Transthoracic ultrasound sign in severe asthmatic patients: a lack of “gliding sign” mimic pneumothorax

Colle, Anna Del; Carpagnano, Giovanna Elisiana; Feragalli, Beatrice; Barbaro, Maria Pia Foschino; Lacedonia, Donato; Scioscia, Giulia; Quarato, Carla Maria Irene; Buonamico, Enrico; Tinti, Maria Giulia; Rea, Gaetano; Cipriani, Cristiana; Frongillo, Elisabettamaria; Cosmo, Salvatore De; Guglielmi, Giuseppe; Sperandeo, Marco

doi:10.1259/bjrcr.20190030

Cited by 11 publications

(11 citation statements)

References 19 publications

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“…However, pattern for COVID-19 at LUS are characteristic but non-specific [ 17 ]. The presence of artifactual B-lines is reported in several other pathologies, such as pulmonary edema, interstitial fibrosis, and asthma [ 19 , 30 , 31 ]. In addition B-lines can occur even in healthy individuals and should be interpreted in relation with the age of the observed patient [ 32 , 33 ].…”

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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“…B-lines can resolve rapidly in response to treatment, and, therefore, LUS data must be interpreted in the context of previous interventions [33,34]. B-lines can be seen in several of pulmonary conditions, including pulmonary fibrosis or interstitial lung disease, ARDS, trauma, asthma, and pneumonitis (Table 3) [31,32,[35][36][37][38][39]. However, the coexistence of diffuse B-lines echo-pattern with the presence of heterogeneous lung echo-texture, irregular thickened pleura and presence of scattered "shred sign" could help in diagnosing multifocal pneumonia complicated by ARDS on the related severe degree of hypoxemia, but the ultrasound findings for a consolidation are not specific and must necessarily be correlated with the clinical history, as in the case of aspiration pneumonia (Fig.…”

Section: Variability Interpretation Of the Data And Confusing Findingsmentioning

confidence: 99%

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

et al. 2020

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Ultrasound is the most disruptive innovation in intensive care life, above all in this time, with a high diagnostic value when applied appropriately. In recent years, point-of-care lung ultrasound has gained significant popularity as a diagnostic tool in the acutely dyspnoeic patients. In the era of Sars-CoV-2 outbreak, lung ultrasound seems to be strongly adapting to the follow-up for lung involvement of patients with ascertaining infections, till to be used, in our opinion emblematically, as a screening test in suspected patients at the emergency triage or at home medical visit. In this brief review, we discuss the lung ultrasound dichotomy, certainties and uncertainties, describing its potential role in validated clinical contexts, as a clinicaldependent exam, its limits and pitfalls in a generic and off-label clinical context, as a virtual anatomical-dependent exam, and its effects on the clinical management of patients with COVID-19. Keywords Lung ultrasound • Point of care ultrasound • Dyspnoea • COVID-19 • Sars-CoV-2 Abbreviations ARDS Acute respiratory distress syndrome BLUE Bedside lung ultrasonography in emergency CAUSE Cardiac arrest ultrasound exam CHP Chronic hypersensitivity pneumonia COPD Chronic obstructive pulmonary disease CT Computed tomography CXR Chest X-ray COVID-19 Coronavirus disease 19 ECMO Extra-corporeal membrane oxygenation EVD Ebola virus disease FALLS Fluid administration limited by lung sonography LUS

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“…Some case reports also mentioned absence of B-mode pleural sliding, with loss of its M-mode correspondent "seashore sign" and appearance of "bar-code sign", in cases of severe airflow impairment [10,11]. This is also assumed to be a consequence of hyperinflation with pleural over-tension.…”

Section: Discussionmentioning

confidence: 99%

“…In adult patients with asthma/chronic obstructive pulmonary disease (COPD) presenting with wheezing, LUS usually shows as an A/nude profile (normal profile, with sliding and A-lines, without any other findings), or at most reveals a decrease in the intensity/absence of pleural sliding due to over-tension. However, this is not only unspecific (as it can be associated with other conditions, most notably pneumothorax), but also very difficult to quantify [1,10,11]. Therefore, until this moment, simple point-of-care ultrasonography (POCUS) appeared to be unable to assess the severity of airflow limitation.…”

Section: Introductionmentioning

confidence: 99%

Vertical displacement of pleura: a new method for bronchospasm evaluation?

Martins

Nogué

2020

Ultrasound J

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Background: Lung ultrasonography has been increasingly recognized has a valuable diagnostic tool. In adult patients with asthma/chronic obstructive pulmonary disease and wheezing, LUS usually presents as an A/nude profile (normal profile, with sliding and A-lines, and without any abnormal findings) or at most reveals a decrease/absence of lung sliding. Therefore, until now simple point-of-care ultrasonography appeared to be unable to assess the severity of airflow limitation. Case presentation: We report the case of a woman presenting to the emergency department with an asthma exacerbation. Bedside ultrasound showed the usual A/normal profile, but also an associated vertical pleural displacement, probably secondary to hyperinflation and accessory muscle recruitment. We evaluated the described movement with M-mode and established a comparison index between end-inspiration and end-expiration, using the skin as reference. This index showed improvement and complete normalization during treatment. Conclusions: Pleural vertical displacement appears to be a sonographic alteration associated to bronchospasm and accessory muscle recruitment. It is easily identifiable and measurable on LUS, thus possibly representing a new method to evaluate bronchospasm and monitoring treatment response. Further research is needed to confirm or refute this finding.

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Transthoracic ultrasound sign in severe asthmatic patients: a lack of “gliding sign” mimic pneumothorax

Cited by 11 publications

References 19 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

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

Vertical displacement of pleura: a new method for bronchospasm evaluation?

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