Pleural Irregularities Research Articles

Pleural Irregularities: a new ultrasound marker for lung involvement in primary Sjögren’s disease

Pleural Irregularities: a new ultrasound marker for lung involvement in primary Sjögren’s disease

Clinical utility of lung ultrasound for the detection of interstitial lung disease in patients with rheumatoid arthritis.

To establish the diagnostic value of lung ultrasound (LUS) in patients with rheumatoid arthritis (RA) for the detection of interstitial lung disease (ILD). A cross-sectional study was performed. Consecutive patients with RA (American College of Rheumatology/European League Against Rheumatism 2010 criteria) who had a chest high-resolution computed tomography (HRCT) performed within 12 months before inclusion, regardless of symptomatology, were included. Demographic, clinical, laboratory, and pharmacological data were recorded. Each patient underwent a LUS with assessment of B-lines (BL) and pleural irregularities (PI). HRCT was considered the gold standard for the confirmatory diagnosis of ILD. Receiver operating characteristic (ROC) curves were calculated to test the ability of LUS findings (BL and PI) in discriminating patients with ILD. A total of 104 RA patients were included, of which 21.8% had ILD. Patients with ILD had more BL (median 26 versus 1, p<0.001) and PI (median 16 versus 5, p<0.001) than patients without ILD. The diagnostic accuracy in ROC curves was: area under the curve (AUC) 0.88 and 95% confidence interval (CI) 0.78-0.93 for BL and AUC 0.82 and 95% CI 0.74-0.89 for PI. The best cut-off points for (ILD detection) discriminating the presence of significant interstitial lung abnormalities were 8 BL and 7 PI. The presence of 8 BL and/or 7 PI in the LUS showed an adequate cut-off value for discriminating the presence of significant interstitial lung abnormalities, evocative of ILD.

The lung ultrasound in children with SARS-COV-2 infection: a national multicenter prospective study.

Coronavirus disease-19 (COVID-19) caused hospitalizations, severe disease, and deaths in any age, including in the youngest children. The aim of this multicenter national study is to characterize the clinical and the prognostic role of lung ultrasound (LU) in children with COVID-19.We enrolled children between 1 month and 18 years of age with severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection who underwent a LU within 6h from the first medical evaluation.A total of 213 children were enrolled, 51.6% were male, median age was 2 years and 5 months (interquartile range (IQR) 4months-11 years and 4 months). One hundred and forty-eight (69.4%) children were admitted in hospital, 9 (6.1%) in pediatric intensive care unit. We found an inverse correlation between the lung ultrasound score (LUS) and the oxygen saturation at the first clinical evaluation (r = -0.16; p = 0.019). Moreover, LUS was significantly higher in patients requiring oxygen supplementation (8 (IQR 3-19) vs 2 (IQR 0-4); p = 0.001).Among LU pathological findings, irregular pleural lines, subpleural consolidations, and pleural effusions were significantly more frequent in patients needing oxygen supplementation (p = 0.007,p = 0.006, and p = 0.001, respectively). Conclusion: This multicenter study showed that LU in children with COVID-19 can highlight pleural line irregularities, vertical artifacts, and subpleural consolidation. Notably, children with higher LUS have a higher risk of hospitalization and need for oxygen supplementation, supporting LU as a valid and safe point-of-care first level tool for the clinical evaluation of children with COVID-19. What is Known: • Few children infected with SARS-CoV-2 develop a severe disease and need oxygen therapy. • Lung ultrasound can easily detect low respiratory tract infection during SARS-CoV-2. What is New: • Children with higher lung ultrasound score have a higher risk of need for oxygen supplementation. • Irregular pleural line, sub-pleural consolidations and pleural effusions were significantly more frequent in patients needing oxygen supplementation.

High Prevalence of the Lung Ultrasound Interstitial Syndrome in Systemic Sclerosis Patients with Normal HRCT and Lung Function-A Pilot Study.

