Abstract
The pandemic spread of the new severe acute respiratory syndrome coronavirus 2 has raised the necessity to identify an appropriate imaging method for early diagnosis of coronavirus disease 2019 (COVID-19). Chest computed tomography (CT) has been regarded as the mainstay of imaging evaluation for pulmonary involvement in the early phase of the pandemic. However, due to the poor specificity of the radiological pattern and the disruption of radiology centers' functionality linked to an excessive demand for exams, the American College of Radiology has advised against CT use for screening purposes. Lung ultrasound (LUS) is a point-of-care imaging tool that is quickly available and easy to disinfect. These advantages have determined a “pandemic” increase of its use for early detection of COVID-19 pneumonia in emergency departments. However, LUS findings in COVID-19 patients are even less specific than those detectable on CT scans. The scope of this perspective article is to discuss the great number of diseases and pathologic conditions that may mimic COVID-19 pneumonia on LUS examination.
Highlights
The pandemic spread of the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has solicited the necessity to identify a diagnostic method to early detect coronavirus disease 2019 (COVID-19)
A chest computed tomography (CT) scan is more accurate in the study of initial ground glass opacities (GGOs) [2]
To avoid the disruption of radiology centers’ functionality due to an excessive demand for exams, the American College of Radiology stated that CT in COVID-19 was not to be used for screening purposes, suggesting its employment only in hospitalized patients, symptomatic or with specific clinical indications [5]
Summary
The pandemic spread of the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has solicited the necessity to identify a diagnostic method to early detect coronavirus disease 2019 (COVID-19). Because COVID-19 pneumonia itself represents a cause of ARDS in the most severe stages [32], the differential diagnosis from the other causes of alveolar damage is practically impossible on the basis of chest imaging and in the absence of viral testing Viral pneumonia, such as influenza A virus (H7N9, H1N1), respiratory syncytial virus, parainfuenza virus, adenovirus, cytomegalovirus (CMV), and human metapneumovirus [33,34,35,36], commonly manifests as a sonographic “alveolar-interstitial syndrome” with unspecific ultrasound findings, including ≥3 focal or confluent B-lines, a thickened and irregular hyperechoic pleural line, and subpleural consolidations (Figures 2C,C’). An area of peripheral atelectasis or any consolidation that does not reach the pleural surface may cause a non-specific increase in B-lines as a result of the variation of the normal proportional content between air, lung tissue, and fluid (Figures 2H,H’) This gives rise to another possible false positive sonographic pattern of early COVID-19 pneumonia. Virtually impossible to rule out COVID-19 pneumonia using LUS in the elderly
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