The images are courtesy of Elsevier's STATdx at https://www.statdx.com/. Chest radiographs and Axial CECT of patients presenting with COVID-19.

1. Chest X-ray and CT scans
Chest radiographs and Axial CECT of
patients presenting with COVID-19

2. April 9, 2020
We’d like to thank Drs. Santiago Martínez-
Jiménez, MD, Melissa Rosado de Christenson,
MD, FACR, and Sherief Garrana, MD for
providing the images found in this document.

3. AP chest radiograph in a 57-year-old patient with COVID-19
infection shows diffuse bilateral mid and lower lung zone
predominant peripheral opacities, which correspond to areas
of acute lung injury and organizing pneumonia.

4. AP chest radiograph in a 65-year-old patient with COVID-19
infection shows patchy bilateral mid and lower lung zone
opacities with a peripheral distribution, a common
radiographic pattern in affected patients.

5. AP chest radiograph of a 40-year-old man with progressive
dyspnea and hypoxemia requiring hospital admission
shows mid and lower lung zone predominant peripheral
heterogeneous pulmonary opacities.

6. AP chest radiograph of a 44-year-old patient with PCR-proven COVID-19 who
developed acute respiratory distress syndrome (ARDS) shows bilateral
heterogeneous opacities and a dense left basilar consolidation. ARDS is a known
complication of Coronaviridae-associated pulmonary infections.

7. PA chest radiograph of 55-yr-old patient with mild dyspnea, low-
grade fever shows subtle hazy opacities in right upper and left
lower lung zones. These findings can be easily overlooked but
were new when compared to an old chest radiograph (not shown).

8. AP chest radiograph of same patient 5 days later after PCR-proven
COVID-19 shows extensive bilateral heterogeneous opacities in right
upper and left mid to lower lung zones. Patient required intubation
shortly thereafter due to severe dyspnea and hypoxemia.

9. PA chest radiograph of patient with Middle East respiratory
syndrome (MERS) shows multifocal bilateral heterogeneous
opacities and a right upper lobe coalescent heterogeneous
consolidation. (Courtesy Kyung Soo Lee, MD.)

10. Axial CECT of the same patient shows right upper
lobe ground-glass opacity on a background of septal
thickening, the so-called crazy-paving CT pattern.
(Courtesy Kyung Soo Lee, MD.)

11. Axial NECT of 77-yr-old man obtained 5 days after diagnosis of symptomatic
COVID-19 shows subtle bilateral ill-defined peripheral ground-glass opacities. Two
images published in The Lancet Infectious Diseases, Shi H et. al. Radiological
Findings of 81 Patients with COVID-19. Copyright Elsevier (2020).

12. Axial NECT of same patient obtained 15 days after the initial
onset of symptoms shows progression of bilateral pulmonary
involvement manifesting with bilateral peripheral consolidations
and ground-glass opacities.

13. AP chest radiograph of a patient with Middle East respiratory syndrome (MERS)
obtained 10 days after presentation shows interval endotracheal intubation and
disease progression with diffuse bilateral heterogeneous consolidations consistent
with acute respiratory distress syndrome (ARDS). (Courtesy Kyung Soo Lee, MD.)

14. Axial NECT of a patient with Middle East respiratory syndrome
(MERS) shows a left lower lobe peribronchovascular consolidation
and surrounding centrilobular acinar ground-glass opacities.
(Courtesy Kyung Soo Lee, MD.)

15. AP chest radiograph of a patient on chronic steroids for
treatment of systemic lupus erythematosus who presented
with pneumonia shows ill-defined left greater than right
heterogeneous pulmonary opacities.

16. Axial NECT of the same patient shows left lung-predominant ill-defined
ground-glass opacities and a small left pleural effusion. Coronavirus may
cause upper and lower respiratory infections and may sporadically result
in epidemics that tend to be associated with a high mortality.

17. AP chest radiograph of a patient with pulmonary
hypertension, chronic atrial fibrillation, and
community-acquired coronavirus pneumonia shows
right basilar heterogeneous consolidation

18. Axial NECT of the same patient shows scattered bilateral peribronchovascular ground-
glass and airspace opacities that predominantly affect the middle and right lower lobes.
Coronavirus is a common etiology of viral upper respiratory infection but causes up to
3% of all community-acquired pneumonias.

19. Axial NECT of a patient with severe acute respiratory syndrome
(SARS) shows multifocal bilateral left greater than right patchy ground-
glass opacities and nodular consolidations. (Courtesy Yeun-Chung
Chang, MD.)

20. Axial CECT of a patient with SARS shows a left lung
peribronchovascular consolidation and ground-glass
opacities. (Courtesy Yeun-Chung Chang, MD.)

21. AP chest radiograph of 58-yr-old patient with PCR-proven COVID-
19 who presented with cough, fever, chills shows ill-defined
peripherally predominant opacities bilaterally. Ferritin level: 551
ng/ml and C-reactive protein: 193 mg/l.

22. Axial CECT of same patient shows peripheral, subpleural, well-demarcated
ground-glass opacities interspaced with central areas of spared lung . Preliminary
incidental pathologic reports have shown some features suggesting acute
fibrinous organizing pneumonia (AFOP).

23. Coronal CECT of the same patient shows well-
demarcated, peripheral, subpleural ground-glass
opacities bilaterally, which are reminiscent of areas of
organizing pneumonia.

24. AP chest radiograph of a 47-year-old patient with
PCR-proven COVID-19 with history of gestational
diabetes shows a right lower lobe mass.

25. Axial CECT of the same patient shows subpleural mass-like area of ground-glass opacities and
denser peripheral opacities (i.e., reversed halo sign). Features of organizing pneumonia (possibly
acute fibrinous organizing pneumonia, AFOP) have been described as early histologic changes in
COVID-19 infection.