Back to the basics: Study of portable chest radiographic findings in 116 COVID-19 positive patients in an Indian tertiary care hospital

CONTEXT: Paucity of literature of portable CXR findings in COVID-19. AIMS: Evaluate radiographic findings in COVID-19 patients and calculate sensitivity of radiographs with RT-PCR as gold standard. SUBJECTS AND METHODS: Total 116 COVID-19 patients underwent portable CXR between April-June, 2020. Two radiologists reviewed radiographs with respect to laterality, craniocaudal, mediolateral distribution, shape, density, unifocality/multifocality and number of lung zones. Sensitivity of radiography was calculated with RT-PCR as gold standard. STATISTICAL ANALYSIS USED: IBM SPSS Statistics Subscription software (IBM, New York, USA). RESULTS: Many patients 67.2% (78/116) were asymptomatic. Cough (21.5%, 25/116) and fever (17.6%, 20/116) were the most frequent symptoms. 36.2% (42/116) patients revealed COVID-19 pneumonia-like abnormalities on CXR. Sensitivity of CXR with RT-PCR as gold standard was 36.2% (CI: Confidence interval = 27.46% - 44.95%). More patients in symptomatic group (68.4%, 26/38) had abnormal CXR compared to asymptomatic group (20.5%, 16/78) [P < 0.0001]. Radiographs revealed both unilateral (57.1%, 24/42), bilateral (42.8%, 18/42), GGO (80.9%, 34/42), or consolidation (11/42, 26.1%) in a middle (57.1%, 24/42), lower zone (83.3%, 35/42) and peripheral distribution (78.5%, 33/42). Lesions were commonly patchy (88%, 37/42) and multifocal (59.5%, 25/42). Majority had single (40.4%, 17/42) or two zone (35.7%, 15/42) involvement. CONCLUSIONS: Significant number of COVID-19 patients were asymptomatic. Over 1/3(rd) of patients showed radiographic abnormalities. Symptomatic patients were more likely to show radiographic findings than asymptomatic patients. If radiographs identify pneumonia in appropriate clinical setting, CT can be avoided. Common radiographic abnormalities among COVID 19 patients were bilateral/unilateral, patchy, multifocal, ground glass opacity or consolidation in peripheral and middle/lower zone distribution.