BACKGROUND: Coronavirus disease 2019 (COVID-19) is highly contagious and has claimed more than one million lives, besides causing hardship and disruptions . The Fleischner Society has recommended chest X-ray (CXR) in detecting cases with high risk for disease progression, for triaging suspected patients with moderate-to-severe illness, and to eliminate false negatives in areas with high pre-test probability or limited resources . Although CXR is less sensitive than real-time reverse transcription polymerase chain reaction (RT-PCR) in detecting mild COVID-19, it is nevertheless useful because of equipment portability, low cost and practicality in serial assessments of disease progression among hospitalized patients.

OBJECTIVE: This study aims to review the typical and relatively atypical CXR manifestations of COVID-19 pneumonia in a tertiary care hospital .

METHODS: The CXRs of 136 COVID-19 patients confirmed through real-time RT-PCR from March to May 2020 were reviewed . Literature search was performed using PubMed .

RESULTS: A total of 54 patients had abnormal CXR whilst the others were normal . Typical CXR findings included pulmonary consolidation or ground-glass opacities in a multifocal, bilateral peripheral or lower zone distribution, whereas atypical CXR features comprised cavitation and pleural effusion .

CONCLUSION: Typical findings of COVID-19 infection in chest computed tomography studies can also be seen in CXR . The presence of atypical features is associated with worse disease outcome . Recognition of these features on CXR will improve accuracy and speed of diagnosing COVID-19 patients.