Lung ultrasound for early diagnosis and severity assessment of pneumonia in patients with coronavirus disease 2019

Abstract

Background/Aims: Current evidence supports lung ultrasound as a point-ofcare alternative diagnostic tool for various respiratory diseases. We sought to determine the utility of lung ultrasound for early detection of pneumonia and for assessment of respiratory failure among patients with coronavirus disease 2019 (COVID-19). Methods: Six patients with confirmed COVID-19 by reverse transcription-polymerase chain reaction were enrolled. All had undergone chest X-ray and chest computed tomography (CT) on the day of admission and underwent multiple point-of-care lung ultrasound scans over the course of their hospitalization. Results: Lung ultrasound detected early abnormal findings of representative B-lines in a patient with a normal chest X-ray, corresponding to ground-glass opacities on the chest CT scan. The ultrasound findings improved as her clinical condition improved and her viral load decreased. In another minimally symptomatic patient without significant chest X-ray findings, the ultrasound showed B-lines, an early sign of pneumonia before abnormalities were detected on the chest CT scan. In two critically ill patients, ultrasound was performed to assess for evaluation of disease severity. In both patients, the clinicians conducted emergency rapid sequence intubation based on the ultrasound findings without awaiting the laboratory results and radiological reports. In two children, ultrasound was used to assess the improvement in their pneumonia, thus avoiding further imaging tests such as chest CT. Conclusions: Lung ultrasound is feasible and useful as a rapid, sensitive, and affordable point-of-care screening tool to detect pneumonia and assess the severity of respiratory failure in patients hospitalized with COVID-19.

Ultrasonic Characteristics and Severity Assessment of Lung Ultrasound in COVID-19 Pneumonia in Wuhan, China: A Retrospective, Observational Study

“…LUS is a fast, accurate, and portable examination that can be performed in real time with no radiation exposure, to evaluate lung lesions. However, only a few studies have reported employing LUS to assess COVID-19 pneumonia severity [28] , [29] , [30] , and these were mainly descriptive studies or narrative reviews. A study found that LUS was performed to assess the severity of respiratory failure in six patients with COVID-19 [28] .…”

“…However, only a few studies have reported employing LUS to assess COVID-19 pneumonia severity [28] , [29] , [30] , and these were mainly descriptive studies or narrative reviews. A study found that LUS was performed to assess the severity of respiratory failure in six patients with COVID-19 [28] . Another study that recruited ten patients with COVID-19 suggested that LUS score monitoring seemed to reflect disease progression [29] .…”

Exposure of Pediatric Emergency Patients to Imaging Exams, Nowadays and in Times of Covid-19: An Integrative Review

“… Huang et al 18 Ssytematic review and meta-analysis Thoracic CT presents high sensitivity and low specificity in the detection of COVID-19, and should be performed in individuals with certain clinical characteristics, together with RT-PCR. Cho et al 19 Retrospective review (n=6) LUS has proven to be a fast and sensitive method as a screening tool to detect pneumonia and assess the severity of respiratory failure in hospitalized patients with COVID-19. Smargiassi et al 20 Review In pediatric patients admitted in the emergency room with symptoms similar to COVID-19, LUS should be performed early.…”

“…Imaging examinations are essential for diagnosis and for the early detection and monitoring of COVID-19. 5 , 17 CT is a widely used instrument in the investigation of the infection, 5 , 17 , 18 , 19 even though it does not distinguish it from other viral pneumonias. 17 However, CT exposes patients to unnecessary radiation, and health professionals, to higher risk of cross contamination in the hospital.…”

“…19 Besides, it is important to train doctors from different specialties to recognize the pathological findings of LUS and to store the results in a database, in order to create, in the future, an automatic algorithm to identify these echographic patterns. 20 However, the use of other imaging examinations should not be ruled out, 5,19 such as CT and thoracic X-ray, considering the fast evolution of the SARS-CoV-2 infection 17 and the different clinical staging of the disease. 5 This review allowed to identify that, nowadays, there is a tendency for the exacerbated use of imaging examinations in pediatric patients in UEs.…”