Lung ultrasound findings in patients with COVID-19 pneumonia

Abstract

Since December 2019, the outbreak of pneumonia caused by a new coronavirus [1], which was later identified as coronavirus disease 2019 (COVID19), has infected more than 410,000 patients globally according to the situation report of World Health Organization. Lung ultrasound is an important tool for the diagnosis and follow-up of pneumonia in neonates, children, and adults [2][3][4]. Recent CT reports demonstrated that most of the lesions were distributed peripherally in the lung, which facilitates detection by lung ultrasound [5,6]. In this study, we characterize the lung ultrasound findings COVID-19 pneumonia, and study the relationship between the ultrasound findings and clinical severity and the time-course of disease progress. Bedside lung ultrasound was performed to detect B-lines, lung consolidation, and pleural line abnormalities at 5 areas in each lung. Vascular ultrasound was also performed to detect potential deep vein thrombosis.A total of 20 patients of COVID-19 pneumonia (12 males and 8 females) were categorized as 4 moderate, 5 severe, and 11 critical cases according to the current diagnosis and treatment program. All patients showed abnormal lung ultrasound findings, including 100% (20) pleural line abnormalities, 100% (20) B-lines, and 50% (10) consolidation. Most of the moderate and severe cases could show both separated B-lines and confluent B-lines during admission. All critical patients showed confluent Blines, and 18% (2) of them had compact B-lines. Bilateral involvement was observed in all patients. The predominate involved areas in moderate patients were on the back, i.e., the interscapular and infrascapular areas. For severe and critical patients, all 5 areas could be involved. Consolidations were not detected in moderate cases, and distributed mainly on the posterior areas in severe and critical cases. Pleural effusion (18%, 2 cases), pericardial effusion (9%, 1 case), and deep vein thrombosis (64%, 5 cases) were only found in critical patients. (Table 1).A total of 36 ultrasound examinations were categorized to four groups based on the time interval between onset of symptoms and ultrasound examinations (1st to 4th week). All of the examinations showed abnormal lung ultrasound findings, including 100% (36) pleural line abnormalities, 100% (36) B-lines, and 64% (23) consolidation. The separate B-lines were found more than half of the examinations after the 2nd week. The majority of examinations during the 2nd and 3rd weeks showed confluent B-lines. The involvement of anterior areas with B-lines decreased along with the infected time course. The lateral and back areas were always involved in all stages for B-lines. Consolidations were found in more than half examinations after the 1st week. Most of consolidation lesions confined within unilateral lung except at the 2nd week. The anterior and lateral areas were not involved of consolidations during 1st and 4th week. Consolidations were

Sensitivity of Lung US compared to Chest CT for the screening of COVID-19: preliminary report of our experience

“…Nevertheless, it should be considered that the speci city and the positive predictive of the same LUS signs may be lowered in a normal setting of non epidemic COVID-19. Indeed, the sonographic ndings described in our case series and in the current available literature on this topic 11,12,13,14,15 shows a considerable overlap with many other lung diseases. An irregular pleural line with increased B-lines may be visible in ARDS, heart failure, nephrotic syndrome, bacterial pneumonia, other viral pneumonia, also minimal pleural effusion, hydropneumothorax, brosis, pulmonary contusion, exacerbations of chronic obstructive pulmonary diseases and neoplastic lymphangitis 16 .…”

“…Frequently reported LUS ndings are the appearance of multiple, con uent or not, B-lines, a thickened and irregular pleural line and small super cial or large areas of consolidation 11,12,13 . Also minimal or rarely larger pleural space uid effusions has been evidenced 14,15 .…”

Lung ultrasound in pregnant women with suspicion of COVID‐19

“…concluded that ‘a rapid teaching program is sufficient to provide gynecologists and obstetricians who are already skilled in obstetric and/or gynecological ultrasound examination with the theoretical skills necessary to recognize specific lung ultrasound patterns.’, adding that they believe that their course ‘represents one possible model for implementing lung ultrasound education and might be a useful launch‐pad for gynecologists and obstetricians involved in the management of pregnant patients with confirmed or suspected COVID‐19.’ We agree that a short training course is important to improve the knowledge and skill of practitioners. The usefulness of lung ultrasonography in the diagnosis of lung pathology in pregnant women with COVID‐19 has been confirmed 2 . Yet, the limited availability of data on lung ultrasound findings in COVID‐19 is a challenge, particularly as various non‐specific forms of lung abnormality are observable in this disease 2 .…”

Ultrasonography and SARS-CoV 2 infection: a review of what we know and do not yet know

“…• B artifact -B line or lighthouse sign, often multiple, grouped, leading to the waterfall sign; • loss of A line; • pleural roughening / cobblestone; • reduction of pleural sliding; • discontinuous pleural line; • subpleural consolidation -multifocal small nontranslobar or translobar, with or without mobile air bronchogram; • posterior, basal and right-sided most frequent location; • without pleural effusion or very rare incidence of it [1,2]. It is noteworthy that these changes are not specific for COVID19 infection as they also occur in venous pulmonary hypertension / cardiogenic interstitial or alveolar edema or interstitial fibrosis.…”

“…• A lines or insignificant B lines = 0 points (normal); • significant B lines (respectively more than 3 per intercostal space) = 1 point; • coalescent B lines with or without small subpleural consolidations = 2 points; • obvious, macroscopic, segmental or more extensive lung consolidation = 3 points. The proposed score has both the ability to express severity and to monitor the evolution and to guide the treatment with ventilation and posture [1]).…”