Lung Ultrasound Patterns and Clinical-Laboratory Correlates during COVID-19 Pneumonia: A Retrospective Study from North East Italy

Abstract

Background and Aim. Lung ultrasound (LUS) is a convenient imaging modality in the setting of coronavirus disease-19 (COVID-19) because it is easily available, can be performed bedside and repeated over time. We herein examined LUS patterns in relation to disease severity and disease stage among patients with COVID-19 pneumonia. Methods. We performed a retrospective case series analysis of patients with confirmed SARS-CoV-2 infection who were admitted to the hospital because of pneumonia. We recorded history, clinical parameters and medications. LUS was performed and scored in a standardized fashion by experienced operators, with evaluation of up to 12 lung fields, reporting especially on B-lines and consolidations. Results. We included 96 patients, 58.3% men, with a mean age of 65.9 years. Patients with a high-risk quick COVID-19 severity index (qCSI) were older and had worse outcomes, especially for the need for high-flow oxygen. B-lines and consolidations were located mainly in the lower posterior lung fields. LUS patterns for B-lines and consolidations were significantly worse in all lung fields among patients with high versus low qCSI. B-lines and consolidations were worse in the intermediate disease stage, from day 7 to 13 after onset of symptoms. While consolidations correlated more with inflammatory biomarkers, B-lines correlated more with end-organ damage, including extrapulmonary involvement. Conclusions. LUS patterns provide a comprehensive evaluation of patients with COVID-19 pneumonia that correlated with severity and dynamically reflect disease stage. LUS patterns may reflect different pathophysiological processes related to inflammation or tissue damage; consolidations may represent a more specific sign of localized disease, whereas B-lines seem to be also dependent upon generalized illness due to SARS-CoV-2 infection.

New International Guidelines and Consensus on the Use of Lung Ultrasound

“…Experience with LUS in assessing COVID‐19 patients shows, however, that the alterations visualized in the posterior areas are the most significant 101 . Assessing each intercostal space along its entire length is time‐consuming, so reasonably simplified protocols have been suggested for COVID‐19 patients as well, such as 18 28–55,57–151 and 14 scan protocols 24,101 . Lately one interesting study on the correlation between LUS and laboratory results also described a protocol of 12 scans (quick COVID‐19 severity index [qCSI]), 6 for each half of the chest (upper and lower areas of the anterior, lateral and posterior surfaces, respectively), for assessing the presence of B‐line and/or consolidation 152 .…”

Lung Ultrasound Findings and Endothelial Perturbation in a COVID-19 Low-Intensity Care Unit

“…In particular, the most prevalent pattern in our cohort was B2 with both scores. Moreover, a LUS score >15 points, a proposed cut-off for LUS severity [19,20], was found in 71.2% and 55.9% of patients assessed with Soldati and Vetrugno score, respectively (Table 4). The two LUS scores were strongly correlated with each other (rho = 0.95).…”

Lung Ultrasound as a Triage Method in Primary Care for Patients with Suspected SARS-CoV-2 Pneumonia

“…There are many studies that recommend lung ultrasound as an aid in the diagnosis and monitoring of patients with dyspnea [ 20 , 21 , 22 , 25 ] as well as in the triage of patients who consult a respiratory clinic [ 17 , 20 , 26 , 27 , 28 ], but we did not identify any previous study that evaluates the usefulness of lung ultrasound in primary care, including in the home and in nursing homes, for patients with clinical suspicion of SARS-CoV-2 pneumonia.…”