Doctor Explains COVID-19 - Chest X-ray

What is going on with everybody on YouTube! Welcome back to my channel and for those of you who are new around here, my name is Michael a.k.a Dr. Chile and I are a fifth-year interventional radiology resident physician. On today's video, I wanted to discuss the coronavirus and koban 19 x-ray findings and I was planning on making this video, anyways but then I saw this video that CNN posted about their one of their main correspondents, Chris Cuomo who is also the brother of Andrew Cuomo the governor of New York, so it's been very public over the last few days that Chris Cuomo has been diagnosed as positive for koban 19 and he's kind of been giving an update throughout his course and disease progression. In this particular video, I saw a few days ago they discussed Chris Cuomo's chest x-ray findings and I feel like I could do a better job and explaining it than they do. So we're going to go through this video and use it as a way to kind of discuss the chest x-ray

findings of koban 19 or the novel coronavirus infection and go from there, so let's go ahead get into it.

So like I said before, Chris Cuomo is a CNN news correspondent which I see him all the time. On this channel, he is the brother of the New York State Governor Andrew Cuomo, which I actually didn't put two and two together for a while, but that's a different story. Last week he tested positive for koban 19 and they've been in viewing him almost daily. About the course of his disease and he does a pretty good job of

opening up about it, so I'm gonna start the video and I'll stop it intermittently when I feel like I need to interrupt. I feel better than I deserved and I now know that I can't just take it from this thing that with the fever spikes you, just want to curl up in a ball and stay there for the next six-seven hours and you can get a bundle up your clothes. You've got it and you know start drowning yourself influence, you got to take your time off and you got to get out if you don't want it to get into your lungs. You gotta force yourself to breathe, you got to get up off your ass, you got to walk around and it hurts you don't want to do it. Everything in your body is telling you, not to do it and it's lying to you. So I really like what he's doing here and he's staying positive, he's staying active and he's mobilizing which is fantastic. You don't want to just lay in bed and let this disease take a hold of you and if you can help it and it's lying to you and I know that and the more I do, the more I push myself to do, the better I'm gay, so I'm gonna take faith in that for now, and  I know I'm not through it but that's good.

Let's talk about the collective, though for a second. So he's actually onto something with this because, when patients will lay flat in the hospital bed on, ventilators the actual back or posterior of the lungs do not aerate as well, because they aren't expanding and because that is the dependent portion of the thorax. So, as you've seen in many cases with this virus, we actually prone the patients and allow the posterior or back of the chest to expand which allows those Airways to kind of open up and if you don't allow those Airways to open up, that lung becomes collapsed or a delight attack and can cause that infection, just to kind of sit there and not resolve.

So I'm going to fast forward this part because they're just talking about data and whatnot. So, I think let's fast-forward to the part where you start talking about his chest x-ray. Now, in terms of all we're we don't want to go through he'll have coronavirus in most of the cases and your big fear is that it's gonna get your lungs, that's what it wants. It wants your lungs this thing, so this virus does love the small Airways or your lungs and this weekend, I had the fever start to go down a little bit and I started to feel it come into my chest, so I went to get a chest x-ray and I want you guys to see this just so you can see what we're looking for. Now, so first and foremost this is just a normal frontal radiograph as we call it. It's not labeled pa or a peek probably a PA radiographed given the way it looks, but let's see what they say about it. Obviously you understand this, what we're looking for in the lungs are big white areas and what are the terms that people will hear, what are they looking for and what do you see in this mighty expansive, chest and trunk.

