Lung Ultrasound as a First-Line Test in the Evaluation of Post-COVID-19 Pulmonary Sequelae

Abstract

Background: Interstitial lung sequelae are increasingly being reported in survivors of COVID-19 pneumonia. An early detection of these lesions may help prevent the development of irreversible lung fibrosis. Lung ultrasound (LUS) has shown high diagnostic accuracy in interstitial lung disease (ILD) and could likely be used as a first-line test for post-COVID-19 lung sequelae.Methods: Single-center observational prospective study. Follow-up assessments of consecutive patients hospitalized for COVID-19 pneumonia were conducted 2–5 months after the hospitalization. All patients underwent pulmonary function tests (PFTs), high-resolution computed tomography (HRCT), and LUS. Radiological alterations in HRCT were quantified using the Warrick score. The LUS score was obtained by evaluating the presence of pathological B-lines in 12 thoracic areas (range, 0–12). The correlation between the LUS and Warrick scores was analyzed.Results: Three hundred and fifty-two patients who recovered from COVID-19 pneumonia were recruited between July and September 2020. At follow-up, dyspnea was the most frequent symptom (69.3%). FVC and DLCO alterations were present in 79 (22.4%) and 234 (66.5%) patients, respectively. HRCT showed relevant interstitial lung sequelae (RILS) in 154 (43.8%) patients (Warrick score ≥ 7). The LUS score was strongly correlated with the HRCT Warrick score (r = 0.77) and showed a moderate inverse correlation with DLCO (r = −0.55). The ROC curve analysis revealed that a LUS score ≥ 3 indicated an excellent ability to discriminate patients with RILS (sensitivity, 94.2%; specificity, 81.8%; negative predictive value, 94.7%).Conclusions: LUS could be implemented as a first-line procedure in the evaluation of Post-COVID-19 interstitial lung sequelae. A normal LUS examination rules out the presence of these sequelae in COVID-19 survivors, avoiding the need for additional diagnostic tests such as HRCT.

Lung ultrasound in the follow-up of severe COVID-19 pneumonia: six months evaluation and comparison with CT

“…Our study observed a significant association between LUS score and the presence of fibrotic-like changes on chest HRCT after a follow-up of 6 months from the acute disease. Our results are consistent with two previous studies, in which patients were evaluated 3 [ 24 ] and 2–5 [ 26 ] months after COVID-19 hospitalization. In particular, the study by Clofent et al reported a strong correlation between LUS and CT scores in a patient cohort characterized by a wide range of clinical severity in the acute phase, including a relevant amount of patients who did not require oxygen supplementation [ 26 ].…”

“…Our results are consistent with two previous studies, in which patients were evaluated 3 [ 24 ] and 2–5 [ 26 ] months after COVID-19 hospitalization. In particular, the study by Clofent et al reported a strong correlation between LUS and CT scores in a patient cohort characterized by a wide range of clinical severity in the acute phase, including a relevant amount of patients who did not require oxygen supplementation [ 26 ]. In contrast with our study, a high variability in the timing of follow-up evaluation (median 90 days, IQR, 64–114) was described.…”

“…Thus, lung ultrasound could theoretically be useful in detecting long-term pulmonary sequelae of COVID-19 pneumonia. To the best of our knowledge most studies focused on the role of LUS in acute COVID-19 infection while limited data are available regarding LUS findings after hospital discharge [ 24 – 26 ].…”

Point-of-care ultrasound for tuberculosis management in Sub-Saharan Africa—a balanced SWOT analysis

“…The value of LUS for the follow-up and early detection of interstitial lung disease post COVID-19 seems of interest. Albeit small and monocentric datasets, characterization of the sonographic interstitial syndrome seems to correlate well with CT findings such as ground glass opacities or parenchymal bands (Clofent et al 2021). Where chest X-ray offers a static impression of TB sequelae, lung ultrasound might be a complementary dynamic exam to help identify patients at risk for post-TB fibrosis, pachypleuritis and superinfections.…”

Severe chronic cough relating to post-COVID-19 interstitial lung disease: a case report

“…Though CXR is recommended as a routine test to evaluate post-COVID-19 patients at the long COVID-19 outpatient clinic [ 10 ], it is less sensitive than high-resolution CT of chest in detecting pulmonary abnormalities in acute COVID-19 patients [ 11 ]. Recent evidence has suggested the utility of lung ultrasound to assess for interstitial pulmonary complications in post-COVID-19 patients [ 12 ]. Our patient presented with prominent diffuse ground glass opacities and emphysema which could be difficult to detect on CXR and would require characterization with a high-resolution CT of the chest.…”