Irregular Pleural Line Research Articles

A single-center comparative study of lung ultrasound versus chest computed tomography during the COVID-19 era.

BackgroundLung ultrasound (LUS) is a bedside imaging tool that has proven useful in identifying and assessing the severity of pulmonary pathology. The aim of this study was to determine LUS patterns, their clinical significance, and how they compare to CT findings in hospitalized patients with coronavirus infection.MethodsThis observational study included 62 patients (33 men, age 59.3±15.9 years), hospitalized with pneumonia due to COVID-19, who underwent chest CT and bedside LUS on the day of admission. The CT images were analyzed by chest radiographers who calculated a CT visual score based on the expansion and distribution of ground-glass opacities and consolidations. The LUS score was calculated according to the presence, distribution, and severity of anomalies.ResultsAll patients had CT findings suggestive of bilateral COVID-19 pneumonia, with an average visual scoring of 8.1±2.9%. LUS identified 4 different abnormalities, with bilateral distribution (mean LUS score: 26.4±6.7), focal areas of non-confluent B lines, diffuse confluent B lines, small sub-pleural micro consolidations with pleural line irregularities, and large parenchymal consolidations with air bronchograms. LUS score was significantly correlated with CT visual scoring (rho = 0.70; p<0.001). Correlation analysis of the CT and LUS severity scores showed good interclass correlation (ICC) (ICC =0.71; 95% confidence interval (CI): 0.52–0.83; p<0.001). Logistic regression was used to determine the cut-off value of ≥27 (area under the curve: 0.97; 95% CI: 90-99; sensitivity 88.5% and specificity 97%) of the LUS severity score that represented severe and critical pulmonary involvement on chest CT (CT: 3-4).ConclusionWhen combined with clinical data, LUS can provide a potent diagnostic aid in patients with suspected COVID-19 pneumonia, reflecting CT findings.

Point-of-care ultrasonography in the initial characterization of patients with COVID-19

BackgroundThere is growing evidence regarding the imaging findings of coronavirus disease 2019 (COVID-19) in chest X-rays and computed tomography scans; however, their availability during this pandemic outbreak might be compromised. Currently, the role of point-of-care ultrasonography (POCUS) has yet to be explored. ObjectivesTo describe the POCUS findings of COVID-19 in patients with the disease admitted to the emergency department (ED), correlating them with vital signs, laboratory and radiologic results, therapeutic decisions, and the prognosis. MethodsProspective study performed in the ED of 2 academic hospitals. Patients with highly suspected or confirmed COVID-19 underwent a lung ultrasonography (lung POCUS), focused cardiac ultrasound (FOCUS), and inferior vena cava (IVC) exam. ResultsBetween March and April 2020, 96 patients were enrolled. The mean age was 68.2 years (SD 17.5). The most common findings in the lung POCUS were an irregular pleural line (63.2%), bilateral confluence (55.2%), and isolated B-lines (53.1%), which were associated with a positive RT-PCR (odds ratio 4.327; 95% CI 1.216–15.401; p<.001), and correlated with IL-6 levels (rho=0.622; p=.002). The IVC negatively correlated with levels of expiratory pO2 (rho=−0.539; p=.014) and inspiratory pO2 (rho=−0.527; p=0.017), and expiratory diameter positively correlated with troponin I (rho=0.509; p=.03). After the POCUS exam, almost 20% of the patients had an associated condition that required a change in their treatment or management. ConclusionsPOCUS parameters have the potential to impact the diagnosis, management, and prognosis of patients with confirmed or suspected COVID-19.

Application of quantitative lung ultrasound instead of CT for monitoring COVID-19 pneumonia in pregnant women: a single-center retrospective study

