With a lung ultrasound (LUS) the typical findings are interstitial pneumonia. COVID-19 pneumonia is often manifested in sub-pleural areas, which is preferably detected by sonography. An RT-PCR test cannot always ensure a safe differentiation of COVID-19- and non-diseased cases. Clinically challenging is that a reliable and time efficient decision regarding COVID-19 suspects requiring isolation. Therefore, this study was aimed at evaluating the significance of LUS in symptomatic patients with COVID-19 suspicion at hospital admission. A total of 101 patients admitted to a suspect ward with COVID-19-typical symptoms were assessed. All patients received prospectively a standardized LUS at admission. Patients were classified as LUS-positive and -negative cases based on a specific LUS score. The RT-PCR test in combination with the clinical findings served as a reference. Correctly classified were 14/15 COVID-19 diseased suspects as LUS-positive (sensitivity: 93.3%). Twenty-seven out of 61 non-positive cases were classified as false positive with LUS (specificity: 55.7%). In 34/35 patients who were assessed as LUS negative, no COVID-19 disease was detected during the hospitalization. The PPV and NPV of the LUS were 34.1% and 97.1%. LUS is a valuable tool in symptomatic patients for the assessment of COVID-19-disease. The high negative predictive value of LUS is helpful to rule out the disease.

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Indications for intercorporal fusion are progressive spondylolisthesis in children and adolescents, painful segmental instability in adults (spondylolisthesis, post-discectomy-syndrome, failed-back-syndrome). From 1980-86 152 isolated anterior intercorporal fusions had been realized, and in 1987/88 we carried out 79 combined anterior-posterior fusions. The rate of pseudarthrosis has been 25% with isolated anterior fusion and on the contrary 9% with combined fusion. With combined fusion the rate of complications did not increase, but the objective and subjective results became better. The postoperative period became more convenient, the stay in hospital and the consolidation of fusion were shorter. The reposition of spondylolisthesis was durable and the spine channel was accessible. We consider the instrumented fusion to be a complex reconstructive operation with high chances of success.

Despite the high-diagnostic value of sonographic lung imaging, providing substantial patient benefit, clinician should be aware that ultrasound exposure on lung is not absolutely without risk of harm. As shown in animal models, lung ultrasound (LUS) even in the diagnostic regime can induce pulmonary capillary haemorrhage (PCH) at the alveolar epithelium-gas interface. Acoustic peak negative pressure in the range of 1.0–1.5 MPa correlates well with PCH threshold. However, in retrospective human studies, adverse events could not be demonstrated following LUS examination, which is evidence of symptomatic PCH after therapeutic ultrasound ablation in proximity of lung exists. Therefore, this subject remains controversial. This work summarizes the underlying physical causes and consequences of ultrasound induced PCH. The complexity of PCH thresholds depending on imaging modes, pathological lung conditions including ventilation parameters will be presented. In addition, current recommendations for the safe use of LUS based on Safety Indices given by AIUM and EFSUMB guidelines and the impact of LUS specific settings, available on modern scanners, will be discussed.

Lung ultrasound (LUS), particular under aspects of pneumonia and cardiopulmonary insufficiency, requires specialised sonographic expertise as well as knowledge of its specific features. Due to restricted access to clinical cases such as with viral pneumonia, alternatively large animal models can be used for education and research. Therefore this work summarizes approaches for inducing pathologic LUS features on large animals. These will be classified regarding presentation of A/B-Lines, White Lung (WLS), pleural irregularities, consolidations and are further discussed regrading their cardio-pulmonary stability. Most commonly ARDS inducing lung lavage, oleic acid injection and endobronchial saline administration were published. Dominantly B-lines, WLS were found in all such models. Albeit a specialized technique using endobronchial saline instillation (OLF) visualised all LUS features as typical present during viral pneumonia, such as consolidations with air/fluid bronchogram, pleural irregularities and their patchy distribution with areas of aerated lung. With regard to haemodynamic and oxygenation stability, OLF provides best haemodynamic stability and enables reusable usability of animals. Non-infective large animal models can be used for safe, reliable education of clinicians for teaching practical handling of lung ultrasound and could serve for research aspects regarding ultrasound imaging or safety.