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COVID-19 can present with respiratory symptoms ranging from mild cough to viral pneumonia and ARDS. Lung ultrasonography has emerged as a promising imaging modality during the pandemic, but there is still a paucity of systematic analysis of lung ultrasound findings. In this retrospective observational study, 12 Zone ultrasound scans of COVID-19 positive patients were systematically analysed for pleural irregularities, subpleural consolidations, B lines, deep consolidations and effusions. Lung abnormalities were analysed according to overall frequency, frequency distribution in coronal and sagittal lung planes and were also correlated to clinical severity groups as determined by oxygenation deficit. Our results show that lung zones with abnormalities can occur juxtaposed to normal lung. Irregular pleural and small subpleural consolidations appear ubiquitously distributed throughout both lungs and occur early in the disease process. Wide B-lines are a predominant feature in COVID-19 infection. B-lines are found in a variety of patterns with number and width correlated to disease severity. In our analysis we also describe a previously unrecognised finding of small peri-pleural effusions in 8.7% of scans occurring in all areas of the lung. The current results form the basis for a more thorough understanding of the lung changes occurring in COVID-19 and the incorporation of lung ultrasound in the setting of COVID-19 infection including triage, diagnosis, treatment approach and prognosis.

Bouveret syndrome is a rare cause of gastric outlet obstruction due to gallstone impaction in the pylorus or proximal duodenum. This paper reports a case of Bouveret syndrome in a 66-year-old male patient in whom pre-operative investigations revealed a gallstone within the distal stomach, but spontaneous migration of the stone resulted in intraoperative difficulty requiring further surgical exploration than originally anticipated.

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