BackgroundComputed tomography (CT) is the preferred imaging technique for the evaluation of COVID-19 pneumonia. However, it is not suitable as a monitoring tool for pregnant women because of the risk of ionizing radiation damage to the fetus as well as the possible infection of others. In this study, we explored the value of bedside lung ultrasound (LUS) as an alternative to CT for the detection and monitoring of lung involvement in pregnant women with COVID-19.MethodsClinical and LUS data of 39 pregnant women with COVID-19 were retrospectively reviewed. All LUS and CT images were analyzed to summarize the findings and calculate LUS scores and CT scores for each patient. LUS findings were compared with CT, and correlation between LUS scores and CT scores was evaluated.ResultsAmong the 39 pregnant women, there were 6 mild-type cases, 29 common-type cases, 4 severe-type cases, and no critical-type cases. The most common LUS findings of COVID-19 pneumonia in pregnant women were various grades of multiple B-lines (84.6%), thickened and irregular pleural lines (71.8%), pleural effusion (61.5%) and small multifocal consolidation limited to the subpleural space (35.9%). The mean LUS score at admission was 0 points in mild-type cases, 10.6 points in common-type cases and 15.3 points in severe-type cases (P < 0.01). The correlation between LUS scores and CT was 0.793. All patients were clinically cured and each underwent an average of three LUS follow-ups during hospitalization. The mean LUS score at discharge was 5.6 points lower than that at admission. The consistency of LUS and chest CT during follow-up was 0.652.ConclusionsQuantitative LUS scoring can effectively instead of CT for detecting and monitoring of COVID-19 pneumonia in pregnant women and protect fetuses from the risk of ionizing radiation.

ThOracic Ultrasound in Idiopathic Pulmonary Fibrosis Evolution (TOUPIE): research protocol of a multicentric prospective study

IntroductionIdiopathic pulmonary fibrosis (IPF) is the most common and severe interstitial lung disease (ILD). It is a progressive disease that requires a regular follow-up: clinical examination, pulmonary function testing (PFT)...

Point-of-care ultrasonography in the initial characterization of patients with COVID-19

BackgroundThere is growing evidence regarding the imaging findings of coronavirus disease 2019 (COVID-19) in chest X-rays and computed tomography scans; however, their availability during this pandemic outbreak might be compromised. Currently, the role of point-of-care ultrasonography (POCUS) has yet to be explored. ObjectivesTo describe the POCUS findings of COVID-19 in patients with the disease admitted to the emergency department (ED), correlating them with vital signs, laboratory and radiologic results, therapeutic decisions, and the prognosis. MethodsProspective study performed in the ED of 2 academic hospitals. Patients with highly suspected or confirmed COVID-19 underwent a lung ultrasonography (lung POCUS), focused cardiac ultrasound (FOCUS), and inferior vena cava (IVC) exam. ResultsBetween March and April 2020, 96 patients were enrolled. The mean age was 68.2 years (SD 17.5). The most common findings in the lung POCUS were an irregular pleural line (63.2%), bilateral confluence (55.2%), and isolated B-lines (53.1%), which were associated with a positive RT-PCR (odds ratio 4.327; 95% CI 1.216–15.401; p<.001), and correlated with IL-6 levels (rho=0.622; p=.002). The IVC negatively correlated with levels of expiratory pO2 (rho=−0.539; p=.014) and inspiratory pO2 (rho=−0.527; p=0.017), and expiratory diameter positively correlated with troponin I (rho=0.509; p=.03). After the POCUS exam, almost 20% of the patients had an associated condition that required a change in their treatment or management. ConclusionsPOCUS parameters have the potential to impact the diagnosis, management, and prognosis of patients with confirmed or suspected COVID-19.

Ultrasonography: An Unchartered Modality in the Current Pandemic - A Study among Patients Admitted in the COVID-19 Intensive Care Unit.

Background:The objectives were to perform an analysis of lung ultrasonography (LUS) findings in severely ill patients with novel coronavirus disease-2019 (COVID-19) and to compare the accuracy with high-resolution computed tomography (HRCT) of the thorax.Methods:Sixty-two intensive care unit (ICU) patients with COVID-19 were evaluated during their hospital stay. LUS was performed with convex and linear transducers using a designated ultrasonography machine placed in the COVID-19 ICU. The thorax was scanned in 12 areas. Initial LUS was performed on admission and follow-up LUS was done in 7 (mean) days. At the time of the initial LUS, HRCT was performed in 28/62 patients and a chest radiography in 19/62 patients.Results:On admission, LUS detected pleural line thickening (>6 lung areas) in 49/62, confluent B-lines in 38/62, and separate B-lines in 34/62, consolidation in 12/62, C prime profile in 19/62, and pleural and cardiac effusions in 4/62 and 1/62, respectively. The single beam “torchlight” artifact was seen in 16/62, which may possibly be a variation of the B-line which has not been described earlier. Follow-up LUS detected significantly lower rates (P < 0.05) of abnormalities.Conclusion:Ultrasound demonstrated B-lines, variable consolidations, and pleural line irregularities. This study also sheds light on the appearance of the C prime pattern and “torchlight” B-lines which were not described in COVID-19 earlier. LUS findings were significantly reduced by the time of the follow-up scan, insinuating at a rather slow but consistent reduction in some COVID-19 lung lesions. However, the lung ultrasound poorly correlated with HRCT as a diagnostic modality in COVID-19 patients.

