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

Serafino, Marco Di; Notaro, M.; Rea, Gaetano; Iacobellis, Francesca; Paoli, Venere Delli; Acampora, Ciro; Ianniello, Stefania; Brunese, Luca; Romano, Luigia; Vallone, Gianfranco

doi:10.1007/s11547-020-01236-5

Cited by 55 publications

(64 citation statements)

References 45 publications

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“…In addition the use of LUS is limited in several conditions, particularly in obese patients. Moreover, LUS is highly dependent on operator experience, without clear evidence-based guidelines about the training required to achieve adequate skills [ 28 , 34 ]. Our results support this statement, demonstrating that despite significant lower experience of the readers in MP (11 years vs 15 years), LUS performance in diagnosis of COVID-19 was significantly better in MP as compared with HP, proving the relevance of specific training to assess pulmonary abnormalities related to COVID-19.…”

Section: Discussionmentioning

confidence: 99%

Comparison of admission chest computed tomography and lung ultrasound performance for diagnosis of COVID-19 pneumonia in populations with different disease prevalence

Colombi

Petrini

Maffi

et al. 2020

European Journal of Radiology

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Purpose Chest computed tomography (CT) is considered a reliable imaging tool for COVID-19 pneumonia diagnosis, while lung ultrasound (LUS) has emerged as a potential alternative to characterize lung involvement. The aim of the study was to compare diagnostic performance of admission chest CT and LUS for the diagnosis of COVID-19. Methods We included patients admitted to emergency department between February 21-March 6, 2020 (high prevalence group, HP) and between March 30-April 13, 2020 (moderate prevalence group, MP) undergoing LUS and chest CT within 12 h. Chest CT was considered positive in case of “indeterminate”/“typical” pattern for COVID-19 by RSNA classification system. At LUS, thickened pleural line with ≥ three B-lines at least in one zone of the 12 explored was considered positive. Sensitivity, specificity, PPV, NPV, and AUC were calculated for CT and LUS against real-time reverse transcriptase polymerase chain reaction (RT-PCR) and serology as reference standard. Results The study included 486 patients (males 61 %; median age, 70 years): 247 patients in HP (COVID-19 prevalence 94 %) and 239 patients in MP (COVID-19 prevalence 45 %). In HP and MP respectively, sensitivity, specificity, PPV, and NPV were 90–95 %, 43–69 %, 96−72 %, 20–95 % for CT and 94−93 %, 7–31 %, 94−52 %, 7–83 % for LUS. CT demonstrated better performance than LUS in diagnosis of COVID-19, both in HP (AUC 0.75 vs 0.51; P < 0.001) and MP (AUC 0.85 vs 0.62; P < 0.001). Conclusions Admission chest CT shows better performance than LUS for COVID-19 diagnosis, at varying disease prevalence. LUS is highly sensitive, but not specific for COVID-19.

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Section: Discussionmentioning

confidence: 99%

Comparison of admission chest computed tomography and lung ultrasound performance for diagnosis of COVID-19 pneumonia in populations with different disease prevalence

Colombi

Petrini

Maffi

et al. 2020

European Journal of Radiology

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“…Different US protocols for studying the lung parenchyma are described in the literature. Some authors evaluate eight zones of the chest, four at each side (two anterior and two lateral), using low- and high-frequency probes [ 20 ]. Other authors [ 21 ] evaluate 14 areas (three posterior, two lateral, and two anterior) for 10 s, with an intercostal scan; for LUS examinations of patients who are not able to maintain a sitting position, the operator tries to have a partial view of the basal and dorsal regions.…”

Section: Lung Ultrasoundmentioning

confidence: 99%

Diagnostic imaging in COVID-19 pneumonia: a literature review

et al. 2021

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In December 2019 in Wuhan (China), a bat-origin coronavirus (2019-nCoV), also known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was identified, and the World Health Organization named the related disease COVID-19. Its most severe manifestations are pneumonia, systemic and pulmonary thromboembolism, acute respiratory distress syndrome (ARDS), and respiratory failure. A swab test is considered the gold standard for the diagnosis of COVID-19 despite the high number of false negatives. Radiologists play a crucial role in the rapid identification and early diagnosis of pulmonary involvement. Lung ultrasound (LUS) and computed tomography (CT) have a high sensitivity in detecting pulmonary interstitial involvement. LUS is a low-cost and radiation-free method, which allows a bedside approach and needs disinfection of only a small contact area, so it could be particularly useful during triage and in intensive care units (ICUs). High-resolution computed tomography (HRCT) is particularly useful in evaluating disease progression or resolution, being able to identify even the smallest changes.

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“…More importantly, mild LUS findings (score 1) in an asymptomatic woman should be approached cautiously. For example, A-lines that are known as physiologic artifacts can represent abnormal signs in atelectasis, asthma, chronic obstructive pulmonary disease, and pneumothorax ( 16 ) . Similarly, B-lines can represent normal signs in healthy patients when they are fewer than three and do not reach the bottom of the screen ( 16 ) .…”

Section: Discussionmentioning

confidence: 99%

How to perform and interpret the lung ultrasound by the obstetricians in pregnant women during the SARS-CoV-2 pandemic

Yassa¹,

Mutlu²,

Kalafat³

et al. 2020

tjod

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Objective: Evidence for the use of lung ultrasound scan (LUS) examinations in coronavirus 2019 pneumonia is rapidly growing. The safe and non-ionizing nature of LUS drew attention, particularly for pregnant women. This study aimed to contribute to the interpretation of LUS findings in pregnant women for the obstetricians. Materials and Methods: LUS was performed to pregnant women suspected of or diagnosed as having Severe Acute Respiratory syndrome coronavirus-2 (SARS-CoV-2) in the first 24 hours of admission. Fourteen areas (3 posterior, 2 lateral, and 2 anterior) were scanned per patient for at least 10 seconds along the indicated anatomical landmarks. The scan was performed in supine, right-sided and left-sided positions, respectively. Each area was given a score between 0 and 3 according to the specific pattern. Results: In this study, 21 still images and 21 videoclips that enabled dynamic and real-time evaluation were provided. Pleural line assessment, physiologic A-lines, pathologic B-lines, light beam pattern, white lung pattern, and specific patterns for quick recognition and evaluation are described. Conclusion: The potential advantages and limitations of LUS and its areas of use for obstetricians are discussed. LUS is a promising supplementary imaging tool during the SARS-CoV-2 pandemic. It is easy to perform and may be feasible in the hands of obstetricians after a brief didactic course. It may be a firstline imaging modality for pregnant women.

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

Cited by 55 publications

References 45 publications

Comparison of admission chest computed tomography and lung ultrasound performance for diagnosis of COVID-19 pneumonia in populations with different disease prevalence

Comparison of admission chest computed tomography and lung ultrasound performance for diagnosis of COVID-19 pneumonia in populations with different disease prevalence

Diagnostic imaging in COVID-19 pneumonia: a literature review

How to perform and interpret the lung ultrasound by the obstetricians in pregnant women during the SARS-CoV-2 pandemic

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