Background: Coronavirus disease 2019 (COVID-19) is highly contagious and has claimed more than one
million lives, besides causing hardship and disruptions. The Fleischner Society has recommended chest X-ray (CXR) in
detecting cases with high risk for disease progression, for triaging suspected patients with moderate-to-severe illness, and
to eliminate false negatives in areas with high pre-test probability or limited resources. Although CXR is less sensitive
than real-time reverse transcription polymerase chain reaction (RT-PCR) in detecting mild COVID-19, it is nevertheless
useful because of equipment portability, low cost and practicality in serial assessments of disease progression among
Objective: This study aims to review the typical and relatively atypical CXR manifestations of COVID-19 pneumonia in a
tertiary care hospital.
Methods: The CXRs of 136 COVID-19 patients confirmed through real-time RT-PCR from March to May 2020 were
reviewed. Literature search was performed using PubMed.
Results: A total of 54 patients had abnormal CXR whilst the others were normal. Typical CXR findings included
pulmonary consolidation or ground-glass opacities in a multifocal, bilateral peripheral or lower zone distribution, whereas
atypical CXR features comprised cavitation and pleural effusion.
Conclusion: Typical findings of COVID-19 infection in chest computed tomography studies can also be seen in CXR.
The presence of atypical features is associated with worse disease outcome. Recognition of these features on CXR will
improve accuracy and speed of diagnosing COVID-19 patients.