Early diagnosis is critical for the prevention and control of the coronavirus disease 2019 (COVID-19).We attempted to apply a protocol using teleultrasound, which is supported by the 5G network, to explore the feasibility of solving the problem of early imaging assessment of COVID-19. Four male patients with confirmed or suspected COVID-19 were hospitalized in isolation wards in two different cities. Ultrasound specialists, located in two other different cities, carried out the robot-assisted teleultrasound and remote consultation in order to settle the problem of early cardiopulmonary evaluation. Lung ultrasound, brief echocardiography,and blood volume assessment were performed. Whenever difficulties of remote manipulation and diagnosis occurred, the alternative examination was repeated by a specialist from another city, and in sequence, remote consultation was conducted immediately to meet the consensus. The ultrasound specialists successfully completed the telerobotic ultrasound. Lung ultrasound indi-
To investigate the value of lung ultrasound (LUS) in asymptomatic patients with confirmed COVID-19. Methods:A retrospective analysis was performed on nine patients in a designated isolation hospital in Sanya from February 22nd, 2020 to February 23rd, 2020. All patients were confirmed with COVID-19 pneumonia by PCR test, but none had the typical symptoms of COVID-19. All patients first underwent LUS examination and then chest computed tomography (CT) scanning. The application value of LUS in asymptomatic confirmed patients with COVID-19 was evaluated, compared with chest CT which was regarded as the golden standard.Results: Among nine asymptomatic patients with COVID-19, there were two cases (22.22%) with abnormal ultrasonic manifestations, of which one (11.11%) showed a fusion B3-line in zone 5 of the right lung, and the other showed localized pulmonary consolidation in zone 6 of the left lung. The remaining seven cases (77.78%) showed no abnormal changes in LUS, but only clear pleura sliding sign and A-line. Chest CT showed abnormal changes in three cases (33.33%). Two of them (22.22%) showed flocculent high-density shadow at the base of both lungs (especially in the right lung), while the other case showed ground-glass opacity with thickened interlobular septal in the left lower lobe, involving the pleura. There were no abnormalities on chest CT of the remaining six cases (66.67%). The two (22.22%) LUS-positive patients were in complete coincidence with CT-positive patients. This study showed that the coincidence rate of the two examination methods was 88.89%. Taking chest CT as golden standard, the sensitivity, specificity, positive predictive value, negative predictive value, and Kappa value of lung ultrasound in the diagnosis of COVID-19 were 66.67%, 100%, 100%, 85.71%, and 0.727, respectively. Conclusion:LUS can evaluate lung lesions in asymptomatic patients with COVID-19. Compared with chest CT, the diagnostic coincidence rate and diagnostic consistency of LUS are relatively higher. For this asymptomatic type of patient, ultrasound can be used as a diagnosis method, which can avoid the risk of radiation exposure in a short period of time. As a rapid and dynamic assessment method, LUS can cooperate with remote consultation to provide timely and accurate guidance for clinical diagnosis and treatment when necessary.
Although the outbreak in China has been effectively controlled, the international situation of prevention and control of coronavirus disease 2019 (COVID-19) still poses a serious public health risk. COVID-19 has been declared a pandemic by World Health Organization (WHO) due to its highly contagious nature, rapid transmission, swift clinical course, profound worldwide impact, and high mortality among critically ill patients. COVID-19 is mainly transmitted by respiratory droplets and contact routes, which could be effectively prevented by proper medical equipment and hand hygiene. However, due to the lack of effective protective measures and personal protective equipment of healthcare personnel in some area, the infectious rate of COVID-19 remains high, especially in clinical settings. At present, due to its portability and accuracy, ultrasound has been playing an indispensable role in the diagnosis, evaluation, and follow-up of COVID-19 patients, especially those in severe conditions. In the course of diagnosis and treatment, because sonographers often work closely with patients, coupled with the increasing number of patients and relatively poor ventilation in the working area, the risk of occupational exposure is undoubtedly high. This article combined the standard precaution methods with current Chinese government's COVID-19 strategy and polices, aiming to provide suggestions on the prevention and control of COVID-19 pandemic for ultrasound professionals.
Neuromyelitis optica spectrum disorder (NMOSD) is an idiopathic autoimmune inflammatory disorder which is characterized by central nervous system (CNS) demyelinating. Common symptoms of area postrema clinical syndrome (APS) include intractable hiccup, nausea and vomit which may lead to aspiration pneumonia. In this article, we report a patient with suspicious COVID-19 infection and complicated with NMOSD and aspiration pneumonia. The question still remains that whether 2019-nCoV could infect CNS and cause NMO.
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