Review of X-ray and computed tomography scan findings with a promising role of point of care ultrasound in COVID-19 pandemic

Abstract

As healthcare professionals continue to combat the coronavirus disease 2019 (COVID-19) infection worldwide, there is an increasing interest in the role of imaging and the relevance of various modalities. Since imaging not only helps assess the disease at the time of diagnosis but also aids evaluation of response to management, it is critical to examine the role of different modalities currently in use, such as baseline X-rays and computed tomography scans carefully. In this article, we will draw attention to the critical findings for the radiologist. Further, we will look at point of care ultrasound, an increasingly a popular tool in diagnostic medicine, as a component of COVID-19 management.

Discrepancies in the clinical and radiological profiles of COVID-19: A case-based discussion and review of literature

“…Furthermore, in critically ill COVID-19 patients, extensive coalescent and disappearing B lines affecting upper and anterior lungs, with corresponding consolidation are observed[ 33 , 63 , 64 ]. Apart from the physiological A lines, and pathological B lines, other artifacts such as C, E and Z lines, have been described[ 65 ]. Moreover, as consolidation increases, the echogenicity of the lung changes to resemble that of the liver (‘hepatic pattern’), while also demonstrating changes to the bronchi morphology.…”

Highlighting COVID-19: What the imaging exams show about the disease

“…Although the detection of SARS-CoV-2 RNA using the RT-PCR remains the gold standard diagnostic method, the unspecific or asymptomatic initial stage of COVID-19 highlights the important role of imaging exams in assisting the early diagnosis, as well as in monitoring and identifying complications[ 32 , 29 ]. Figure 1 summarizes the main points regarding the imaging modalities used in COVID-19.…”

“…Some studies have also shown high sensitivity (93%-98%) for acute respiratory distress syndrome[ 82 ]. Thus, LUS is comparable to CT, but CT shows intra-pulmonary and apical lesions more clearly and comprehensively than LUS[ 29 ]. LUS is considered advantageous for detecting smaller lesions and peripulmonary effusions as well as pleural injuries, and is a dynamic and easily accessible method[ 34 ].…”

“…The demonstration of B-lines are described as laser-like hyperechoic artifacts that resemble a "comet tail" or "light beam" and have been commonly observed in cases of COVID-19 pneumonia; these B-lines may be associated with an interstitial syndrome and decreased aeration and when the confluents may appear as a "white lung" equivalent to the frosted glass opacities of CT. These characteristics suggest a more severe loss of lung aeration[ 84 , 29 ].…”

“…It is worth mentioning that CXR is more often used in the evaluation of disease progression than in the detection of the infection itself due to its lower value in the early identification of GGO compared to CT[ 28 ]. LUS is a faster and safer method than the aforementioned methods and, even though it provides images with an inferior quality than those obtained with a CT scan, it has become very useful due to its practicality, as it is possible to perform this technique at the patient's bedside, whereas the other procedures involve displacement and longer periods of time[ 29 ]. Of course, all available resources for patient care should always be taken into consideration, but when dealing with a pandemic, it is of unequal importance to thoroughly evaluate aspects related to the speed and efficiency of diagnostic methods[ 30 ].…”