Can Lung Ultrasound be Used to Screen for Pulmonary Embolism in Patients with SARS-CoV-2 Pneumonia?

Boccatonda, Andrea; Ianniello, Eugenia; D’Ardes, Damiano; Cocco, Giulio; Giostra, Fabrizio; Borghi, Claudio; Schiavone, Cosima

doi:10.12890/2020_001748

Cited by 12 publications

(11 citation statements)

References 5 publications

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“…COVID-19 patients present a wide range of clinical conditions, ranging from asymptomatic infections, minimal symptoms (the majority of patients) to fatal respiratory distress (ARDS) [ 1 ]. Data in published literature have shown that about a quarter of COVID-19 infected patients experienced thrombocytopenia and about half of these patients succumb to infection due to coagulopathy [ 3 , 4 ]. The mechanisms leading to thrombocytopenia are not yet well known.…”

Section: Introductionmentioning

confidence: 99%

Platelet Count in Patients with SARS-CoV-2 Infection: A Prognostic Factor in COVID-19

Boccatonda

D’Ardes

Rossi

et al. 2022

JCM

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COVID-19 patients may manifest thrombocytopenia and some of these patients succumb to infection due to coagulopathy. The aim of our study was to examine platelet count values in patients infected with SARS-CoV-2, comparing them to a control group consisting of non-COVID-19 patients. Moreover, we evaluated the correlation between the platelet value and the respiratory alteration parameters and the outcome (hospitalization and mortality) in COVID-19 patients. The mean platelet values (×109/L) differed between patients with positive or negative SARS-CoV-2 swabs (242.1 ± 92.1 in SARS-CoV-2 negative vs. 215.2 ± 82.8 in COVID-19 patients, p < 0.001). In COVID-19 patients, the platelet count correlated with the A-aO2 gradient (p = 0.001, rho = −0.149), with its increase over the expected (p = 0.013; rho = −0.115), with the PaO2 values (p = 0.036; rho = 0.093), with the PCO2 values (p = 0.003; rho = 0.134) and with the pH values (p = 0.016; rho = −0.108). In COVID-19 negative patients, the platelet values correlated only with the A-aO2 gradient: (p = 0.028; rho = −0.101). Patients discharged from emergency department had a mean platelet value of 234.3 ± 68.7, those hospitalized in ordinary wards had a mean value of 204.3 ± 82.5 and in patients admitted to sub-intensive/intensive care, the mean value was 201.7 ± 75.1. In COVID-19 patients, the survivors had an average platelet value at entry to the emergency department of 220.1 ± 81.4, while that of those who died was 206.4 ± 87.7. Our data confirm that SARS-CoV-2 infection may induce thrombocytopenia, and that the reduction in platelet counts could be correlated with the main blood gas parameters and with clinical outcome; as a consequence, platelet count could be an important prognostic factor to evaluate and stratify COVID-19 patients.

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Section: Introductionmentioning

confidence: 99%

Platelet Count in Patients with SARS-CoV-2 Infection: A Prognostic Factor in COVID-19

Boccatonda

D’Ardes

Rossi

et al. 2022

JCM

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“…Sometimes, post-COVID-19 vaccine supraclavicular and axillary lymph nodes may mimic pathological lymph nodes. Ultrasound (US) examination may represent the firstline imaging method due to its speed, low cost and repeatability and has already played a central role in this pandemic [15][16][17]. Sonologists should be aware that a recent anti-COVID-19 vaccine can present an etiology of supraclavicular and axillary lymph nodes with suspicious US features.…”

Section: Introductionmentioning

confidence: 99%

Lymphadenopathy after the Anti-COVID-19 Vaccine: Multiparametric Ultrasound Findings

