Chest X-ray findings in COVID-19 patients: a descriptive study

Asraf Hussain, Jeetendra Mishra, Achutanand Lal Karn, Alok Kumar Singh, Parwez Ansari, M. Kalim Akhtar, Bikranta Rimal, Dambar Shah, Rajan Mahato, Sagun Bista, Aadarsh Singh, Omprakash Kushwaha, Surendra Yadav, Rupesh Shah, Ramji Ram


Background: Early suspicion and diagnosis remains the cornerstone for the better outcome of patients and to decrease cross infection in cases of COVID-19 pneumonia. In a country like Nepal X-ray facilities are readily available radiological tool in most of the centers and can be important screening tool.  There is a lack of studies detailing the chest XR (C-XR) findings in these patients when compared to that dedicated to the CT features. Study aims to describe the patterns of the lung opacities in CXR in these patients.

Methods: This is retrospective descriptive study conducted at NMCTH in COVID-19 patients from 12 September to 17 October 2020. Demographic characteristics, symptoms, co-morbidities and C-XR findings were studied. CXR findings were categorized according to BSTI classification.

Results: Among 111 COVID-19 RT-PCR positive cases admitted 102 (91.9%) belonged to age group 18-65 years, 89 (80.2%) were males. Cough and fever were the commonest symptoms present in 109 (98.2%) patients. Ischemic heart disease and hypertension in 32 (28.8%) patients were the commonest co morbidities. According to British society of thoracic imaging (BSTI) COVID-19 CXR classification, six patients (5.4%) had normal chest X-rays. Classic/probable COVID-19 picture was present in 79 (71.17%) patients while (7.2%) had intermediate for COVID-19 X-ray findings. Among 79 patients with classic/probable COVID-19 CXR findings 71 (89.8%) had bilateral consolidation/ground glass haze, 72 (91.1%) had peripheral lung involvement while 66 (83.5%) had middle and lower zone involvement.

Conclusions: Ground glass opacities/consolidations with bilateral location, peripheral distribution and middle- lower zone predominance were the commonest X-ray findings in our study.


COVID-19, CXR, Lungs, Co-morbidities, BSTI

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World Health Organization. Naming the coronavirus disease (COVID-19) and the virus that causes it: World Health Organization (WHO). Available at: Accessed on 27th March 2021.

World Health Organization. 2019-nCoV outbreak is an emergency of international concern. 2020. Available at: international-concern. Accessed on 27th March 2020.

Shrestha R, Shrestha S, Khanal P, KC B. Nepal’s first case of COVID-19 and public health response. J Travel Med. 2020;27(3):024.

Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507-13.

CDC, Centers for disease control and prevention. Groups at higher risk for severe illness. Available at: Accessed on 27th March 2020.

Nepal concludes first phase of COVID-19 vaccination drive; 184,857 receive. Available at: https://the Accessed on 27th March 2020.

Hare S, Rodrigues J, Nair A. The continuing evolution of COVID-19 imaging pathways in the UK: a British Society of Thoracic Imaging expert reference group update. Clin Radiol. 2020;75:399-404.

NHS England Specialty guides for patient management during the coronavirus pandemic Clinical guide for the management of Radiology patients during the coronavirus pandemic. Available at: Accessed on 27th March 2020.

Tavare AN, Braddy A, Brill S. Managing high clinical suspicion COVID-19 inpatients with negative RT-PCR: a pragmatic and limited role for thoracic CT Thorax. 2020.

Rodrigues JCL, Hare SS, Edey A, Devaraj A, Jacob J, Johnstone A et al. An update on COVID-19 for the radiologist - A British society of Thoracic Imaging statement. Clin Radiol. 2020;75(5):323-5.

Hansell DM, Bankier AA, MacMahon H, McLoud TC, Müller NL, Remy J. Fleischner Society: Glossary of terms for thoracic imaging. Radiology. 2008;246(3):697-722.

Durrani M, Haq IU, Kalsoom U, Yousaf A. Chest X-rays findings in COVID 19 patients at a University Teaching Hospital - A descriptive study. Pak J Med Sci. 2020;36(COVID19-S4):S22-6.

Bajracharya S, Shrestha A, Rajbhandari B. Symptoms of COVID-19 Confirmed cases Presenting to Emergency Department in A Tertiary Care Centre: A Descriptive Cross-sectional Study. J Nepal Med Assoc. 2020;31

Richardson S, Hirsch JS, Narasimhan M. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA. 2020;323(20):2052-9.

Rousan LA, Elobeid E, Karrar M. Chest x-ray findings and temporal lung changes in patients with COVID-19 pneumonia. BMC Pulm Med. 2020;20:245.

Kanne JP, Little BP, Chung JH, Elicker BM, Ketai LH. Essentials for Radiologists on COVID-19: An Update-Radiology Scientific Expert Panel. Radiology. 2020;27.

Wong HYF, Lam HYS, Fong AH-T, Leung ST, Chin TW-Y, Lo CSY et al. Frequency and distribution of chest radiographic findings in COVID-19 positive patients. Radiology. 2020;27.