Usefulness of lung ultrasound imaging in COVID‐19 pneumonia: The persisting need of safety and evidences

Trovato, Guglielmo M.; Sperandeo, Marco

doi:10.1111/echo.14769

Cited by 6 publications

(11 citation statements)

References 8 publications

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“…In our COVID-19 patients, LUS resulted falsely negative in most cases, showing much less sensitivity than Chest CT in assessing disease-related lesions. This inevitable result is conform with the physical characteristics and limitations of the pleuro-pulmonary ultrasound examination and highlights LUS inadequacy for a screening purpose 24 . Furthermore, due to the high non-speci city of US ndings and the di culty to discriminate possible pre-existing cardio-pulmonary comorbidities, the incidental detection of alterations that could be attributable to COVID-19 pneumonia should be regarded and classi ed with much more attention.…”

Section: Discussionsupporting

confidence: 53%

“…To date, no comparative studies have been performed between COVID-19 patients and patients with other possible overlapping cardio-pulmonary diseases. Therefore, LUS is not suitable for formulating diagnostic hypotheses based on conjecturally speci c clues that are, actually, not reproducible, di cult to demonstrate, confusing in case of pre-existing comorbidities and have never received unanimous consensus or solid support 24,25 . Moreover, one must ask how a method like US, which only visualizes a small part of the pulmonary parenchyma could ever enable a reliable assessment of diseases extent and severity 16,26 .…”

Section: Discussionmentioning

confidence: 99%

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

Quarato

Mirijello

Lacedonia

et al. 2020

Preprint

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As lung ultrasound (LUS) is a noninvasive, radiation-free, repeatable and portable imaging tool suitable for a point-of-care use, several recent literature reports have emphasized its role as the ideal screening tool for SARS-CoV2 pneumonia. To evaluate the actual diagnostic accuracy of LUS for this purpose, we performed a systematic comparative study between LUS and CT scan findings in a population of 82 patients hospitalized because of COVID-19. LUS and Chest CT have been performed in all patients within 6-12 hours from the admission. The sensitivity of LUS in assessing typical CT findings was 60%. Despite LUS detected consolidations adherent to pleural surface in all cases, it was not able to detect all the consolidations assessed at CT scan (p=0.002), showing a risk to underestimate the actual disease’s extent. Moreover, only 70% of pleural surface is visible by LUS. Considering that the specificity and the positive predictive value of the same LUS signs may be lowered in a normal setting of non epidemic COVID-19 and in case of pre-existing cardio-pulmonary diseases, LUS use should not be indicated for diagnosis of COVID-19. However, it may be very useful for the assessment of pleural effusion and to guide safer fluid drainage.

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Section: Discussionsupporting

confidence: 53%

Section: Discussionmentioning

confidence: 99%

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

Quarato

Mirijello

Lacedonia

et al. 2020

Preprint

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“…However, in our COVID-19 patients, this imaging method resulted falsely negative in most cases, showing a lower sensitivity than Chest CT in assessing specific disease-related lung lesions not facing to the superficial pleura. This inevitable result conforms with the physical characteristics and limitations of the pleuro-pulmonary ultrasound examination and highlights LUS inadequacy in ruling out a COVID-19 pneumonia [ 38 ]. The use of a LUS score for clinically relevant pulmonary involvement in COVID-19 patients who are present at the Emergency Department seems not to be a safe option, due to the impossibility to predict a sudden worsening of the disease.…”

Section: Discussionmentioning

confidence: 55%

“…Summarizing, LUS is not suitable for formulating diagnostic hypotheses based on conjecturally specific clues that are, actually, not reproducible, difficult to demonstrate, confusing in the case of pre-existing comorbidities, and have never received unanimous consensus or solid support [ 38 , 41 ].…”

Section: Discussionmentioning

confidence: 99%

Low Sensitivity of Admission Lung US Compared to Chest CT for Diagnosis of Lung Involvement in a Cohort of 82 Patients with COVID-19 Pneumonia

et al. 2021

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Background and Objectives: The potential role of lung ultrasound (LUS) in characterizing lung involvement in Coronavirus disease 2019 (COVID-19) is still debated. The aim of the study was to estimate sensitivity of admission LUS for the detection of SARS-CoV-2 lung involvement using Chest-CT (Computed Tomography) as reference standard in order to assess LUS usefulness in ruling out COVID-19 pneumonia in the Emergency Department (ED). Methods: Eighty-two patients with confirmed COVID-19 and signs of lung involvement on Chest-CT were consecutively admitted to our hospital and recruited in the study. Chest-CT and LUS examination were concurrently performed within the first 6–12h from admission. Sensitivity of LUS was calculated using CT findings as a reference standard. Results: Global LUS sensitivity in detecting COVID-19 pulmonary lesions was 52%. LUS sensitivity ranged from 8% in case of focal and sporadic ground-glass opacities (mild disease), to 52% for a crazy-paving pattern (moderate disease) and up to 100% in case of extensive subpleural consolidations (severe disease), although LUS was not always able to detect all the consolidations assessed at Chest-CT. LUS sensitivity was higher in detecting a typical Chest-CT pattern (60%) and abnormalities showing a middle-lower zone predominance (79%). Conclusions: As admission LUS may result falsely negative in most cases, it should not be considered as a reliable imaging tool in ruling out COVID-19 pneumonia in patients presenting in ED. It may at least represent an expanded clinical evaluation that needs integration with other diagnostic tests (e.g., nasopharyngeal swab, Chest-CT).

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“…This may be due to its many limitations. First, LUS is constantly limited by the presence of artifacts related to air in the lungs; thus, it is mainly based on the interpretation of imaging artifacts [ 67 , 68 , 69 , 70 , 71 , 72 ]. Two main artifacts are created by the physical interaction of the ultrasonic beam with the tissue–air interface: the horizontal A line and vertical B line ( Figure 3 ) [ 67 , 68 ].…”

Section: Lung Ultrasoundmentioning

confidence: 99%

A Pictorial Review of the Role of Imaging in the Detection, Management, Histopathological Correlations, and Complications of COVID-19 Pneumonia

Brogna

Bignardi

Brogna³

et al. 2021

Diagnostics

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Imaging plays an important role in the detection of coronavirus (COVID-19) pneumonia in both managing the disease and evaluating the complications. Imaging with chest computed tomography (CT) can also have a potential predictive and prognostic role in COVID-19 patient outcomes. The aim of this pictorial review is to describe the role of imaging with chest X-ray (CXR), lung ultrasound (LUS), and CT in the diagnosis and management of COVID-19 pneumonia, the current indications, the scores proposed for each modality, the advantages/limitations of each modality and their role in detecting complications, and the histopathological correlations.

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Usefulness of lung ultrasound imaging in COVID‐19 pneumonia: The persisting need of safety and evidences

Cited by 6 publications

References 8 publications

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

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

Low Sensitivity of Admission Lung US Compared to Chest CT for Diagnosis of Lung Involvement in a Cohort of 82 Patients with COVID-19 Pneumonia

A Pictorial Review of the Role of Imaging in the Detection, Management, Histopathological Correlations, and Complications of COVID-19 Pneumonia

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