Residual Lung Injury in Patients Recovering From COVID-19 Critical Illness: A Prospective Longitudinal Point-of-Care Lung Ultrasound Study.

We performed a prospective analysis of point-of-care ultrasound (POCUS) findings in critically ill COVID-19 patients during and after hospitalization. We enrolled 171 COVID-19 intensive care unit patients. POCUS of the lungs was performed with phased array (2-4 MHz), convex (2-6 MHz) and linear (10-15 MHz) transducers, scanning 12 lung areas. Chest computed tomography angiography was performed to exclude suspected pulmonary embolism. Survivors were clinically and sonographically evaluated during a 4 month period for evidence of residual lung injury. Chest computed tomography angiography and echocardiography were used to exclude pulmonary hypertension (PH) and chest high-resolution-computed-tomography to exclude interstitial lung disease (ILD) in symptomatic survivors. Cox regression analysis showed that lymphocytopenia (hazard ratio [HR]: 0.88, 95% confidence intervals [CI]: 0.68-0.96, p=.048), increased lactate (HR: 1.17, 95% CI: 0.94-1.46, p=0.049), and D-dimers (HR: 1.21, 95% CI: 1.03-1.44, p=.03) were mortality predictors. Non-survivors had increased incidence of pulmonary abnormalities (B-lines, pleural line irregularities, and consolidations) compared to survivors (p < .05). During follow-up, POCUS with clinical and laboratory parameters integrated in the semi-quantitative Riyadh-Residual-Lung-Injury scale had sensitivity of 0.82 (95% CI: 0.76-0.89) and specificity of 0.91 (95% CI: 0.94-0.95) in predicting ILD. The prevalence of PH and ILD (non-specific-interstitial-pneumonia) was 7% and 11.8%, respectively. POCUS showed ability to monitor the evolution of severe COVID-19 pneumonia after hospital discharge, supporting its integration in clinical predictive models of residual lung injury.

Point-of-care lung ultrasound in the assessment of patients with COVID-19: A tutorial.

The adoption of point-of-care lung ultrasound for both suspected and confirmed COVID-19 patients highlights the issues of accessibility to ultrasound training and equipment. Lung ultrasound is more sensitive than chest radiography in detecting viral pneumonitis and preferred over computed tomography for reasons including its portability, reduced healthcare worker exposure and repeatability. The main lung ultrasound findings in COVID-19 patients are interstitial syndrome, irregular pleural line and subpleural consolidations. Consolidations are most likely found in critical patients in need of ventilatory support. Hence, lung ultrasound may be used to timely triage patients who may have evolving pneumonitis. Other respiratory pathology that may be detected by lung ultrasound includes pulmonary oedema, pneumothorax, consolidation and large effusion. A key barrier to incorporate lung ultrasound in the assessment of COVID-19 patients is adequate decontamination of ultrasound equipment to avoid viral spread. This tutorial provides a practical method to learn lung ultrasound and a cost-effective method of preventing contamination of ultrasound equipment and a practical method for performing and interpreting lung ultrasound.

Lung Ultrasound in Children with Respiratory Tract Infections: Viral, Bacterial or COVID-19? A Narrative Review.

Respiratory tract infections (RTIs) are common complaints among patients presenting to the pediatric emergency department. In the diagnostic assessment of children with RTIs, many patients ultimately undergo imaging studies for further evaluation. Point-of-care lung ultrasound (LUS) can be used safely and with a high degree of accuracy in differentiating etiologies of RTIs in pediatric patients. Ultrasonographical features such as an irregular pleural line, subpleural consolidations, focal and lobar consolidation and signs of interstitial involvement can be used to distinguish between several pathologies. This work offers a comprehensive overview of pediatric LUS in cases of the most common pediatric RTIs including bacterial and viral pneumonia, bronchiolitis, and COVID-19.

