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Introduction/Objective. Chest X-ray (CXR) is a common diagnostic procedure for monitoring the course and outcome of pneumonia. The aim of the study was to examine the frequency, type and degree of CXR changes in COVID-19 pneumonia and compare it with demographic data and the presence of comorbidities. Methods. In this retrospective study, CXRs taken on the day of admission were analyzed for 620 patients with COVID-19. CXR were defined as ground-glass opacification (GGO), consolidation, reticular changes, pulmonary nodules, and pleural effusions. CXR severity score (CXR-SS) was determined based on the adjusted Radiographic Assessment of Lung Edema score. SPSS version 17.0 was used for statistical analyses. Results. The average age was 62.75 ± 14.8 years 66.5% of analyzed patients had comorbidities. CXR changes were bilateral in 53.2%, dominant in the lower lung in 68.1% and diffuse in 24.5%. GGO were present in 55%, reticular changes in 37.3%, and consolidations in 24% of patients. Based on CXR-SS, 47.2% of patients had mild pneumonia, 40.2% moderate, 7.9% severe, and 4.6% very severe. Severe/very severe pneumonia was in 71.8% of older than 65 years. Bilateral changes were found in 97.4% of people with severe/very severe pneumonia, diffuse in 56.4%, and consolidation in 66.7% of the patients. GGO were in 58.1% of subjects with mild/moderate pneumonia. Conclusion. CXR in patients with COVID-19 pneumonia are more frequently bilateral, dominantly peripheral, in the lower lung zone. The degree of diffuse changes is proportional to older age and more frequent comorbidities. In a severe form of the disease, consolidation and reticular opacification dominate.

Introduction. Rheumatoid arthritis is a systemic autoimmune disease with inflammation of the joints as its hallmark. Extra-articular manifestations affect nearly half of the patients either at the onset of disease or later during the disease course. Case outline. A 43-year-old man complained of chest pain, dry cough, and fatigue. Diagnosis of pericarditis was made based on echocardiography findings. Due to worsening of respiratory symptoms, he was admitted to the hospital. Initial diagnostic workup revealed elevated concentrations of acute phase reactants, pericardial effusion, and bilateral pulmonary nodules. Pathohistological analysis of lung nodules ruled out malignancy and tuberculosis. He was treated with colchicine, which led to a regression of a pericardial effusion. Afterwards, due to arthritis of the right wrist, high erythrocyte sedimentation rate, and C-reactive protein, positive immunoserology and bone erosion at the distal ulna diagnosis of seropositive rheumatoid arthritis was established. He was treated with antimalarial, methotrexate, and glucocorticoids until he suffered from COVID-19 pneumonia, which triggered arthritis flare. Owing to the loss of efficiency of combination therapy with methotrexate and glucocorticoid, baricitinib was added to the treatment. Low disease activity was achieved after three months of administering baricitinib and methotrexate, and no adverse events occurred during 20-month-long therapy. Conclusion. Every patient with pericarditis of unknown etiology should be diagnostically evaluated in term of connective tissue disease including rheumatoid arthritis, because the initial clinical presentation in some group of patients could lack characteristic synovitis.

One year after the first reported case of SARS-CoV-2 infection, the pandemic is still active. Considering non-specific clinical manifestations, tests' insufficient sensitivity, and restricted availability of PCR testing, radiological methods are often used for making a preliminary diagnosis. Additionally, chest X-rays and computerized tomography (CT) help discover previously existing cardiopulmonary conditions, follow the disease progression in moderately and severely ill patients, and detect complications. On a CT scan, we can see four stages of pneumonia: early (initial), progressive, peak, and resolution (absorption) phase. Considering that various imaging studies are being used among large populations of different ages and the necessity of repeated imaging in moderately and severely ill patients, special focus must be paid on lowering the radiation dose while maintaining optimal image quality.