A Case of Covid-19 Diagnosed at Home With Portable Ultrasound and Confirmed With Home Serology Test

Abstract

Background The COVID-19 pandemic has pushed us to find better ways to accurately diagnose what can be an elusory disease, preferably in a way that limits exposure to others. The potential for home diagnosis and monitoring could reduce infectious risk for other patients and healthcare providers, limit use of finite hospital resources and enable better social distancing/isolation practices. Case Report We report a case of an otherwise healthy Emergency Physician diagnosed with COVID-19 at home using portable ultrasound, pulse oximetry and antibody testing. Her clinical picture and typical lung findings of COVID-19 on ultrasound, combined with a normal echo and negative DVT study, helped inform her diagnosis. She then monitored her clinical course using pulse oximetry, was able to self-isolate for four weeks and had an uneventful recovery. Her diagnosis was confirmed with a positive IgG antibody test after three weeks. Conclusions Novel times call for novel solutions and our case demonstrates one possible path for home diagnosis and monitoring of COVID-19. The tools used, namely ultrasound and pulse oximetry, should be familiar with most modern emergency physicians. Ultrasound in particular was helpful in eliminating other potential diagnoses, such as pulmonary embolus.

Simplified Lung Ultrasound Examination and Telehealth Feasibility in Early SARS-CoV-2 Infection

“…Although prevalent in inpatients, B-lines were also reported by infected health care providers who imaged themselves during their own home isolation. [15][16][17] The presence of three B-lines in the lung apex alone, a site specifically shown to be feasible for patient selfimaging, 18 was observed by our group in a significant proportion, 33%, of hospitalized patients, who remarkably had only mild to moderate disease and lacked hypoxemia. 19 Given these observations, the concept of incorporating simplified lung self-imaging into a telehealth appointment was envisioned to help identify and allocate resources to those outpatients who may develop worsening disease while in isolation.…”

Patient Self-Performed Point-of-Care Ultrasound: Using Communication Technologies to Empower Patient Self-Care

“…A limited experience suggests that health care professionals can self-image themselves satisfactorily (including for appendicitis) [ 50 ]. An emergency physician reported using home ultrasound upon themselves to confirm a COVID diagnosis and thereafter to follow herself to rule out other worrisome conditions, such as deep vein thrombosis, right heart strain from a massive pulmonary embolus, pericardial effusion, and lobar pneumonia [ 51 ]. Pivetta also reported a case of a nurse who had previous point-of-care ultrasound training on vascular access and bladder scanning who was “teleguided” by an expert operator to image her own lungs with a 12-zone protocol after she was diagnosed with COVID [ 52 ].…”

One-day seminar for residents for implementing abdominal pocket-sized ultrasound

“…The clinicians feel confident using the pocket-sized US when caring for patients in limited medical conditions[ 44 ]. Physicians proficient in its use can quickly answer specific questions at the bedside[ 45 ].…”