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Some thoughts on Chest X-Ray interpretation in the COVID era (thread)...
1. Peripheral consolidation is now the first thing to look for. Can be really tricky with overweight patients and AP films. Comparing to prior, looking for asymmetry and inverting the film can help avoid overcalling
2. Unilateral consolidation can be difficult to call as definite COVID so will always need to correlate with clinical picture (fever, CRP, lymphocytes) - new peripheral consolidation and having bloods open has helped sway decisions as a radiologist...
...repeat films can help where there is doubt and cases can ‘reveal’ themselves as classic COVID on a subsequent CXR
3. Hunting for subtle consolidation has become more important - I have found inverting the film has improved my confidence in equivocal calls
4. Remember peripheral opacity within the posterior left lower lobe will manifest as a retrocardiac opacity on CXR so can’t neglect this review area
5. Although the classic COVID pattern is a ‘reverse bat wing’ with bilateral peripheral consolidation we are seeing cases of central consolidation and the more classic bat wing pattern. This can be hard to differentiate from pulmonary oedema
6. Easy to forget about the tubes and lines in the COVID panic and not follow their course thoroughly
7. Incidental lung cancers will inevitably show themselves on suspected COVID films so can’t forget the usual review areas such as apices
8. Experience so far has seen very little of pleural effusions on COVID positive CXR but small effusions have been seen on CT. One case of significant pneumothorax on a positive COVID film
9. Usual follow up strategies will have to be adapted. Locally a virtual COVID clinic has worked well so far with plans to repeat film 4 weeks after admission in discharged patients after close early telephone follow up, bearing in mind some patients reattend after discharge
