Severity of lung shadowing on a chest X-ray can be classified by comparing the area of abnormal lung (white) with the area of normal lung (black). If there is more black than white then shadowing is classified as 'Mild'. If there is approximately equal white and black then shadowing is classified as 'Moderate'. If there is more white than black then shadowing is classified as 'Severe'.
History of heart disease with implantable cardioverter defibrillator (ICD)
Cough and fever
Crackles and reduced air entry
COVID-19 swab positive 2 days after this chest X-ray and died that day
Severe shadowing
Patchy shadowing is seen throughout both lungs
Shadowing is not as dense as in the previous example but there is less normal lung remaining
Shadowing is classified as severe - more than 50% of the lungs are affected (more white than black)
Classification: Severe
Severity of shadowing v clinical outcome
Although severity of shadowing is likely to be a helpful marker of overall clinical severity, it is not an accurate predictor of clinical outcome. Patients with severe shadowing can make a full clinical and radiological recovery - see patient journey 2. Patients with mild shadowing can die rapidly - see below.