Cocco

Pizzi

Fabiani

et al. 2021

Biology

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Background: Post-anti-COVID-19 vaccine lymphadenopathy has recently been described in the literature. In this study, we investigated the multiparametric US findings of patients with post-vaccine lymphadenopathy and compared these findings among different anti-COVID-19 vaccines. Methods: We retrospectively evaluated 24 patients who underwent US between January and May 2021 due to post-anti-COVID-19 lymphadenopathy. The presence, size, location, number, morphology, cortex-hilum, superb microvascular imaging (SMI) and elastosonography of lymph nodes were assessed. Descriptive statistics were calculated and differences among anti-COVID-19 vaccines were analyzed using the Kruskal–Wallis test. A p-value ≤ 0.05 was considered statistically significant. Results: Sixty-six nodes were assessed. They were axillary (mean 1.6 cm ± 0.16) in 11 patients (45.8%) and supraclavicular (mean 0.9 cm ± 0.19) in 13 patients (54.2%). In 20 patients (83.3%), the number of nodes was ≤3. Prevalent US features included oval morphology (18, 75%), asymmetric cortex with hilum evidence (9, 37.5%), central and peripheral vascular signals (12, 50%) at SMI and elastosonography patterns similar to the surrounding tissue (15, 71.4%). No significant differences among the three anti-COVID-19 vaccines were observed (p > 0.05). Conclusions: Anti-COVID-19 vaccines may present lymphadenopathy with “worrisome” US features regarding size, shape, morphology, cortex-hilum, SMI and elastosonography. An awareness of the patient’s history and US findings may help in the early recognition of this clinical scenario and in the appropriate selection of patients for a short-term US follow-up.

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“…A direct assessment of the pulmonary hilar vessels and its branches is not possible on ultrasound due to the generation of artifacts that prevent an "anatomical" visualization of the lung. 19 However, some transthoracic echocardiographic scans are able to highlight the initial portion of the pulmonary artery, and less frequently, the two main branches; the transthoracic method can go no farther. 7 The main contribution of LUS in a patient with pulmonary thromboembolism is the visualization of a peripheral pulmonary infarction, 7,19 which is the ultimate outcome of the pathophysiological process that leads to an ischemic alteration of the lung parenchyma.…”

Section: Basics Of Lung Ultrasoundmentioning

confidence: 99%

“…Venous thromboembolism can manifest in peculiar ways in patients with coronavirus disease 2019 (COVID-19). 19,52 Pulmonary infarction may stem from a "local" inflammatory response in the lung-which may result in a hypercoagulable state (so-called endotheliopathy)-rather than peripheral venous thrombosis. 19,52 This mechanism can result in widespread areas of in situ pulmonary thrombosis and subsequent infarction.…”

Section: Role Of Contrast-enhanced Ultrasoundmentioning

confidence: 99%

The Diagnostic Role of Lung Ultrasound and Contrast-Enhanced Ultrasound in Pulmonary Embolism

Boccatonda,

Andreetto,

Vicari

et al. 2023

Semin Thromb Hemost

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The diagnosis of pulmonary embolism (PE) relies essentially on a probabilistic approach that requires careful clinical assessments, targeted laboratory tests, and the use of appropriate imaging tools. Nowadays, the diagnostic gold standard is computed tomographic pulmonary angiography. Lung ultrasound (LUS) can play a role in the diagnosis of PE mainly by allowing the visualization of peripheral lung infarctions. Hypoechoic, pleural-based parenchymal consolidation is the most typical and common finding of pulmonary infarction. More than 85% of infarct lesions are wedge-shaped, extending to the pleural surface and are localized to where the patient complains of pleuritic chest pain. Contrast-enhanced ultrasound can be performed in addition to basic ultrasound examination to ascertain nonvascularization of the consolidation, thus confirming that the lesion is an infarct. The aim of this narrative review is to summarize the latest evidence on the application of LUS to the diagnosis of PE, focusing purely on thoracic/lung signs.

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Can Lung Ultrasound be Used to Screen for Pulmonary Embolism in Patients with SARS-CoV-2 Pneumonia?

Cited by 12 publications

References 5 publications

Platelet Count in Patients with SARS-CoV-2 Infection: A Prognostic Factor in COVID-19

Platelet Count in Patients with SARS-CoV-2 Infection: A Prognostic Factor in COVID-19

Lymphadenopathy after the Anti-COVID-19 Vaccine: Multiparametric Ultrasound Findings

The Diagnostic Role of Lung Ultrasound and Contrast-Enhanced Ultrasound in Pulmonary Embolism

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