Lung Ultrasound Findings in Patients Hospitalized With COVID‐19

Abstract

Objectives Lung ultrasound (LUS) can accurately diagnose several pulmonary diseases, including pneumothorax, effusion, and pneumonia. LUS may be useful in the diagnosis and management of COVID‐19. Methods This study was conducted at two United States hospitals from 3/21/2020 to 6/01/2020. Our inclusion criteria included hospitalized adults with COVID‐19 (based on symptomatology and a confirmatory RT‐PCR for SARS‐CoV‐2) who received a LUS. Providers used a 12‐zone LUS scanning protocol. The images were interpreted by the researchers based on a pre‐developed consensus document. Patients were stratified by clinical deterioration (defined as either ICU admission, invasive mechanical ventilation, or death within 28 days from the initial symptom onset) and time from symptom onset to their scan. Results N = 22 patients (N = 36 scans) were included. Eleven (50%) patients experienced clinical deterioration. Among N = 36 scans, only 3 (8%) were classified as normal. The remaining scans demonstrated B‐lines (89%), consolidations (56%), pleural thickening (47%), and pleural effusion (11%). Scans from patients with clinical deterioration demonstrated higher percentages of bilateral consolidations (50 versus 15%; P = .033), anterior consolidations (47 versus 11%; P = .047), lateral consolidations (71 versus 29%; P = .030), pleural thickening (69 versus 30%; P = .045), but not B‐lines (100 versus 80%; P = .11). Abnormal findings had similar prevalences between scans collected 0–6 days and 14–28 days from symptom onset. Discussion Certain LUS findings may be common in hospitalized COVID‐19 patients, especially for those that experience clinical deterioration. These findings may occur anytime throughout the first 28 days of illness. Future efforts should investigate the predictive utility of these findings on clinical outcomes.

Point-of-care lung ultrasound in COVID-19 patients: inter- and intra-observer agreement in a prospective observational study

“…In a recently published study investigating interobserver agreement of LUS in COVID-19 (although without measuring intraobserver agreement), Kumar et al found lower agreement for consolidations, similar agreement for pleural thickening and higher agreement especially when assessing B-lines 18 . This is in line with our assumption that low agreement in B-Line quantification might be due to a lack in specific training as observers met for a one hour calibration session before grading in the aforementioned study.…”

“…LUS is assumed to be an operator-dependent modality, as interobserver variabilities may influence detection and interpretation of specific findings in patients 18 . Furthermore, previous studies have demonstrated a high accuracy for LUS compared to conventional radiographic imaging, such as chest x-rays or CT imaging 19 , 20 .…”

Performance of a computer aided diagnosis system for SARS-CoV-2 pneumonia based on ultrasound images

“…During the progression of SARS-CoV-2 virus syndrome, the distal regions of the lung tended to be more frequently involved where can be detected easily and accurately by LUS [7]. The sonographic appearances were characterized with the pleural line irregularities and thickening, increment of B-line artifacts with severity and less frequently pleural effusion, and subpleural consolidations [8,9].…”

A Lower Global Lung Ultrasound Score Is Associated with Higher Likelihood of Successful Extubation in Invasively Ventilated COVID-19 Patients

“…11,12 Previous studies have shown a correlation between LUS and severity of acute respiratory distress syndrome (ARDS), 13 and with mortality in invasively ventilated critically ill patients. 14 LUS has previously been performed in a general population of COVID-19 patients outside the hospital, 15 presenting to the emergency department (ED) [16][17][18] and on the general wards [19][20][21][22][23][24][25][26] and has been found to be related to adverse outcomes including the need of invasive ventilation. Nevertheless, the role of LUS in evaluating the severity of patients after initiation of invasive ventilation is much less certain.…”