Comparative study of lung ultrasound and chest computed tomography scan in the assessment of severity of confirmed COVID-19 pneumonia

Abstract

The relationship between lung ultrasound (LUS) and chest computed tomography (CT) scans in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia is not clearly defined. The primary objective of our study was to assess the performance of LUS in determining severity of SARS-CoV-2 pneumonia compared with chest CT scan. Secondary objectives were to test the association between LUS score and location of the patient, use of mechanical ventilation, and the pulse oximetry (SpO 2)/fractional inspired oxygen (FiO 2) ratio. Methods: A multicentre observational study was performed between 15 March and 20 April 2020. Patients in the Emergency Department (ED) or Intensive Care Unit (ICU) with acute dyspnoea who were PCR positive for SARS-CoV-2, and who had LUS and chest CT performed within a 24-h period, were included. Results: One hundred patients were included. LUS score was significantly associated with pneumonia severity assessed by chest CT and clinical features. The AUC of the ROC curve of the relationship of LUS versus chest CT for the assessment of severe SARS-CoV-2 pneumonia was 0.78 (CI 95% 0.68-0.87; p < 0.0001). A high LUS score was associated with the use of mechanical ventilation, and with a SpO 2 /FiO 2 ratio below 357. Conclusion: In known SARS-CoV-2 pneumonia patients, the LUS score was predictive of pneumonia severity as assessed by a chest CT scan and clinical features. Within the limitations inherent to our study design, LUS can be used to assess SARS-CoV-2 pneumonia severity.

Lung ultrasound predicts clinical course and outcomes in COVID-19 patients

“…With worsening disease, more pleural thickening and subpleural consolidations were recorded. The relation between clinical severity and LUS findings is in line with previously published data using LUS and chest CT scores [26,27], as well as with previously described patterns in swine (H1N1) and avian (H7N9) Influenza [28,29]. Interestingly, the main contributor to the worsening LUS score was new, or greater, involvement of anterior segments, a finding that may be used clinically to warn from imminent deterioration.…”

Lung ultrasonography: A prognostic tool in non-ICU hospitalized patients with COVID-19 pneumonia

“…As shown, literature on LUS in COVID-19 patients is rapidly growing; however few studies evaluated the prognostic value of LUS in COVID-19 patients [20] , [21] , [22] , [23] . All these studies enrolled a significant percentage of patients who were hospitalized in Intensive Care Units (ICU).…”

Combining lung ultrasound and wells score for diagnosing pulmonary embolism in critically ill COVID-19 patients

“…Since LUS can identify changes in super cial lung tissue that correlate with histopathological ndings which could only be identi ed in CT-scan, but remain hidden in a large percentage of chest X-rays, the role of LUS in the context of viral pneumonia may be relevant [17]. In view of the recent outbreak of pneumonia from Wuhan, China, in December 2019 by the SARS-CoV2 pathogen, which is referred to as COVID-19, lung sonography proved to be useful [7,17,18]. Typical signs for COVID-19 have been de ned, which might be particularly helpful in the emergency rooms for diagnosis and triage [17,18].…”

“…Since the beginning of the outbreak multiple studies evaluating imaging techniques described bilateral ground-glass opacities, crazy-paving and air-space consolidations in peripheral and basal distribution in patients with COVID-19 pneumonia [5,6]. Zieleskiewicz et al were able to show that the assessment of the LUS score was an indication of the severity of pneumonia, which was evaluated by a chest CT scan [7].…”