Objective: High-resolution computed tomography (HRCT) may lack sensitivity for the early detection of interstitial lung disease associated with systemic sclerosis (SSc-ILD). Lung ultrasound is an emerging technique for the diagnosis of SSc-ILD. This cross-sectional study aimed to describe the prevalence of ultrasound interstitial syndrome in SSc patients with normal HRCT and pulmonary function tests (PFT). Methods: Thirty SSc patients with normal HRCT, FVC > 80% predicted and DLCO > 70% predicted were included. Echocardiography and PFT including impulse oscillometry and cardiopulmonary exercise testing were performed. Lung ultrasound was analyzed by two blinded operators. Patients were classified into two groups, according to the presence or absence of ultrasound interstitial syndrome, defined as the sum of B-lines in all thoracic areas ≥10 and/or pleural line thickness >3 mm on at least one thoracic area and/or a pleural line irregularity score >16%. Results: Ultrasound interstitial syndrome was present in 12 patients (40%). Inter-reader agreement for the diagnosis of ultrasound interstitial syndrome defined by the Kappa coefficient was 0.93 (95%CI 0.79-1.00). Patients with ultrasound interstitial syndrome were younger (37 years vs. 53 years, p = 0.009), more often had pitting scars (n = 7/12 vs. 3/18, p = 0.045) and had lower FVC (102 vs. 110% pred, p = 0.009), TLC (114 vs. 122% pred, p = 0.042) and low-frequency respiratory system reactance (Xrs5 Z-score 0.16 vs. 1.02, p = 0.018), while pulmonary gas exchange was similar. Conclusions: Ultrasound interstitial syndrome was detected in 12/30 SSc patients with normal HRCT and PFT. Patients with ultrasound interstitial syndrome had differences in lung function consistent with reduced respiratory compliance, suggesting minimal and/or early suspected SSc-ILD.

A Modified Corona Score Using Lung Ultrasound to Identify COVID-19 Patients.

COVID-19 continues to circulate around the world with multiple different strains being active at once. While diagnosis with antigen and molecular testing is more readily available, there is still room for alternative methods of diagnosis, particularly in out-of-hospital settings, e.g., home or nursing homes, and in low-medium income countries, where testing may not be readily available. To evaluate the performance of two modified corona score methods compared with a traditional corona score approach to identify patients with COVID-19. This was a retrospective multicenter study performed to compare the ability to predict SARS-CoV-2 test results on a nasopharyngeal swab between the corona scores and two novel corona scores (modified 1 corona score (M1CS) and modified 2 corona score (M2CS)). The M1CS included lung ultrasound (LUS) and chest X-ray (CXR) results, while the M2SC only utilized LUS findings without CXRs. Emergency physicians performed point-of-care LUS and a physical examination upon admission to the emergency department. Subjects positive for SARS-CoV-2 were older and had higher ferritin levels and temperature and lower diastolic blood pressure and oxygen saturation. The two groups differed on corona score and modified corona scores (p < 0.001 for all). SARS-CoV-2-positive patients had fewer pleural line irregularities (p = 0.025) but presented more frequently with an interstitial pattern on CXRs (p < 0.001). In our study, LUS alone provided a valuable contribution to the corona score and improved its performance more than when CXR results were included. These results suggest that resource-limited areas where CXRs may be unavailable or prohibitively expensive can utilize an ultrasound as the sole imaging modality without a loss of diagnostic performance for SARS-CoV-2 pneumonia diagnosis.

Lung ultrasound and high-resolution computed tomography quantitative variations during nintedanib treatment for systemic sclerosis-associated interstitial lung disease.

