Ultrasound assessment of SARS-CoV-2 pneumonia: a literature review for the primary care physician

Abstract

The SARS-CoV-2 pandemic is considered one of the most critical global health emergencies in the last century. The diagnostic approach to the novel coronavirus disease (COVID-19) and its possible complications through a point-of-care-ultrasound (POCUS) evaluation could represent a good solution in the primary care setting. POCUS is a non-invasive technique that can be used outside hospitals to screen COVID-19 patients and their complications safely. Moreover, it offers several applications of diagnostic evaluation not only on lung parenchyma but also to search disease complications, such as the cardiovascular system, even at the patients' home. This narrative review aims to analyse the literature and provide data to primary care physicians engaged in monitoring and treating patients with SARS-CoV-2 infection. Key Messages POCUS is an important tool for the diagnostic approach in the primary care setting already before the start of the SARS-CoV-2 pandemic. Portable devices are useful in monitoring the clinical evolution of patients with infection from SARS-CoV-2 at home. The ultrasonographic features can help the general practice physicians to evaluate the presence of lung involvement and to diagnose complications from the SARS-CoV-2 infection involving districts such as the cardiovascular system.

Insights from comparison of the clinical presentation and outcomes of patients hospitalized with COVID-19 in an Italian internal medicine ward during first and third wave

“…During the third wave, the organization of pre-hospital care was improved in comparison with the abrupt emergence of the pandemic. At a community level, medical teams dedicated to home care of COVID-19 patients were formed, prompting early diagnosis and rationalizing pathways of hospital referral for more severe cases ( 35 , 36 ). Home treatment protocols could include administration of anti-inflammatory agents, antivirals or, in selected cases, even corticosteroids ( 37 ).…”

Approach to COVID-19 in older adults and indications for improving the outcomes

“…Peripheral saturation (SO2) measurement and scales such as the 6-min walking test and the Modified Early Warning Score (MEWS) remain good easy-to-use instruments to evaluate the risk of deterioration from COVID-19. However peripheral saturation is not always a reliable parameter especially in older adults having comorbid conditions such as heart disease or chronic pneumonia which could be associated with hypoperfusion, hypothermia and tremor [ 92 ] A bedside ultrasound assessment can be useful to assess COVID-19 patients [ 93 ]. The lung ultrasound (LUS) score has been shown to effectively identify those patients having the highest risk of mortality (LUS score ≥20), but requires availability of US devices at home and an adequate training [ 94–96 ].…”

Sarcoidosis and COVID-19: At the Cross-Road between Immunopathology and Clinical Manifestation

“…Unenhanced CT is considered the main investigator for diagnosis, detection of complications, and prognostication of COVID-19 because it allows more sensitive results than the chest X-ray [ 83 ]. More than half of patients imaged quickly after symptom onset have a normal CT scan.…”