Lung Ultrasound in COVID-19 Pneumonia: Correlations with Chest CT on Hospital admission

Abstract

Background: Lung ultrasound (LUS) is an accurate, safe, and cheap tool assisting in the diagnosis of several acute respiratory diseases. The diagnostic value of LUS in the workup of coronavirus disease-19 (COVID-19) in the hospital setting is still uncertain. Objectives: The aim of this observational study was to explore correlations of the LUS appearance of COVID-19-related pneumonia with CT findings. Methods: Twenty-six patients (14 males, age 64 ± 16 years) urgently hospitalized for COVID-19 pneumonia, who underwent chest CT and bedside LUS on the day of admission, were enrolled in this observational study. CT images were reviewed by expert chest radiologists, who calculated a visual CT score based on extension and distribution of ground-glass opacities and consolidations. LUS was performed by clinicians with certified competency in thoracic ultrasonography, blind to CT findings, following a systematic approach recommended by ultrasound guidelines. LUS score was calculated according to presence, distribution, and severity of abnormalities. Results: All participants had CT findings suggestive of bilateral COVID-19 pneumonia, with an average visual scoring of 43 ± 24%. LUS identified 4 different possible abnormalities, with bilateral distribution (average LUS score 15 ± 5): focal areas of nonconfluent B lines, diffuse confluent B lines, small subpleural microconsolidations with pleural line irregularities, and large parenchymal consolidations with air bronchograms. LUS score was significantly correlated with CT visual scoring (r = 0.65, p < 0.001) and oxygen saturation in room air (r =-0.66, p < 0.001). Conclusion: When integrated with clinical data, LUS could represent a valid diagnostic aid in patients with suspect COVID-19 pneumonia, which reflects CT findings.

Portable Pocket-Sized Ultrasound Scanner for the Evaluation of Lung Involvement in Coronavirus Disease 2019 Patients

“…Due to its easy handling and dynamic nature, LUS is increasingly used in clinical settings, especially in critical care ( Mojoli et al 2019 ). In SARS-CoV-2 infection, it is invaluable in clinical management, showing higher accuracy than chest radiography (Smith et al 2019) and good correlation with CT imaging and pneumonia severity ( Nouvenne et al 2020 , Zieleskiewicz et al 2020 ). In experimental models of ARDS, it was found to detect lung lesions before the onset of hypoxemia ( Soldati et al 2020 ).…”

Development of a deep learning classifier to accurately distinguish COVID-19 from look-a-like pathology on lung ultrasound

“…[9][10][11] Deep learning has shown similarly favorable results in recent CXR and CT studies of COVID-19. 26,27 Given LUS image creation is fundamentally different (producing artifacts, rather than anatomic images of the lung), it could not be expected that our work with LUS would have yielded such similar results. The value of identifying such accuracy in a LUS model rests in the ability of LUS (unlike CT or CXR) to be delivered by limited personnel, at low cost and in any location.…”

Combining lung ultrasound and wells score for diagnosing pulmonary embolism in critically ill COVID-19 patients

“…In addition, infectious patients do not have to be transported as ultrasound can be performed on the bed side (point-of-care). Since LUS can identify changes in super cial lung tissue that correlate with histopathological ndings which could only be identi ed in CT-scan, but remain hidden in a large percentage of chest X-rays, the role of LUS in the context of viral pneumonia may be relevant [17]. In view of the recent outbreak of pneumonia from Wuhan, China, in December 2019 by the SARS-CoV2 pathogen, which is referred to as COVID-19, lung sonography proved to be useful [7,17,18].…”

“…Since LUS can identify changes in super cial lung tissue that correlate with histopathological ndings which could only be identi ed in CT-scan, but remain hidden in a large percentage of chest X-rays, the role of LUS in the context of viral pneumonia may be relevant [17]. In view of the recent outbreak of pneumonia from Wuhan, China, in December 2019 by the SARS-CoV2 pathogen, which is referred to as COVID-19, lung sonography proved to be useful [7,17,18]. Typical signs for COVID-19 have been de ned, which might be particularly helpful in the emergency rooms for diagnosis and triage [17,18].…”

“…In view of the recent outbreak of pneumonia from Wuhan, China, in December 2019 by the SARS-CoV2 pathogen, which is referred to as COVID-19, lung sonography proved to be useful [7,17,18]. Typical signs for COVID-19 have been de ned, which might be particularly helpful in the emergency rooms for diagnosis and triage [17,18]. Our study con rms the signs described by Peng et al in all but one COVID-19 patient included in the study thou consolidations are not exclusive for COVID-19.…”