Lung ultrasound (LUS) and high-resolution computed tomography (HRCT) are commonly used for the evaluation of interstitial lung disease (ILD). Nintedanib (NIN) is an antifibrotic therapy approved for systemic sclerosis-associated ILD (SSc-ILD). We assessed LUS and quantitative HRCT changes in SSc-ILD patients treated with NIN during a one-year follow-up, evaluating relationships between imaging variations and functional or quality-of-life outcomes. SSc-ILD patients who started NIN were enrolled and followed for twelve months. Pulmonary function tests and patient-reported outcome measures (PROMs) were assessed half-yearly and quarterly, respectively. LUS was performed quarterly evaluating the presence of B-lines (BL) and pleural line irregularities (PLI). HRCT was repeated after one year and quantitatively analysed with CALIPER software. Ten patients (70% female, mean age 62 years) were enrolled. The mean total number of both BL and PLI was constantly decreased during NIN treatment, being significantly reduced after twelve months (from 175.1 ± 66.7-120.8 ± 70.3 for BL, p= 0.005 and from 50.6 ± 32.5-37.2 ± 22.4 for PLI, p= 0.05). Male gender, smoking habit and baseline forced vital capacity <70% predicted were associated with worse LUS outcomes. A greater reduction of both BL and PLI was observed in those who improved in PROMs, especially modified Medical Research Council dyspnoea scale (p= 0.016 and p= 0.04, respectively) and Saint George's Respiratory Questionnaire (p= 0.006 and p= 0.026, respectively). No significant changes in the CALIPER percentages of normal parenchyma or ILD elements were observed after twelve months of NIN, thus paralleling the stabilization obtained at pulmonary function tests. We present preliminary results on NIN effects on SSc-ILD as assessed by LUS, a useful method for frequently repeated monitoring, and CALIPER, a valid implementation whenever a HRCT is performed.

Relative Hypoxemia at Depth During Breath-Hold Diving Investigated Through Arterial Blood Gas Analysis and Lung Ultrasound.

Pulmonary gas exchange in breath-hold diving (BHD) consists of a progressive increase in arterial PO2 and PCO2 (PaO2 and PaCO2) during descent. However, recent findings have demonstrated that PaO2 does not consistently rise in all subjects. This study aimed at verifying and explaining PaO2 derangements during BHD analyzing arterial blood gases and searching for pulmonary alterations with lung ultrasound. After ethical approval, 14 fit breath-hold divers were included. Experiments were performed in warm water (temperature: 31°C). We analyzed arterial blood gases immediately before, at depth, and immediately after a breath-hold dive - to -15 meters of fresh water (mfw) and -42 mfw. Signs of lung interstitial edema and atelectasis were searched simultaneously with a marinized lung ultrasound. In 5 subjects (-15 mfw) and 4 subjects (-42 mfw) the PaO2 at depth seems to decrease instead of increasing. PaCO2 and lactate showed slight variations. At depth, no lung ultrasound alterations were seen except in one subject (hypoxemia and B-lines at -15 mfw; B-lines at the surface). Lung interstitial edema was detected in 3 and 12 subjects after resurfacing from -15 mfw and -42 mfw, respectively. Two subjects developed hypoxemia at depth and a small lung atelectasis (a focal pleural irregularity of triangular shape, surrounded by thickened B lines) after resurfacing from -42 mfw. Current experiments confirmed that some BH divers can experience hypoxemia at depth. The hypothesized explanation for such a discrepancy is lung atelectasis, which could not be detected in all subjects probably due to limited time available at depth.

Lung Ultrasound Abnormalities in Patients Without Pulmonary Pathology Prior to Surgery.

The occurrence of lung ultrasound abnormalities in patients without lung disease remains uncertain, while patients with respiratory disease often exhibit such abnormalities. The primary aim was to identify pathological ultrasonographic pulmonary findings and their correlation with baseline diseases and static lung compliance in patients without any pre-existing respiratory conditions. This prospective observational study enrolled a series of surgical patients with no history of pulmonary pathology (n = 104). Baseline diseases and patients' physical status classification, based on the American Society of Anesthesiologists (ASA), were documented by reviewing medical records. Prior to surgery, a lung ultrasound was performed to assess pulmonary changes. During surgery with general anesthesia, static lung compliance was measured. The Spearman correlation coefficient was employed to determine the correlation between the two variables. Twenty-four patients (23.07%) exhibited 1 - 2 B-lines in certain lung fields. Seven patients (6.7%) had an ultrasound B-line score > 0 (indicating ≥ 3 B-lines). Among these patients, the average number of lung fields with ≥ 3 B-lines was 3.71 ± 2.43. Patients with systemic diseases (ASA ≥ 2) displayed a higher number of B-lines compared to ASA I patients (P-value = 0.039). Pleural irregularities were found in 10 patients (9.6%), while atelectasis and pleural effusion were observed in five (4.8%) and four (3.8%) patients, respectively. The mean lung compliance value was 56.78 ± 15.33. No correlation was observed between the total score of the B-lines and lung compliance (Spearman's correlation: rho = -0.028, P-value = 0.812). Patients without pulmonary pathology may exhibit ultrasound pulmonary abnormalities, which tend to increase with higher ASA scores and do not appear to have a correlation with static lung compliance.