152 Correlation of Point of Care Lung Ultrasound and CT Scan Findings in Patients with COVID-19

Chest CT scan (CT) is often considered the gold-standard imaging modality to evaluate pulmonary pathology, and thus is used to assess patients with COVID-19. While CT offers higher resolution images, Point-of-care ultrasound (POCUS) has the advantages of being rapid, low cost, low radiation exposure, and offers the ability for monitoring real-time disease progression. As such, POCUS has also been used to assess patients with COVID-19, and characteristic POCUS findings of COVID-19 are described. In the present study, we compare chest CT to lung ultrasound findings in patients with COVID-19 and examine consistency in pathological findings between the two imaging modalities. 125 patients presenting to an urban emergency department in Tehran, Iran with symptoms concerning for COVID-19 were prospectively enrolled. Participants underwent lung POCUS following a 12-zone protocol assessing each zone for pleural line irregularities, alveolar interstitial syndrome (eg, B-lines), and presence of consolidations including subpleural consolidations (SCs). Patients also received chest CT read by a radiologist evaluating for ground glass opacity, crazy paving patterns, or consolidations. For POCUS and CT, each zone was scored using a 4-point measure, then aggregated total lung involvement scores were calculated for each patient and imaging modality. Descriptive statistics were performed to asses consistently between POCUS and CT findings. POCUS findings overall corresponded well with abnormalities seen on CT, without a significant difference in lung involvement scores between the modalities. On CT, COVID-19 patients showed greater incidence of crazy paving in the AI, PS, PI, AX, PLAPS, CS, and CI distributions (p adj= .00293, 0, .000600, .000533, .00272, .0004) and effusion in CI (p adj= .0216), and on POCUS patients had increased B-lines in the AS, AX, and PLAPS distributions (p adj= .0086, .0012, .0024 respectively), increased pleural thickening in all lung regions (AS, AI, PS, PI, AX, PLAPS; p adj= .0182, .0014, .0375, .0328, .0003, 0), and SCs in AS, AX, and PLAPS (p adj= .0312, .0398, .0324). Both CT and POCUS demonstrated more right-sided findings as a whole, though sidedness of findings was not statistically significant. Both CT and POCUS demonstrated differences in finding densities between lung regions (for CT- ARDS: p adj= 1.00e+ 0; consolidation: p adj= 1.04e- 1; Crazy Paving: p adj= 1.92e-16; effusion: p adj= 8 4.94e- 8; GGO: p adj= 8.73e- 2; interstitial: p ajd= 68e- 6; POCUS- atelectasis: p adj= 1.92e- 7; B-lines: p adj= 6.77e -7; consolidation: p adj= 0.00119; effusion: p adj= 7.20e- 9; pleural thickening: p adj= 7.20e -9; SCs: p adj= 4.39e -5) with the highest concentration of positive findings in the PLAPS region on both modalities. Given comparable findings in the presence and distribution of abnormalities between POCUS and chest CT, POCUS may be a viable alternative to chest CT for diagnosis and risk stratification in patients with suspected COVID-19.

Lung Ultrasonography for Risk Stratification in Patients with Coronavirus Disease 2019 (COVID-19): A Prospective Observational Cohort Study.

BackgroundPoint-of-care lung ultrasound (LUS) is a promising pragmatic risk stratification tool in COVID-19. This study describes and compares LUS characteristics between patients with different clinical outcomesMethodsProspective observational study of PCR-confirmed COVID-19 adults with symptoms of lower respiratory tract infection in the emergency department (ED) of Lausanne University Hospital. A trained physician recorded LUS images using a standardized protocol. Two experts reviewed images blinded to patient outcome. We describe and compare early LUS findings (acquired within 24hours of presentation to the ED) between patient groups based on their outcome at 7 days after inclusion: 1) outpatients, 2) hospitalised and 3) intubated/death. Normalized LUS score was used to discriminate between groupsResultsBetween March 6 and April 3 2020, we included 80 patients (17 outpatients, 42 hospitalized and 21 intubated/dead). 73 patients (91%) had abnormal LUS (70% outpatients, 95% hospitalised and 100% intubated/death; p=0.003). The proportion of involved zones was lower in outpatients compared with other groups (median 30% [IQR 0-40%], 44% [31-70%] and 70% [50-88%], p<0.001). Predominant abnormal patterns were bilateral and multifocal spread thickening of the pleura with pleural line irregularities (70%), confluent B lines (60%) and pathologic B lines (50%). Posterior inferior zones were more often affected. Median normalized LUS score had a good level of discrimination between outpatients and others with area under the ROC of 0.80 (95% CI 0.68-0.92)ConclusionsSystematic LUS has potential as a reliable, cheap and easy-to-use triage tool for the early risk stratification in COVID-19 patients presenting in EDs

Lung sonographic findings in COVID-19 patients.

