Chest X-ray Findings and Temporal Lung Changes in Patients With COVID-19 Pneumonia

Liqa A. Rousan; Eyhab Elobeid; Musaab Karrar; Yousef Khader


BMC Pulm Med. 2020;20(245) 

In This Article


An outbreak of severe cases of pneumonia from an unidentified origin emerged in Wuhan, China in December 31, 2019. The illness rapidly spread in China and in many other countries. In January 2020, the World Health Organization (WHO) declared it a pandemic.[1] A virus was identified and isolated from the epithelial cells of the respiratory system of infected individuals and was named as Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and the outbreak was named coronavirus disease (COVID-19).[2]

Coronaviruses are enveloped, positive-sense, single strand, non-segmented, and ribonucleic acid viruses that belong to the coronaviridae family.[3] The viruses have characteristic morphology under the electron microscope with presence of viral spike peplomers arising from the viral envelope giving a crown appearance.[4] The coronaviruses are widely distributed among humans and mammals.[5] Six coronaviruses are identified, four of which cause mild common cold symptoms, and two strains were responsible for Severe Acute Respiratory Syndrome (SARS) that began in southern China in 2003 and Middle East Respiratory Syndrome (MERS) that originated in Saudi Arabia in 2012.[6]

The most common symptoms of COVID-19 include fever, cough, dyspnea, fatigue, and myalgia, less common symptoms are sputum, hemoptysis, headache, and gastrointestinal symptoms.[5] COVID-19 infection is confirmed in many countries by Reverse Transcription Polymerase Chain Reaction (RT-PCR) on nasopharyngeal and throat swabs, with a positive rate of 30–70%.[7,8] Chest CT scan was found to be more sensitive than RT-PCR in confirming the diagnosis of COVID-19 reaching 98%.[8] Chest x-ray was found to have limited value in the initial diagnosis of COVID-19 with a sensitivity of about 69%.[9,10] Patients with COVID-19 had typical radiological findings on chest imaging including multifocal and bilateral ground glass opacities and consolidations with peripheral and basal predominance. Septal thickening, bronchiectasis, pleural effusion, lymphadenopathy, and cavitation were less commonly seen.[1,6,11–14]

The outbreak of COVID-19 began in March 2020 in Jordan. RT-PCR was used in the diagnosis and chest x-ray was used in the follow up of patients. Information on chest x-ray findings in patients with COVID-19 pneumonia is still limited in the literature and the majority of the reports described the lung changes on chest CT scan. This study aimed to report the chest x-ray findings in 88 patients with confirmed COVID-19 and to describe the temporal changes of the chest radiological findings throughout the disease course.