Lung ultrasound: A comparison of image interpretation accuracy between curvilinear and phased array transducers.

Both curvilinear and phased array transducers are commonly used to perform lung ultrasound (LUS). This study seeks to compare LUS interpretation accuracy of images obtained using a curvilinear transducer with those obtained using a phased array transducer. We invited 166 internists and trainees to interpret 16 LUS images/cineloops of eight patients in an online survey: eight curvilinear and eight phased array, performed on the same lung location. Images depicted normal lung, pneumothorax, pleural irregularities, consolidation/hepatisation, pleural effusions and B-lines. Primary outcome for each participant is the difference in image interpretation accuracy scores between the two transducers. A total of 112 (67%) participants completed the survey. The mean paired accuracy score difference between the curvilinear and phased array images was 3.0% (95% CI: 0.6 to 5.4%, P = 0.015). For novices, scores were higher on curvilinear images (mean difference: 5.4%, 95% CI: 0.9 to 9.9%, P = 0.020). For non-novices, there were no differences between the two transducers (mean difference: 1.4%, 95% CI: -1.1 to 3.9%, P = 0.263). For pleural-based findings, the mean of the paired differences between transducers was higher in the novice group (estimated mean difference-in-differences: 9.5%, 95% CI: 0.6 to 18.4%; P = 0.036). No difference in mean accuracies was noted between novices and non-novices for non-pleural-based pathologies (estimated mean difference-in-differences: 0.6%, 95% CI to 5.4-6.6%; P = 0.837). Lung ultrasound images obtained using the curvilinear transducer are associated with higher interpretation accuracy than the phased array transducer. This is especially true for novices interpreting pleural-based pathologies.

Pulmonary Ultrasonography in Systemic Sclerosis-Induced Interstitial Lung Disease-A Systematic Review and Meta-Analysis.

The aim of the current systematic review was to summarize and evaluate the overall advantages of lung ultrasonography (LUS) examination using high-resolution computed tomography (HRCT) as a reference standard in assessing the presence of interstitial lung disease (ILD) in systemic sclerosis (SSc) patients. Databases PubMed, Scopus, and Web of Science were searched for studies evaluating LUSs in ILD assessments including SSc patients on 1 February 2023. In assessing risk of bias and applicability, the Revised Tool for the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) was used. A meta-analysis was performed and the mean specificity, sensitivity, and diagnostic odds ratio (DOR) with a 95% confidence interval (CI) were obtained. In addition, in a bivariate meta-analysis, the summary receiver operating characteristic (SROC) curve area was additionally calculated. Nine studies with a total of 888 participants entered the meta-analysis. A meta-analysis was also performed without one study that used pleural irregularity to assess the diagnostic accuracy of LUSs using B-lines (with a total of 868 participants). Overall sensitivity and specificity did not differ significantly, with only the analysis of the B-lines having a specificity of 0.61 (95% CI 0.44-0.85) and a sensitivity of 0.93 (95% CI 0.89-0.98). The diagnostic odds ratio of univariate analysis of the eight studies using the B-lines as a criterion for ILD diagnosis was 45.32 (95% CI 17.88-114.89). The AUC value of the SROC curve was 0.912 (and 0.917 in consideration of all nine studies), which indicates high sensitivity and a low false-positive rate for the majority of the included studies. LUS examination proved to be a valuable tool in discerning which SSc patients should receive additional HRCT scans to detect ILD and therefore reduces the doses of ionizing radiation exposure in SSc patients. However, further studies are needed to achieve consensus in scoring and the evaluation methodology of LUS examination.