ObjectiveThe objective of this study was to describe the lung sonographic findings of COVID-19 patients prospectively and investigate its association with disease severity.MethodsThis study was conducted in an emergency department and included consecutively enrolled laboratory confirmed COVID-19 patients. Lung sonography findings were described in all the included patients and analysed with respect to the clinical severity of the patients.Results106 patients were included in the study. Common sonographic findings in COVID-19 patients were pleural line irregularity or shredding (70% of patients), followed by B – profile (59%), pleural line thickening (33%), occasional B – lines (26%), sub-pleural consolidations (35%), deep consolidations (6%), spared areas (13%), confluent B – lines or waterfall sign (14%) and pleural effusion (9%). These findings tended to be present more bilaterally and in lower lung zones. Sonographic characteristics like bilateral lung involvement, B – profile, spared areas and confluent B – lines or waterfall sign were significantly associated (p < 0.01) with clinical severity (more frequent with increasing disease severity).ConclusionThe lung sonographic findings of COVID-19 were found more bilaterally and in lower lung zones, and specific findings like B – profile, pleural thickening, spared areas and confluent B – lines or waterfall sign were associated with severe COVID-19.

Prospective Longitudinal Evaluation of Point-of-Care Lung Ultrasound in Critically Ill Patients With Severe COVID-19 Pneumonia.

ObjectivesTo perform a prospective longitudinal analysis of lung ultrasound findings in critically ill patients with coronavirus disease 2019 (COVID‐19).MethodsEighty‐nine intensive care unit (ICU) patients with confirmed COVID‐19 were prospectively enrolled and tracked. Point‐of‐care ultrasound (POCUS) examinations were performed with phased array, convex, and linear transducers using portable machines. The thorax was scanned in 12 lung areas: anterior, lateral, and posterior (superior/inferior) bilaterally. Lower limbs were scanned for deep venous thrombosis and chest computed tomographic angiography was performed to exclude suspected pulmonary embolism (PE). Follow‐up POCUS was performed weekly and before hospital discharge.ResultsPatients were predominantly male (84.2%), with a median age of 43 years. The median duration of mechanical ventilation was 17 (interquartile range, 10–22) days; the ICU length of stay was 22 (interquartile range, 20.2–25.2) days; and the 28‐day mortality rate was 28.1%. On ICU admission, POCUS detected bilateral irregular pleural lines (78.6%) with accompanying confluent and separate B‐lines (100%), variable consolidations (61.7%), and pleural and cardiac effusions (22.4% and 13.4%, respectively). These findings appeared to signify a late stage of COVID‐19 pneumonia. Deep venous thrombosis was identified in 16.8% of patients, whereas chest computed tomographic angiography confirmed PE in 24.7% of patients. Five to six weeks after ICU admission, follow‐up POCUS examinations detected significantly lower rates (P < .05) of lung abnormalities in survivors.ConclusionsPoint‐of‐care ultrasound depicted B‐lines, pleural line irregularities, and variable consolidations. Lung ultrasound findings were significantly decreased by ICU discharge, suggesting persistent but slow resolution of at least some COVID‐19 lung lesions. Although POCUS identified deep venous thrombosis in less than 20% of patients at the bedside, nearly one‐fourth of all patients were found to have computed tomography–proven PE.

Correlation between Chest Computed Tomography and Lung Ultrasonography in Patients with Coronavirus Disease 2019 (COVID-19)

