IMAGING (CHEST RADIOGRAPHS) ABNORMALITIES IN PATIENTS WITH COVID-19 INFECTION IN BRUNEI DARUSSALAM.

Norhasyimah TAMIN¹, Nabilah AHMED¹, Islya Emma OTHMAN¹, Nur Adibah MD SALLEH¹, Tahir NADEEM², Babu Ivan MANI³, Muhammad Syafiq ABDULLAH¹, Rosmonaliza ASLI¹, Raimiza Natalie MOMIN¹, Pui Ling CHONG¹, Vui Heng CHONG^1,3

¹Department of Medicine, RIPAS Hospital, Bandar Seri Begawan, Brunei Darussalam,

²Department of Radiology, and

³Department of Medicine, PMMPMHAMB Hospital, Tutong, Brunei Darussalam.

ABSTRACT

Introduction: The Corona Virus Infectious Disease (COVID-19) caused by Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-COV-2) can affect any system but is primarily a respiratory disease. Manifestations can range from asymptomatic to severe, and chest radiological changes typically correlate with severity. Computed tomography scan is the best imaging, but is not widely available and plain chest radiography (CXR) remains the first line chest imaging. This study reports on CXR changes among patients with COVID-19 in Brunei Darussalam. Materials and Methods: All patient who had CXRs done were included in this study. Data were retrieved from a prospectively maintained database and anonymised for analyses. Results: Among 132 patients who had CXRs, 24 (18.2%) had radiological changes with mean age of 52.9 ± 11.3 years, which were significantly much older than those without CXR changes (35.9 ± 15.51 years). Of these 24 patients, 70.8% were men. Majority (70.8%) had symptoms on admission. Radiological changes occurred at a median of 3 days (range 0-8) of hospitalizations. Consolidation was the most common finding (62.5%), followed by ground glass opacities (37.5%). Twenty (87%) had resolution of radiological changes on CXRs at a median of 10 days (ranged from 9 to 16 days). Four patients developed progressive CXR changes consistent with acute respiratory distress syndrome requiring intubation with 3 going onto extracorporeal membrane oxygenation support (ECMO). The three patients on ECMO died with one successfully extubated and survive to discharge. Patients with radiological changes were significantly older (>40 years; OR 6.5) and have co-infections (OR 7.3) either at admission or during hospitalization on multivariate analysis. Conclusions: Common radiological manifestations include patchy consolidations and ground glass opacities. Changes were common at admission and can develop within 3 days of hospitalization. Older age groups (6.5 times) and those with co-infections (7.3 times) were more likely to develop chest xray abnormalities. Hence care monitoring and more aggressive management should be provided to these two groups.

Keywords: ARDS, Chest radiograph, Consolidation, COVID-19, Pneumonia, SARS-COV-2.

Corresponding author: Dr. Chong Vui Heng, Department of Medicine, PMMPMHAMB Hospital, Tutong, Brunei Darussalam.

Brunei Int Med J. 2020;16:141-149