Lung Ultrasound in Children With Systemic Juvenile Idiopathic Arthritis-Associated Interstitial Lung Disease.

Systemic juvenile idiopathic arthritis (JIA) associated with lung disease (JIA-LD) is a potentially life threating complication in children with systemic JIA. Although high-resolution computed tomography (HRCT) is considered the gold standard imaging modality for evaluating interstitial lung disease (ILD), lung ultrasound (US) has shown utility for ILD screening in adults with connective tissue diseases at lower cost and without using ionizing radiation. The goals of this pilot study were to describe lung US features in children with known systemic JIA-LD and to assess the feasibility of lung US in this population. Children age <18 years with systemic JIA-LD and healthy controls were enrolled. Lung US acquisition was performed at 14 lung positions. Demographic, clinical, and HRCT data were collected and reviewed. Feasibility was assessed through patient surveys. Lung US findings were qualitatively and semiquantitatively assessed and compared to HRCT findings. Lung US was performed in 9 children with systemic JIA-LD and 6 healthy controls and took 12 minutes on average to perform. Lung US findings in systemic JIA-LD included focal to diffuse pleural irregularity, granularity, and thickening, with associated scattered or coalesced B-lines, and subpleural consolidations. Lung US findings appeared to correspond to HRCT findings. Lung US in systemic JIA-LD reveals highly conspicuous abnormalities in the pleura and subpleura that appear to correlate with peripheral lung findings on HRCT. Lung US is a feasible imaging tool in children even from an early age. This study suggests a potential role of lung US in systemic JIA-LD screening, diagnosis, and/or prognostication.

Lung Ultrasound Findings in Healthy Children and in Those Who Had Recent, Not Severe COVID-19 Infection.

Background: Lung ultrasound (LUS) is gaining consensus as a non-invasive diagnostic imaging method for the evaluation of pulmonary disease in children. Aim: To clarify what type of artifacts (e.g., B-lines, pleural irregularity) can be defined normal LUS findings in children and to evaluate the differences in children who did not experience COVID-19 and in those with recent, not severe, previous COVID-19. Methods: LUS was performed according to standardized protocols. Different patterns of normality were defined: pattern 1: no plural irregularity and no B-lines; pattern 2: only mild basal posterior plural irregularity and no B-lines; pattern 3: mild posterior basal/para-spine/apical pleural irregularity and no B-lines; pattern 4: like pattern 3 plus rare B-lines; pattern 5: mild, diffuse short subpleural vertical artifacts and rare B-lines; pattern 6: mild, diffuse short subpleural vertical artifacts and limited B-lines; pattern 7: like pattern 6 plus minimal subpleural atelectasis. Coalescent B-lines, consolidations, or effusion were considered pathological. Results: Overall, 459 healthy children were prospectively recruited (mean age 10.564 ± 3.839 years). Children were divided into two groups: group 1 (n = 336), those who had not had COVID-19 infection, and group 2 (n = 123), those who experienced COVID-19 infection. Children with previous COVID-19 had higher values of LUS score than those who had not (p = 0.0002). Children with asymptomatic COVID-19 had similar LUS score as those who did not have infections (p > 0.05), while those who had symptoms showed higher LUS score than those who had not shown symptoms (p = 0.0228). Conclusions: We report the pattern of normality for LUS examination in children. We also showed that otherwise healthy children who recovered from COVID-19 and even those who were mildly symptomatic had more “physiological” artifacts at LUS examinations.

Multi-task semantic segmentation of CT images for COVID-19 infections using DeepLabV3+ based on dilated residual network.

