COVID-19 (Let’s look at what we should be looking for on CXR)
As always it’s important to use a system when evaluating a chest X-Ray but with the current COVID-19 pandemic there are some review areas that have become even more important...
👨🏽💻Depending on where in the world you are you may be doing CT or CXR as the first line imaging test in potential COVID patients. Let’s look at what we should be looking for on CXR:
1️⃣ Remember the X-Ray may be normal in COVID, especially in mild or early disease. If we pick up COVID on CXR the most likely thing to find is BILATERAL consolidation. This most commonly is peripheral so it’s important to run your eyes up the sides of the lung. It can be really tricky to make a call with subtle consolidation especially when the film is AP and there is a lot of soft tissue
2️⃣ I find inverting the film can help me make my mind up about whether there may be the beginnings of consolidation that may be tricky to call. It is difficult to say unilateral consolidation is definitely going to be COVID (remember other pneumonias won’t just go away) but if there is a suspicious clinical picture (ie fever, high CRP, lymphopenia) it may then be worth isolating the patient and testing. Repeating the CXR or doing a CT can then help if the PCR test comes back negative (remember PCR is not fully sensitive) but it’s worth knowing what your local guidelines are
3️⃣Most cases will show peripheral consolidation (what we call a ‘reverse’ bat wing) but sometimes you can get bilateral central consolidation (the more classic bat wing picture) - this can be hard to differentiate from pulmonary oedema!
4️⃣Pleural effusions are not commonly reported on positive COVID films and so significant sized effusions should make you consider alternative pathology. Other features to make you think of other diagnoses are:
▫️small nodules
▫️cavitating mass
▫️markedly enlarged lymph nodes
5️⃣Don’t get distracted and forget to follow all tubes and lines - I like to do this first for that reason
✊Good luck to everyone across the world working to fight the COVID-19 pandemic
As always it’s important to use a system when evaluating a chest X-Ray but with the current COVID-19 pandemic there are some review areas that have become even more important...
👨🏽💻Depending on where in the world you are you may be doing CT or CXR as the first line imaging test in potential COVID patients. Let’s look at what we should be looking for on CXR:
1️⃣ Remember the X-Ray may be normal in COVID, especially in mild or early disease. If we pick up COVID on CXR the most likely thing to find is BILATERAL consolidation. This most commonly is peripheral so it’s important to run your eyes up the sides of the lung. It can be really tricky to make a call with subtle consolidation especially when the film is AP and there is a lot of soft tissue
2️⃣ I find inverting the film can help me make my mind up about whether there may be the beginnings of consolidation that may be tricky to call. It is difficult to say unilateral consolidation is definitely going to be COVID (remember other pneumonias won’t just go away) but if there is a suspicious clinical picture (ie fever, high CRP, lymphopenia) it may then be worth isolating the patient and testing. Repeating the CXR or doing a CT can then help if the PCR test comes back negative (remember PCR is not fully sensitive) but it’s worth knowing what your local guidelines are
3️⃣Most cases will show peripheral consolidation (what we call a ‘reverse’ bat wing) but sometimes you can get bilateral central consolidation (the more classic bat wing picture) - this can be hard to differentiate from pulmonary oedema!
4️⃣Pleural effusions are not commonly reported on positive COVID films and so significant sized effusions should make you consider alternative pathology. Other features to make you think of other diagnoses are:
▫️small nodules
▫️cavitating mass
▫️markedly enlarged lymph nodes
5️⃣Don’t get distracted and forget to follow all tubes and lines - I like to do this first for that reason
✊Good luck to everyone across the world working to fight the COVID-19 pandemic
0 Comments: