Chest X-ray findings in asymptomatic and minimally symptomatic quarantined patients in Codogno, Italy

Michele Bandirali, Luca Maria Sconfienza, Roberta Serra, Roberto Brembilla, Domenico Albano, Pregliasco Fabrizio Ernesto,Carmelo Messina 

Published Online:Mar 27 2020

https://doi.org/10.1148/radiol.2020201102

… 

At that time, we had a high demand for chest x-rays from local asymptomatic patients or patients with vague symptoms such as temperature < 99.5°F (37.5°C) and malaise. None of the patients had high clinical suspicion for COVID-19 but many patients were worried about community spread. In addition, all patients came from a very contagious cluster at high risk of virus transmission.

In one week, we found 100 of 170 (59%) chest x-rays (mean patient age 57 ±16 years) had abnormalities highly suspicious for COVID-19 pneumonia (3). Involvement was bilateral in all cases: in 54% of patients the involvement was symmetrical, while chest x-ray abnormalities were greater on one side of the chest in 46%. RT-PCR swabs were not performed for confirmation. The prevalence of abnormal chest x-rays was similar to that reported by Inui et al. who reported CT findings in patients with COVID-19 from the Diamond Princess cruise ship (i.e., 54% of asymptomatic passengers had chest CT abnormalities) (4).

Our findings support data that is emerging about asymptomatic carrier COVID-19 transmission: asymptomatic or minimally symptomatic patients may have positive chest x-rays after 14 days of quarantine, even with no RT-PCR testing for COVID-19 (sensitivity reported to be 59%, Ai et al. (5)). Chest x-rays may represent a low-cost and widely available tool in detecting lung involvement in patients with possible COVID-19 pneumonia. However, the specificity of chest x-ray findings for COVID-19 pneumonia is not established.