COVID-19 is a deadly outbreak that has been declared a public health emergency of international concern. The massive damage of the disease to public health, social life, and the global economy increases the importance of alternative rapid diagnosis and follow-up methods. RT-PCR assay, which is considered the gold standard in diagnosing the disease, is complicated, expensive, time-consuming, prone to contamination, and may give false-negative results. These drawbacks reinforce the trend toward medical imaging techniques such as computed tomography (CT). Typical visual signs such as ground-glass opacity (GGO) and consolidation of CT images allow for quantitative assessment of the disease. In this context, it is aimed at the segmentation of the infected lung CT images with the residual network-based DeepLabV3+, which is a redesigned convolutional neural network (CNN) model. In order to evaluate the robustness of the proposed model, three different segmentation tasks as Task-1, Task-2, and Task-3 were applied. Task-1 represents binary segmentation as lung (infected and non-infected tissues) and background. Task-2 represents multi-class segmentation as lung (non-infected tissue), COVID (GGO, consolidation, and pleural effusion irregularities are gathered under a single roof), and background. Finally, the segmentation in which each lesion type is considered as a separate class is defined as Task-3. COVID-19 imaging data for each segmentation task consists of 100 CT single-slice scans from over 40 diagnosed patients. The performance of the model was evaluated using Dice similarity coefficient (DSC), intersection over union (IoU), sensitivity, specificity, and accuracy by performing five-fold cross-validation. The average DSC performance for three different segmentation tasks was obtained as 0.98, 0.858, and 0.616, respectively. The experimental results demonstrate that the proposed method has robust performance and great potential in evaluating COVID-19 infection.

Review of Machine Learning in Lung Ultrasound in COVID-19 Pandemic.

Ultrasound imaging of the lung has played an important role in managing patients with COVID-19–associated pneumonia and acute respiratory distress syndrome (ARDS). During the COVID-19 pandemic, lung ultrasound (LUS) or point-of-care ultrasound (POCUS) has been a popular diagnostic tool due to its unique imaging capability and logistical advantages over chest X-ray and CT. Pneumonia/ARDS is associated with the sonographic appearances of pleural line irregularities and B-line artefacts, which are caused by interstitial thickening and inflammation, and increase in number with severity. Artificial intelligence (AI), particularly machine learning, is increasingly used as a critical tool that assists clinicians in LUS image reading and COVID-19 decision making. We conducted a systematic review from academic databases (PubMed and Google Scholar) and preprints on arXiv or TechRxiv of the state-of-the-art machine learning technologies for LUS images in COVID-19 diagnosis. Openly accessible LUS datasets are listed. Various machine learning architectures have been employed to evaluate LUS and showed high performance. This paper will summarize the current development of AI for COVID-19 management and the outlook for emerging trends of combining AI-based LUS with robotics, telehealth, and other techniques.

Association Between Lung Ultrasound Patterns and Pneumonia.

Pneumonia is a common respiratory infection that affects the lungs. Lung ultrasound (LUS) is a portable, cost-effective imaging method, which is free of ionizing radiation and has been shown to be useful for evaluating pneumonia. The aim of this retrospective analytical study was to determine the association between lung ultrasound patterns and pneumonia. For the purpose of performing the required analysis, LUS patterns including consolidations, pleural line irregularities, A lines and B lines from 90 subjects (44 patients with confirmed pneumonia and 46 controls) were retrieved from a published open-access data set, which was reviewed and approved by medical experts. A χ 2 test was used for the comparison of categorical variables to determine the association between each LUS pattern and the presence of pneumonia. There is a significant association between LUS consolidation and the presence of pneumonia ( P < 0.0001). Lung ultrasound A lines are significantly associated with the absence of pneumonia ( P < 0.0001), whereas there are no associations between B lines or pleural line irregularities with pneumonia. Lung ultrasound consolidation is found to be associated with the presence of pneumonia. A lines are associated with healthy lungs, and there is no association of B lines and pleural irregularities with the presence of pneumonia. Further studies investigating LUS patterns with clinical information and symptoms of patients with pneumonia are required.

The Role of Lung Ultrasound in Diagnosing COVID-19-Related Multisystemic Inflammatory Disease: A Preliminary Experience.

