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Viral pneumonia chest x ray findings12/7/2023 A transition from alveolar to interstitial opacities in noted. Stage III is a fibro-proliferative phase, in this phase there is proliferation of epithelial cells and fibroblasts with collagen deposition. Linear lucencies in right mid zone (red arrow) representing pulmonary interstitial emphysema Patient was intubated and put on positive ventilation because of diffuse lung involvement. Portable chest radiograph of COVID pneumonia patient with diffuse airspace opacities in bilateral lung fields with relative sparing of left upper zone. In our study 9% of patients progressed to ARDS. The opacities tend to be in the periphery as compared to central in cariogenic oedema as well as don’t change temporally as they do on cardiogenic oedema. In fact if the pulmonary vessels can be distinguished they are often constricted in size. The alveolar oedema of ARDS is not accompanied by widening of the vascular pedicle, cardiomegaly, altered pulmonary blood flow distribution, pleural effusions and septal lines. At this juncture it is important to differentiate cardiogenic, overhydration oedema from the alveolar oedema of ARDS. Rarely there are associated pleural effusions these are usually small if present. This is reflected in the radiographic findings of relatively small lung volumes and atelactasis. opacities tend to become confluent, lungs become totally opaque, air bronchograms may be present with injury to alveolar cells, there is decreased surfactant production and decreased lung compliance. This results in loss of aerated lung tissue, impaired gas exchange, hypoxia. With increasing capillary leak diffuse alveolar damage may progress with extensive lung involvement resulting in Acute Respiratory Distress Syndrome (ARDS). Stage II is an inflammatory stage where there is an alveolar capillary leak of protein, fluid resulting in diffuse alveolar opacities predominantly in the peripheral portions of the lungs. There is limited leakage of fluid into the interstitium as a result radiographs demonstrate essentially clear lung fields. Stage 1 is the exudative phase which occurs in the first few days after infection, usually till day4/5. There are 3 stages of diffuse alveolar damage. The diffuse alveolar damage evolves over 1-3 weeks resulting in temporal changes on imaging. These findings were consistent with smaller cohorts reported earlier. The distribution of abnormalities were predominantly in the lower zone (70%) bilateral (61%) and peripheral and central in location (65%) The type of abnormality was predominantly consolidation (68%). ![]() ![]() Chest radiograph was negative in 26% of positive HRCT indicating CT is far more sensitive than chest X-ray in detecting COVID 19 pneumonia. ![]() In our study 67% of patients with positive RTPCR had abnormalities on the chest X-ray. There is resolution of the opacities visualised in right upper and bilateral mid zones Diffuse airspace consolidation involving right lung field and left mid and lower zone. Serial chest radiographs in a patient on mechanical ventilation. Total patients developing barotrauma during hospital stay Total number of patients which developed acute lung injury (ALI) Patients showing progression on serial X-rayįirst normal x-ray which showed progression in due course of time X-ray showing both central and peripheral opacities RTPCR positive patients with abnormal X-ray RTPCR positive patients with normal X-ray
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