Frequency of Abnormalities Detected by Point-of-Care Lung Ultrasound in Symptomatic COVID-19 Patients: Systematic Review and Meta-Analysis

Abstract

The COVID-19 pandemic has resulted in significant morbidity, mortality, and strained healthcare systems worldwide. Thus, a search for modalities that can expedite and improve the diagnosis and management of this entity is underway. Recent data suggested the utility of lung ultrasound (LUS) in the diagnosis of COVID-19 by detecting an interstitial pattern (B-pattern). Hence, we aimed to pool the proportion of various reported lung abnormalities detected by LUS in symptomatic COVID-19 patients. We conducted a systematic review (PubMed, MEDLINE, and EMBASE until April 25, 2020) and a proportion meta-analysis. We included seven studies examining the role of LUS in 122 COVID-19 patients. The pooled proportion (PP) of B-pattern detected by lung ultrasound (US) was 0.97 (95% CI: 0.94-1.00 I 2 0%, Q 4.6). The PP of finding pleural line abnormalities was 0.70 (95% CI: 0.13-1.00 I 2 96%, Q 103.9), of pleural thickening was 0.54 (95% 0.11-0.95 I 2 93%, Q 61.1), of subpleural or pulmonary consolidation was 0.39 (95% CI: 0.21-0.58 I 2 72%, Q 17.8), and of pleural effusion was 0.14 (95% CI: 0.00-0.37 I 2 93%, Q 27.3). Our meta-analysis revealed that almost all SARS-CoV-2-infected patients have abnormal lung US. The most common abnormality is interstitial involvement depicted as B-pattern. The finding from our review highlights the potential role of this modality in the triage, diagnosis, and follow-up of COVID-19 patients. A sizable diagnostic accuracy study comparing LUS, computed tomography scan, and COVID-19-specific tests is warranted to further test this finding and to delineate the diagnostic and prognostic yield of each of these modalities.

Case Report: COVID-19–Related Pneumothorax—Case Series Highlighting a Significant Complication

“…Point-of-care ultrasound (POCUS) has proven to be effective in COVID-19 diagnosis. 15 Although the treating clinicians can use POCUS for diagnosis and follow-up, they can still use it to look for signs deep venous thrombosis (veins non-compressibility) and pneumothorax (barcode sign, and absence of lung sliding). 16 This modality can be useful in resourceful and resource-limited settings.…”

The Utility of Ultrasound Extends Beyond Interstitial Pneumonia Assessment in COVID-19 Patients

“…In another letter, the same author discusses the significance of finding evidence of interstitial pneumonia evidenced by the B-pattern in the diagnosis of COVID-19; nonetheless, the author acknowledges lack of specificity of this finding (2). In a recent meta-analysis of seven studies (122 patients), we found that the B-pattern is consistently prevalent (97%, 95% CI: 0.94À1.00 I 2 0%) among COVID-19 symptomatic patients (3). Additionally, we found 70% and 54% frequency of finding pleural line abnormalities and pleural thickening, respectively, although they were heterogeneous among constituent studies.…”

Management reorganization of a Radiology ward during the Covid-19 pandemic in a University Hospital structured inpavilions.

“…A recent meta analysis [14] showed that the majority of COVID-19 patients have pathological ndings at LUS. The most frequent is interstitial involvement as demonstrated by a B-lines pattern ( gure 3), followed by pleural thickening and irregularities, consolidations and seldomly pleural effusions.…”