Mobile chest X-ray manifestations of 54 deceased patients with coronavirus disease 2019: Retrospective study

Abstract

To describe the mobile chest X-ray manifestations of deceased patients with coronavirus disease 2019 (COVID-19).In this retrospective study, we analyzed in patients with COVID-19 from Tongji Hospital (Wuhan, China), who had been died between February 18 and March 25, 2020. Two radiologists analyzed the radiologic characteristics of mobile chest X-ray, and analyzed the serial X-ray changes.Fifty-four deceased patients with COVID-19 were included in the study. We found that 50 (93%) patients with lesions occurred in the bilateral lung, 4 (7%) patients occurred in the right lung, 54 (100%) patients were multifocal involvement. The number of lung fields involved was 42 (78%) patients in 6 fields, 3 (6%) patients in 5 lung fields, 4 (7%) patients in 4 lung fields, and 5 (9%) patients in 3 lung fields. Fifty-three (98%) patients had patchy opacities, 3 (6%) patients had round or oval solid nodules, 9 (17%) patients had fibrous stripes, 13 (24%) patients had pleural effusion, 8 (15%) patients had pleural thickening, 6 (11%) patients had pneumothorax, 3 (6%) patients had subcutaneous emphysema. Among the 24 patients who had serial mobile chest X-rays, 16 (67%) patients had the progression of the lesions, 8 (33%) patients had no significant change of the lesions, and there was no case of reduction of the lesions.The mobile chest X-ray manifestations of deceased patients with COVID-19 were mostly bilateral lung, multifocal involvement, and extensive lung field, and pleural effusion, pleural thickening, and pneumothorax probably could be observed. The serial mobile chest X-ray showed that the chest lesions were progressive with a high probability.

Figure 1

Male, 69 years old. There were multiple areas of opacification in both lungs, showing diffuse high-density patchy opacity with uneven density, presenting “white lung.” The patient died 4 hours later after the X-ray.

Figure 2

A 51-year-old male with 3 mobile chest X-rays before death. A. The first X-ray showed small fluffy patchy opacities scattered in bilateral lung fields (arrows), invading 6 lung fields. B. Seven days after the first X-ray, the second X-ray showed that the multiple areas of opacification increased, and the right horizontal fissure thickened (arrow). C. Four days after the second X-ray, the third X-ray showed that the multiple areas of opacification further increased, and patchy opacities were diffusely distributed in all lung fields, presenting “white lung.” The patient died 2 days after the third X-ray.

Figure 3

A 67-year-old male with 5 mobile chest X-rays before death. This series of X-rays showed the rapid progress of the lesions and the appearance of pneumothorax and subcutaneous emphysema. A. The first X-ray, extensive patchy opacities can be seen in both lung fields, involving the entire lung fields. B. Two days after the first X-ray, the second X-ray showed that patchy opacities increased in density and profusion. C. Three days after the second X-ray, the third X-ray showed that pneumothorax in the right upper lung field (arrow) appeared. D. Three days after the third X-ray, the fourth X-ray showed that the region of the right pneumothorax was enlarged, and the right subcutaneous emphysema appeared. E. One day after the fourth X-ray, the fifth X-ray showed that the region of the pneumothorax and subcutaneous emphysema was further enlarged. The patient died 1 day after the fifth X-ray.