Background: To date, there are no data regarding the systematic application of Point-of-Care Lung Ultrasound (PoC-LUS) in children with Multisystem Inflammatory Syndrome in Children (MIS-C). The main aim of this study is to show the role of Point-of-Care Lung Ultrasound as an additional aid in the diagnosis of COVID-19-related Multisystem Inflammatory Syndrome in Children (MIS-C). Methods: Between April 2020 and April 2021, patients aged 0–18 years referred to our emergency department for fever, and later hospitalized without a specific diagnosis, underwent PoC-LUS. Ultrasound images of patients with a final diagnosis of MIS-C were retrospectively evaluated. Results: Ten patients were enrolled. All were described to have pleural irregularities and B-lines. In particular: 8/10 children presented with isolated B-lines in at least half of the lung areas of interest; 8/10 presented with multiple B-lines and 3/8 had them in at least 50% of lung areas; 5/10 had a white lung appearance in at least one lung area and 1/5 had them in half of the areas of interest. Pleural effusion was described in 9/10. Conclusions: During the ongoing COVID-19 pandemic, we suggest performing PoC-LUS in febrile patients with high levels of inflammatory indices and clinical suspicion of MIS-C, or without a certain diagnosis; the finding of many B-lines and pleural effusion would support the diagnosis of a systemic inflammatory disease.

Lung Ultrasound using a Handheld Device to Diagnose COVID-19 in the Emergency Department

The Coronavirus Disease 2019 (COVID-19) pandemic has critically struck healthcare systems and burdened emergency services. To date, there is no accurate and rapid point-of-care diagnostic test. This study aimed to investigate Lung Ultrasound (LUS) against Reverse Transcription-Polymerase Chain Reaction (RT-PCR) test in suspected COVID-19 patients presenting to the emergency department. In 20 eligible patients (mean age ± standard deviation, 49 ± 15 years), 12 had a positive RT-PCR test and undergone an LUS examination over 12 lung zones using a handheld ultrasound device. Each zone was semiquantitatively scored according to the Lung Ultrasound Scoring System (LUSS) from 0 to 3 based on the severity of findings (pleural line irregularity, B-lines, consolidations) and documented the presence of light beam artifacts. A second blinded reader scored the images to investigate interreader reproducibility. The LUSS score had a modest diagnostic performance at 66.6% [95% Confidence Interval (CI), 34.9–90.0%] sensitivity and 75.0% (95% CI, 34.9–96.8%) specificity. The light beam artifact was more prevalent and sensitive to COVID-19 patients with 81.8% (95% CI, 48.2–97.7%) sensitivity and 75.0% (95% CI, 34.9–96.8%) specificity. LUS had an almost perfect interreader reproducibility for LUSS (Kendall’s W = 0.961; 95% CI, 0.894–0.985) and light beam artifact (Cohen’s κ = 0.890; 95% CI, 0.683–1.00). Overall, LUS using handheld devices can offer a safe, reproducible, rapid, and feasible first-line tool for detecting COVID-19 patients in emergency departments. The light beam artifact was more sensitive and specific to COVID-19 patients and can be useful for effectively triaging suspected cases.

