Lung ultrasound in COVID-19: a useful diagnostic tool

Abstract

Coronavirus disease 2019 (Covid-19), caused by a novel enveloped RNA betacoronavirus, has recently been declared a public health emergency by the World Health Organization (WHO). The lack of knowledge at the beginning of the pandemics, associated with the inherent risk of infective spreading, makes initial recognition and management particularly complex, in terms of defining effective diagnostic and therapeutic protocols. In the Emergency setting, Lung Ultrasound (LUS) can play an important role in the management of patients with SARS-CoV2-related pneumonia, expanding from the initial diagnosis to the subsequent monitoring and follow-up. Among many other potential advantages (such has the absence of ionizing radiation, its inherent costeffectiveness, and bedside repeatability), LUS provides immediate diagnostic response and might prevent the risk of spreading the infection by moving the patient from the Emergency Room to the Radiology facilities. Aim of this short review is to define the potential role of lung ultrasound in Covid-19 patients, according to the evidence in the medical literature

Lung Ultrasound Point‐of‐View in Pediatric and Adult COVID‐19 Infection

“…29,30 Musolino et al used "Soldati LUS protocol" for lung ultrasound examinations, whereas Denina et al used the Copetti protocol. 20,21 In both of these pediatric surveys vertical artifacts, areas of white lung, subpleural consolidations and pleural irregularities were the main findings in children with COVID-19 pneumonia; no cases of pleural effusions were detected. 29,30 Denina et al reported only one case (out of 8 children) of discordance of LUS and chest x-ray results, respectively with B-lines pattern and normal radiological imaging.…”

“…The adult studies suggested similar findings: thickening of the pleural line with pleural line irregularity ( Figure 4); B lines: focal ( Figure 5), multifocal ( Figure 6), confluent ( Figure 7); subpleural consolidations (Figure 8), in a variety of patterns including multifocal small, nontranslobar and translobar with occasional mobile air bronchograms; pleural effusion is uncommon. 9,[11][12][13][14][15][16][17][18] In light of these findings researchers have proposed 4 patterns considering the loss of aeration: 21 pattern 0: presence of A-lines or up to 2 different B-lines instead of A lines. pattern 1: 3 or more evident B-lines.…”

The lung ultrasound: facts or artifacts? In the era of COVID-19 outbreak

“…Such movements are linked to pleural sliding. The (1,2,5,6) are delimited medially by the hemi-clavicular line and laterally by the anterior axillary line whereas the lateral ones (3,4,7,8) are included between the anterior and posterior axillary lines. The sub-mammary line divides the upper and lower zones.…”

“…We lacked on-site diagnostic capacity, so as I worked to secure critical resources to improve over all care, I also sought and received approval to incorporate point-of-care ultrasonography" [1]. These claims are so much actually in these days of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-COV-2) pandemic spread so that LUS seems to be strongly adapting to the follow-up for lung involvement of patients with ascertaining Coronavirus up to, in our opinion emblematic, use of LUS at the emergency triage or at home medical visit as a screening imaging test of suspected COVID-19 patients [2][3][4]. If on one hand, many studies have shown the efficacy of LUS in diagnosing pulmonary pathology, with increased sensitivity compared to that of chest X-ray (CXR) [5][6][7], on the other hand, little is discussed about its limits and pitfalls especially in generic and off label clinical contest.…”

Diagnostic technologies for COVID-19: a review

“…Importantly, lung ultrasound is a radiation-free test, making it suitable for special populations, particularly desirable for pregnant women. 67,68 Kalafat et al, reported on a case involving a pregnant woman who initially tested negative using RT-PCR, but was later found to be positive through lung ultrasound. This demonstrates the potential for lung ultrasound to play an important role in the triage of pregnant women with suspected COVID-19.…”