So first and foremost, Sanjay Gupta is the neurosurgery physician. Right there, he is the chief medical correspondent for CNN and he's all over this channel and you've probably seen him everywhere, he is neurosurgery trained and it has been out of practice I think for a little bit now,
and I'm willing to bet he hasn't actually looked at a chest x-ray in a very long time, because neurosurgeons don't really look at chest x-rays that much. That's not in their specialty, so we'll see what he has to say about the chest x-ray. One of the things that you'll hear is infiltrated so if you are a longtime subscriber to my channel, I did a video on where I read a normal chest x-ray versus their really complicated ICU x-ray and I said I don't use the term infiltrate and still to this day I get questions about why I don't use that term and this is a perfect example, so I don't use the term infiltrate because it implies infection. When you say there is an infiltrate on a chest x-ray, it is basically saying that there's an infection there. Well, that's how people interpret it and the problem is that many things on chest x-ray. It looked like an infection, that heart

infection so if I were to call something an infiltrate implying, it's an infection and it was an infection that would be a misdiagnosis. So in short, anything that pacifies the lung fields on chest x-ray and does not always have to be an infection.

Other things can also pacify the lung fields on chest x-rays such as malignancy or cancer, also fluid can also do the same thing, hemorrhage protonation smith Tyrael, etc. So just remember that the term infiltrate is not used by me or anybody. I trained with because not everything on

a chest x-ray doesn't infiltrate or infection. Do you have an infiltrate in your chest and in your lungs? and that's basically a collection of

inflammatory fluid. I would look for those areas where you know the black areas are the air in your lungs, I would look for some of those black hairs and essentially be filled with white spots and I just won't make it clear for the audience, I'm not diagnosing here from afar. In the middle of the chest x-ray, there you can see you have a little bit of infiltrates and you could see the same, so again this is really difficult to see because I'm looking at a picture of an x-ray on a news broadcast and I'm also watching on YouTube, so it's not exactly ideal for diagnosing. However, I don't see any infiltrate on this x-ray and this is a lateral projection here. This is the sternum, up here in the back and as you can see here the spinous processes in the vertebrae, here this is the side view of the heart or the lateral view, so again this x-ray is taken from the lateral projection, which means it is the beam and drawing this way, that's why you can see all the ribs like. This right here I think what

he's seen is the overlapping ribs and normal pulmonary interstitial vasculature that is causing this infiltrative appearance, but this is pretty clear from what I can see. This is the side view and now you'll see in the story, the film there is your spine. You see those sort of Domino looking bones.

Also smaller might, I might add breath and I don't know what he means by small bones. These look like normal vertebrae to me and actually look pretty good for a big guy like you in the middle of the spine there and then in front of that aside is the x-ray of your lungs and so I think what he's saying is in front of the spine is the x-ray of the lungs, but what most people don't realize is that the lungs actually go out well past or well posterior or behind the spine here. As you can see right here, this is the back of the lung and here on both sides and this is the spine column, right here you can see there's a good distance between the spine and the lung, so if you're looking at it from the side the lungs kind of expand posterior to the spine and it looks pretty good maybe a little bit of fluid buildup there. I don't see any fluid buildup, if there were to be fluid buildup, there would be some blunting of the costophrenic angles here. You can't really see all of them, so maybe there is like stant amount of fluid there, but I would never call that pneumonia which is what they're trying to diagnose. Pneumonia is not just diagnosed by a chest x-ray but it's one of the tools that doctors used to diagnose and again, you just make it clear not diagnosing Cris via television here but

that you know looks pretty good and I looked at that more closely on my computer today.

Look I have different pulmonary people they take very close readings because it's either really pneumonia or it really isn't and they expect me to have to infiltrate because I have the virus and I have to tell you it is scary to have your lungs go up there and see this stuff be, like what is that, what is like that smoke in there and they tell you that's the virus, so this is exactly why I wanted to do this video in the first place because chest x-rays are not really good at diagnosing COVID 19 or novel coronavirus and this is the perfect example for that because Chris Cuomo has been diagnosed and contaminated of the virus. However, his chest x-ray is pretty normal and the reason for that is because often in many other disease processes, as well as COVID 19 and will actually lag on chest x-ray and what I mean by that is it actually takes a while for the virus to accumulate within the lungs and actually show itself on chest x-ray. So as you can see here, you can test positive for the virus

but have a normal chest x-ray which is why chest x-rays are not really that valuable. In the beginning stages of the virus, they can, however, be useful in tracking the disease progression so it looks like Chris Cuomo is doing well so far and  I wish him the best.