There is growing evidence regarding chest X-ray and computed tomography (CT) findings for coronavirus disease 2019 (COVID-19). At present, the role of lung ultrasonography (LUS) has yet to be explored. The main purpose of this study was to evaluate the correlation between LUS findings and chest CT in patients confirmed to have (positive reverse transcription polymerase chain reaction [RT-PCR]) or clinically highly suspected of having (dyspnea, fever, myasthenia, gastrointestinal symptoms, dry cough, ageusia or anosmia) COVID-19. This prospective study was carried out in the emergency department, where patients confirmed of having or clinically highly suspected of having COVID-19 were recruited and underwent chest CT and concurrent LUS exam. An experienced emergency department physician performed the LUS exam blind to the clinical history and results of the CT scan, which were reviewed by two radiologists in consensus for signs compatible with COVID-19 (bilateral ground-glass opacities in peripheral distribution). A compatible LUS exam was considered a bilateral pattern of B-lines, irregular pleural line and subpleural consolidations. Between March and April 2020, 51 patients were consecutively enrolled. The indication for CT was a negative or indeterminate RT-PCR test (49.0%) followed by suspicion of pulmonary embolism (41.2%). Radiologic signs compatible with COVID-19 were present in 37 patients (72.5%) on CT scan and 40 patients (78.4%) on LUS exam. The presence of LUS findings was correlated with a positive CT scan suggestive of COVID-19 (odds ratio: 13.3, 95% confidence interval: 4.5–39.6, p < 0.001) with a sensitivity of 100.0%, specificity of 78.6%, positive predictive value of 92.5% and negative predictive value of 100.0%. There was no missed diagnosis of COVID-19 with LUS compared with CT in our cohort. The correlation between LUS score and CT total severity score was good (intraclass correlation coefficient: 0.803, 95% confidence interval: 0.60–0.90, p < 0.001). LUS exhibited similar accuracy compared with chest CT in the detection of lung abnormalities in COVID-19 patients.

Role of Ultrasound-Guided Evaluation of Dyspnea in the Coronavirus Disease 2019 Pandemic

Role of Ultrasound-Guided Evaluation of Dyspnea in the Coronavirus Disease 2019 Pandemic

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

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.

Point-of-Care Lung Ultrasound Findings in Patients with COVID-19 Pneumonia.

Patients with novel coronavirus disease (COVID-19) typically present with bilateral multilobar ground-glass opacification with a peripheral distribution. The utility of point-of-care ultrasound has been suggested, but detailed descriptions of lung ultrasound findings are not available. We evaluated lung ultrasound findings in 10 patients admitted to the internal medicine ward with COVID-19. All of the patients had characteristic glass rockets with or without the Birolleau variant (white lung). Thick irregular pleural lines and confluent B lines were also present in all of the patients. Five of the 10 patients had small subpleural consolidations. Point-of-care lung ultrasound has multiple advantages, including lack of radiation exposure and repeatability. Also, lung ultrasound has been shown to be more sensitive than a chest radiograph in detecting alveolar-interstitial syndrome. The utilization of lung ultrasound may also reduce exposure of healthcare workers to severe acute respiratory syndrome-coronavirus-2 and may mitigate the shortage of personal protective equipment. Further studies are needed to evaluate the utility of lung ultrasound in the diagnosis and management of COVID-19.

Computed tomography and point-of-care ultrasound findings in 2 COVID-19 patients.

We present a comparison of computed tomography of the chest and lung ultrasound in the cases of 2 patients who tested positive for COVID-19. Case #1 is a 60-year-old man with past medical history of asthma. Vital signs upon emergency department (ED) presentation were: blood pressure 126/82 mmHg, pulse 75 bpm, temperature 36.4˚C (97.5˚F), respirations 24/min, and SpO2 95%. Review of systems was positive for cough, shortness of breath, chills, fatigue, and fever. Physical examination was otherwise unremarkable. Point-of-care ultrasound (POCUS) completed before Computed Tomography (CT) showed scattered comet tail artifacts and pleural line irregularities (Figures 1 and 2). Chest CT without contrast was significant for extensive bilateral ground-glass opacities (Figure 3). Case #2 is a 59-year-old man with past medical history of asthma and hypertension. Vital signs upon ED presentation were: blood pressure 137/89 mmHg, pulse 84 bpm, temperature 39.7°C (103.5°F), respirations 23/min, and SpO2 98%. Review of systems was positive for cough, shortness of breath, chills, fatigue, and fever. Physical examination was remarkable for acute respiratory distress. POCUS completed before CT showed confluent comet tail artifacts with pleural thickening (Figures 4 and 5). Chest CT demonstrated diffuse peripheral, bilateral ground-glass opacities consistent with multifocal pneumonia (Figures 6 and 7). The World Health Organization declared COVID-19 an international public health emergency on January 30, 2020,1 and the clinical manifestations in the USA are still rapidly unfolding. Chest CT of both presented cases showed bilateral diffuse ground-glass opacities and pleural-based infiltrates, in line with recent COVID-19 imaging findings.2, 3 Lung ultrasound imaging of our patients revealed that the comet tail artifacts seen in COVID-19 are patchy with areas of normal lung in between; the artifacts are associated with an irregular, thickened pleural line with punctate defects akin to “little dents.” Both of these patients ended up decompensating within 48 hours and being intubated. There are few published case series and reports to date on utilization of ultrasound in COVID-19 patients,4, 5 but there are likely more to come. The benefits of POCUS in COVID-19 patients are substantial given its portability, efficiency, and the ability to reduce exposure of additional health care workers when compared to CT. In preparation for an increase in COVID-19-positive patients in the setting of saturated health care resources, POCUS shows promise as an efficacious tool in the diagnosis and management of COVID-19. The authors would like to acknowledge the open access funding support provided by the Dorothy Rider Pool Trust Foundation.

