P10 Chest radiograph features of the COVID-19 infection: comparison of the initial and follow-up changes

ObjectivesIn December 2019, an outbreak of coronavirus (COVID-19) started in Wuhan, China, and quickly spread across the world. We describe the features seen on chest radiograph (CXR) at disease onset, the natural history of these changes after an approximate two-month follow-up period, and the further respiratory investigations requested following discussion with patients who recovered from the illness.Materials and MethodsFrom March 16, 2020, to June 4, 2020, the CXR features of 86 patients (23–87 years, 50 males) who were admitted to the medical take with COVID-19 were analysed. The initial and follow-up CXRs, obtained a mean of 7.9 days and 63.8 days from illness were retrospectively assessed for the severity and progression of changes. Patients were then contacted by telephone to discuss any ongoing respiratory symptoms, and further investigations requested using the BTS guidelines for COVID-19 follow-up.Results65 of the 80 (83%) patients with abnormal initial CXRs had more than 1 lobe affected, with most (53/80, 66%) having changes in the lower lobes. A diffuse distribution was most common (37/80, 46%), followed by peripheral (28/80, 35%). These abnormalities were predominantly consolidation (61/80, 76%). At follow-up, just over half of CXRs (44/80, 55%) were reported as normal. Of those with ongoing changes, the dominant features were pneumonitis (5/36, 14%), inflammatory change, and atelectasis (4/26 each, 11%). 74 patients have been reviewed, and around half (35/74, 47%) have been discharged from our service. Of the 25 requiring further investigation with cross-sectional imaging, we have identified 1 pulmonary embolus and 4 cases of fibrosis (2 of which look to be asbestos-related and likely pre-date the diagnosis of COVID-19 pneumonia).ConclusionsWe observed an even split between patients demonstrating complete resolution of initial CXR changes and the persistence of radiological features at six weeks. At follow-up, a significant proportion of patients continued to feel symptomatic despite an improvement in radiological features or a lack of positive findings with cross-sectional imaging. This underlines the importance of adopting a holistic approach and the need to exclude other causes of breathlessness in patients with no CXR or CT evidence of cause.