OLD WOUNDS RUN DEEP: A CASE OF THORACIC SPLENOSIS FOLLOWING REMOTE TRAUMA

TOPIC: Disorders of the Pleura TYPE: Medical Student/Resident Case Reports INTRODUCTION: Thoracic splenosis develops as a result of auto-transplantation of splenic tissue into the thoracic cavity following splenic and diaphragmatic injury. Less than 40 cases have been reported in the literature so far and it remains an elusive diagnosis.[1] The majority of cases were asymptomatic and presented as incidental findings on imaging. Few cases reported symptoms like pleuritic chest pain, hemoptysis, and phrenic nerve irritation that prompted a diagnostic workup. [2] We report one such case in which a young female with penetrating abdominal trauma and unexplained shortness of breath was diagnosed with thoracic splenosis. CASE PRESENTATION: Our patient is a 32-year-old female who presented for evaluation of lung nodules found on work-up for recurrent dyspnea. She had previously been treated for suspected bronchitis, however, complained of persistent exertional dyspnea, orthopnea, and fatigue. She denied any chest pain, fever, chills, cough, pedal edema, or weight loss. She had a history of a gunshot to the abdomen that resulted in splenectomy 8 years prior to presentation. Physical exam was unremarkable and bloodwork was normal. Chest x-ray showed pleural irregularities computed tomography revealed nodularity of the left pleural space. PET-CT revealed faint uptake in this area. Transthoracic biopsy of the pleura yielded an acellular specimen. Thoracic splenosis was suspected, and liver and spleen imaging with single-photon emission computed tomography was performed after injecting 5.7 mCi Tc-99m sulfur colloid. The study showed multiple foci of uptake corresponding with underlying soft tissue nodules in the left lower pleura, left lower chest wall, and bilateral mesentery. A diagnosis of thoracic splenosis secondary to penetrating trauma was made. The patient's spirometry was normal and she was managed with supportive care and reassurance. DISCUSSION: The diagnosis of thoracic splenosis can be challenging as there can be a significant lag between thoracoabdominal trauma and chest findings. The Tc-99 m heat-damaged erythrocyte scan has high sensitivity and specificity for splenic tissue, while Tc-99m sulfur colloid and indium-111-labeled platelets are less sensitive alternatives. CT-guided biopsies and needle aspirations typically have a poor yield and increased risk of bleeding. [4,5] As splenic tissue is slow-growing, non-invasive, and mostly asymptomatic, appropriate management is observation and reassurance. Surgical removal carries a significant risk of morbidity and is only attempted in patients with severe, persistent symptoms or increasing size of the mass. [3] CONCLUSIONS: Thoracic splenosis can be diagnosed with a thorough history and appropriate imaging, but patients often undergo invasive procedures such as bronchoscopy or surgery in order to rule out a neoplasm. Pulmonologists should be aware of this rare entity in order to avoid unnecessary procedures REFERENCE #1: Ha YJ, Hong TH, Choi YS. Thoracic Splenosis after Splenic and Diaphragmatic Injury. Korean J Thorac Cardiovasc Surg. 2019;52(1):47-50. doi:10.5090/kjtcs.2019.52.1.47 REFERENCE #2: Le Bars F, Pascot R, Ricordel C, et al. Thoracic splenosis: Case report of a symptomatic case. Chin J Traumatol. 2020;23(3):185-186. doi:10.1016/j.cjtee.2020.05.003 REFERENCE #3: Matthews A, Chesser M, Mand J, Thomas A. A Growth Opportunity: Thoracic Splenosis. Am J Med. 2017;130(4):420-422. doi:10.1016/j.amjmed.2016.11.010 DISCLOSURES: No relevant relationships by Sukhmani Boparai, source=Web Response No relevant relationships by David Chambers, source=Web Response No relevant relationships by Deon Ford, source=Web Response No relevant relationships by Prathik Krishnan, source=Web Response No relevant relationships by Shreedhar Kulkarni, source=Web Response No relevant relationships by Jonathan Packer, source=Web Response

Can follow up lung ultrasound in Coronavirus Disease-19 patients indicate clinical outcome?

PurposeTo evaluate whether there is a change in findings of coronavirus disease 2019 patients in follow up lung ultrasound and to determine whether these findings can predict the development of severe disease.Materials and methodsIn this prospective monocentric study COVID-19 patients had standardized lung ultrasound (12 area evaluation) at day 1, 3 and 5. The primary end point was detection of pathologies and their change over time. The secondary end point was relationship between change in sonographic results and clinical outcome. Clinical outcome was assessed on development of severe disease defined as need for intensive care unit.ResultsData of 30 patients were analyzed, 26 patients with follow-up lung ultrasound. All of them showed lung pathologies with dynamic patterns. 26,7% developed severe disease tending to have an ubiquitous lung involvement in lung ultrasound. In patients with need for intensive care unit a previously developed increase in B-lines, subpleural consolidations and pleural line irregularities was more common. A statistically significant association between change in B-lines as well as change in pleural line irregularities and development of severe disease was observed (p<0,01).ConclusionThe present study demonstrates that follow up lung ultrasound can be a powerful tool to track the evolution of disease and suggests that lung ultrasound is able to indicate an impending development of severe disease in COVID-19 patients.

Prevalence and significance of pulmonary disease on lung ultrasonography in outpatients with SARS-CoV-2 infection

BackgroundThe majority of patients with SARS-CoV-2 infection are diagnosed and managed as outpatients; however, little is known about the burden of pulmonary disease in this setting. Lung ultrasound (LUS) is...