Transthoracic ultrasonography in patients with interstitial lung disease.

Background:Transthoracic ultrasonography (TUS) is suggested as a noninvasive, radiation-free method for the assessment of interstitial lung disease (ILD). This study was designed to study TUS features of ILD. Furthermore, possible correlations of these features with parameters of spirometry, arterial blood gas (ABG) analysis and 6-min walk test (6MWT) were assessed.Materials and Methods:Fifty patients with ILD were diagnosed based on history, examination, chest X-ray/high-resolution computed tomography, and spirometry. Each patient underwent 6MWT, ABG analysis, and TUS. TUS was also performed on 20 healthy volunteering controls.Results:The TUS features among patients were B pattern in 40 patients (80.0%, P < 0.001), decreased lung sliding in 22 patients (44.0%, P < 0.001), pleural line thickening in 28 patients (56.0%, P < 0.001), pleural line irregularity in 39 patients (78.0%, P < 0.001) and subpleural changes in 22 patients (44.0%, P < 0.01). Increasing pleural line thickness was inversely correlated with forced vital capacity (FVC) percent predicted (r = −0.345, P < 0.05), pO2 (r = −0.335, P < 0.01), SpO2 at rest (r = −0.444, P < 0.01), 6-min walk distance (6MWD) (r = −0.554, P < 0.001) and distance-saturation product (DSP) (r = −0.572, P < 0.001). Increasing distance between B lines also correlated inversely with FVC percent predicted (r = −0.278), pO2 (r = −0.207), SpO2 at rest (r = −0.170), 6MWD (r = −0.209), and DSP (r = −0.214); however these correlations were not statistically significant (P > 0.05).Conclusion:TUS seems to be a useful imaging method for the diagnosis of ILD. It can be used to estimate the severity of ILD. It is simple, bedside, cost-effective, and radiation-free. It may be especially useful in the follow up of patients in low resource settings, pregnant females, and bed-ridden or unstable patients who cannot be shifted to radiology suite.

Lung rockets and pulmonary functions

IntroductionThe ultrasound (US) of the chest is useful in the diagnosis of different parenchymal, pleural, and chest wall diseases. The US is preferred because no radiation is used (safe during pregnancy), is not expensive, is easy portability, provides real-time imaging, and has the ability to make a dynamic imaging.AimThis study aimed for the correlation between B-lines and spirometry, arterial blood gases, 6-minute walk test (6MWT), and pulmonary artery systolic pressure (PASP) in patients with diffuse parenchymal lung disease (DPLD).DesignA prospective study was conducted.SettingThe study was conducted at Fayoum University Hospital in Egypt between January 2017 and June 2017.Patients and methodsThis study was done on 60 patients with DPLD. They were subjected to a full medical history, a detailed clinical examination, high-resolution computed tomography, echocardiography, arterial blood gases analysis, spirometry, 6MWT, and chest US.ResultsThe studied group showed female predominance, with 54 (90%) patients. They had a wide range of age from 20 to 75 years, and their mean age was 47.5±13.6 years. Most of them were involved in breeding birds, exposed to biomass, and nonsmokers. The studied patients had bilateral B-lines. The number of B-lines was positively correlated with PaO2, 6MWT, forced vital capacity, and PASP and negatively correlated with high-resolution computed tomography affection, whereas the distance between B-lines was inversely correlated with each of PaO2, numbers of B-line, 6MWT, forced vital capacity, and PASP. Most of patients had irregular and thickened pleura (71.6%), and abolished lung sliding was seen in 51.6%.ConclusionChest US may be used in the evaluation of DPLD. Multiple B-lines with thickened and irregular pleural line are suggestive of DPLD.