell, MD, MSc, FACEP, Ari Leib, MD, Jordan A. Weinstock, MD, Ana Echenique, MD, DABR, Joshua W.
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