The Role of Transthoracic Ultrasound in the novel Coronavirus Disease (COVID-19): A Reappraisal. Information and Disinformation: Is There Still Place for a Scientific Debate?

Sensitivity of Lung US compared to Chest CT for the screening of COVID-19: preliminary report of our experience

“…Indeed, the sonographic ndings described in our case series and in the current available literature on this topic 11,12,13,14,15 shows a considerable overlap with many other lung diseases. An irregular pleural line with increased B-lines may be visible in ARDS, heart failure, nephrotic syndrome, bacterial pneumonia, other viral pneumonia, also minimal pleural effusion, hydropneumothorax, brosis, pulmonary contusion, exacerbations of chronic obstructive pulmonary diseases and neoplastic lymphangitis 16 . Subpleural consolidations may be visible in other viral pneumonia, non viral pneumonia, atelectasis and lung cancer 16 and their LUS patternconsisting in mixed hypo-echogenicity, with irregular, scarcely de ned borders -is non-speci c, not allows to distinguish one condition from another.…”

“…An irregular pleural line with increased B-lines may be visible in ARDS, heart failure, nephrotic syndrome, bacterial pneumonia, other viral pneumonia, also minimal pleural effusion, hydropneumothorax, brosis, pulmonary contusion, exacerbations of chronic obstructive pulmonary diseases and neoplastic lymphangitis 16 . Subpleural consolidations may be visible in other viral pneumonia, non viral pneumonia, atelectasis and lung cancer 16 and their LUS patternconsisting in mixed hypo-echogenicity, with irregular, scarcely de ned borders -is non-speci c, not allows to distinguish one condition from another. Furthermore, some of these overlapping conditions may even be pre-existing in COVID-19 patients (especially in more severe cases) and LUS is often unable to discern a COVID-19 diagnosis in a population with such pre-existing cardiothoracic conditions, including chronic obstructive pulmonary disease, interstitial lung disease, cardiovascular disease and malignancies with cardiothoracic involvement 18,20 .…”

“…Therefore, LUS is not suitable for formulating diagnostic hypotheses based on conjecturally speci c clues that are, actually, not reproducible, di cult to demonstrate, confusing in case of pre-existing comorbidities and have never received unanimous consensus or solid support 24,25 . Moreover, one must ask how a method like US, which only visualizes a small part of the pulmonary parenchyma could ever enable a reliable assessment of diseases extent and severity 16,26 . With these consideration in mind, if the role of CT in COVID-19 is still debated, that of LUS is not unexpectedly even more uncertain.…”

“…In addition, despite typical LUS ndings may show good sensitivity and positive predictive values in the context of COVID-19 epidemic (i.e. high "a priori" probability of disease in the presence of respiratory symptoms), the ability of LUS to rule out COVID-19 in normal condition is far from su cient, as the same US patterns overlap with several other pleuro-pulmonary conditions 16 . At present, there is still a lack of data to establish the appropriate use of LUS in the diagnostic workup of COVID-19.…”

Low Sensitivity of Admission Lung US Compared to Chest CT for Diagnosis of Lung Involvement in a Cohort of 82 Patients with COVID-19 Pneumonia

“…Although typical LUS findings may show good sensitivity and positive predictive values in the context of COVID-19 epidemic (i.e., high “a priori” probability of disease in the presence of respiratory symptoms), the ability of LUS to rule out COVID-19 in normal condition is far from sufficient, as the same US patterns overlap with several other pleuro-pulmonary conditions [ 13 ]. In addition, about 30% of the pleural surface and the deeper lung parenchyma are not accessible to LUS due to technical limitations [ 14 ], with the risk to lose the detection of some lesions and underestimate the actual disease extent.…”