Contrast enhanced ultrasound (CEUS) to assess pleural pulmonal changes in severe COVID-19 infection: First results

Abstract

AIM: Use of contrast enhanced ultrasound (CEUS) in severe cases of COVID-19 infection to assess pulmonary changes near the pleura. MATERIAL AND METHODS: Bedside examinations by an experienced intensive care unit examiner using a multifrequency probe (C1-6 MHz) with B-mode and CEUS to assess pleural-near changes in severe cases of COVID-19 infection with respiratory failure. CEUS with bolus delivery via a central venous catheter of 2.4 ml Sulphur hexafluoride microbubbles from the arterial phase (10-15 s) to the late phase of 5 min. Digital storage of cine sequences of the lung sound with abdomen for independent assessment with the subsequently performed contrast-enhanced dual-source CT. RESULTS: In 11 intubated and ventilated patients (arithmetic mean 62 years, 48 to 78 years, 3 women) with confirmed severe COVID-19 infections, a peripherally accentuated consolidation with irregular hyperemia was found in the CEUS and also in the CT examination. Of the 5 cases with pulmonary arterial embolisms, signs of right ventricular failure were found. In all cases, using CEUS low perfused areas of the pleura with adjacent hyperemia could be detected, while, with CT segmental contrast medium, gaps with subpleural compressions were found. Interstitial changes near the pleura led to B-lines and to ground glass opacities in the CT. Near the diaphragm a delayed arterial contrast of the liver was observed. In addition, in 2 cases partial atelectasis, in 3 cases marginal pleural effusions were found. CONCLUSION: CEUS opens up new possibilities for bedside monitoring of pleural reactive inflammatory or peripheral thrombus embolism in severe cases of COVID-19 infection.

Cerebrovascular comorbidity, high blood levels of C-reactive protein and D-dimer are associated with disease outcomes in COVID-19 patients

“…Stroke incidence and cerebrovascular disease have been reported in 5% and 5.7% of COVID-19 pateints, repectively [7]. However, the thrombotic changes are generalized and occur in all regions of the body -not only in the brain), as it was demonstrated by previous studies like thromboses in the lung [8], kidney infractions [9], as well as overt intravascular disseminated coagulation [10]. The pro-inflammatory biomarkers were elevated signicantly due to the COVID-19…”

Elevated fibrinogen and fibrin degradation product are associated with poor outcome in COVID-19 patients: A meta-analysis

“…Imaging modality which is greatly beneficial in detecting thrombotic events occurrence in these cases in addition to lung CT scan, is contrast-enhanced ultrasound (CEUS). Peripherally accentuated consolidation with irregular hyperemia was found in the CEUS and also in the CT examination in cases of pulmonary thrombus embolism [40]. CEUS can dynamically record the mesenteric arterial and venous blood flow, thus enabling us to quickly rule out abdominal infarction [41].…”

Can erythrocytes behavior in microcirculation help the understanding the physiopathology and improve prevention and treatment for covid-19?

“…Studies have suggested that low plasma estrogens [2,3], vitamin D deficiency [4], obesity [5], diabetes [6], and cardiovascular diseases [7] are factors linked to the severity of covid-19. The most severe forms of covid-19 are often cursed with thromboembolic events [8][9][10][11][12] and impaired microcirculation [13][14][15][16]. Therefore factors related to all these conditions (low estrogens, vitamin D deficiency, obesity, diabetes, cardiovascular diseases, thromboembolic events, and impaired microcirculation) might be implicated in the pathophysiology of covid-19 complications.…”