Figure 2 - available via license: Creative Commons Attribution 4.0 International
Content may be subject to copyright.
Ultrasound findings in SARS-CoV-2 pneumonia: (1) ribs, (2) A line, (3) cluster of B lines, (4) pleural line.
Source publication
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread worldwide causing a global pandemic. In this context, lung ultrasound (LUS) has played an important role due to its high diagnostic sensitivity, low costs, simplicity of execution and radiation safeness. Despite computed tomography (CT) being the imaging gold standard, lung ult...
Context in source publication
Context 1
... of B-lines are the ultrasound sign of the subpleural interlobular thickening. In the scanned fields, more than three B lines or their confluence, configuring the "white lung", suggests an interstitial pneumonia SARS-CoV-2 and the number of B lines is associated with a greater severity of pulmonary involvement [33] (Figure 2). The Kerley B-lines visible on chest X-ray, which are the expression of the thickening of the interlobular septa in the interstitial syndrome, correlate with the ultrasound finding of B-lines in numbers greater than 3 per field [25]. ...
Similar publications
We propose using a pre-trained segmentation model to perform diagnostic classification in order to achieve better generalization and interpretability, terming the technique reverse-transfer learning. We present an architecture to convert segmentation models to classification models. We compare and contrast dense vs sparse segmentation labeling and...
Citations
... The findings also reveal noteworthy trends in the absence of certain LUS abnormalities in viral cases [17,35,41]. Specifically, no patients with viral pathologies exhibited large consolidations of > 1 cm or pleural effusion, which contrasts with the presence of these abnormalities in a significant proportion of bacterial cases [18,35,38]. ...
This prospective observational study aimed to investigate the utility of lung ultrasound (LUS) in diagnosing and managing pediatric respiratory infections, specifically focusing on viral, bacterial, and SARS-CoV-2 infections. Conducted over a period of 1 year and 8 months, this research involved 85 pediatric patients (showcasing a median age of 14 months) recruited based on specific criteria, including age, confirmed infection through multiplex PCR tests, and willingness to undergo LUS imaging. This study employed a 12-area scoring system for LUS examinations, utilizing the lung ultrasound score (LUSS) to evaluate lung abnormalities. The PCR examination results reveal diverse respiratory pathogens, with SARS-CoV-2, influenza, and bacterial co-infections being prominent among the cases. As an observational study, this study was not registered in the registry. Distinct LUS patterns associated with different pathogens were identified, showcasing the discriminatory potential of LUS in differentiating between viral and bacterial etiologies. Bacterial infections demonstrated more severe lung involvement, evident in significantly higher LUSS values compared with viral cases (p < 0.0001). The specific abnormalities found in bacterial superinfection can be integrated into diagnostic and management protocols for pediatric respiratory infections. Overall, this research contributes valuable insights into optimizing LUS as a diagnostic tool in pediatric pneumonia, facilitating more informed and tailored healthcare decisions.
... 13 The normal and abnormal images are judged according to the artefacts. 14 With the rapid development of modern ultrasound technology, it has a wide range of clinical application prospects. 15 Lung ultrasound score (LUS) has gradually become one of the green means of lung disease examination. ...
Introduction
To analyze the significance of lung ultrasound score (LUS) combined with serum inflammatory indexes in different severities of severe pneumonia and its clinical value on prognosis.
Methods
100 patients with severe pneumonia treated in the Gansu Provincial Hospital from June 2017 to June 2021 were selected as the research objects. According to the acute physiology and chronic health (APACHE II) score, they were divided into a low-risk group (28 cases), a medium-risk group (39 cases) and a high-risk group (33 cases). The general clinical data of the patients (age, gender, smoking history, and underlying diseases) were collected, the lung ultrasound score (LUS) of the patients was measured, and the serum inflammatory indicators (IL-6, IL-10, TNF-α, CRP and NLR) levels; Pearson correlation analysis to evaluate the correlation between LUS score, serum inflammatory index levels and disease severity; receiver operating characteristic (ROC) curve analysis to evaluate the prognostic value of the combined diagnosis of LUS score and serum inflammatory index for the severity of severe pneumonia.
Results
With the increase in the severity of severe pneumonia, the LUS score and the level of inflammation in the body continued to increase, and LUS combined with serum inflammatory indexes could distinguish the severity of low-risk, medium-risk and high-risk severe pneumonia and had high diagnostic value. In addition, the combined diagnosis of LUS and serum inflammatory markers is also closely related to the prognosis of patients with severe pneumonia, which can distinguish the prognosis.
Conclusion
LUS combined with serum inflammatory indicators (IL-6, IL-10, TNF-α, CRP and NLR) can differentiate the severity and prognosis of severe pneumonia, which may be a new direction for diagnosing severe pneumonia and guide early clinical intervention.
... In response to the challenges posed by the COVID-19 pandemic, several protocols and scoring systems have been developed to diagnose and redirect clinical judgment. Lung ultrasound (LUS) has emerged as a suitable alternative to CT scans due to its practicality, low cost, lack of radiation risk, and minimal requirement for health personnel [3]. The peripheral distribution of COVID-19 in the lungs makes ultrasound particularly wellsuited to investigate the disease [4]. ...
... The most common finding is B-lines (shown in Figure 1), which may fuse together to create the characteristic "white lung" appearance. B-lines serve as a densitometer, indicating the progressive loss of air-filled alveoli [3]. Typically, the findings are patchy and have a bilateral distribution, with clusters alternating with spared areas, leading to the definition of a "storm of clusters of B-lines" [31]. ...
The WHO recently declared that COVID-19 no longer constitutes a public health emergency of international concern; however, lessons learned through the pandemic should not be left behind. Lung ultrasound was largely utilized as a diagnostic tool thanks to its feasibility, easy application, and the possibility to reduce the source of infection for health personnel. Lung ultrasound scores consist of grading systems used to guide diagnosis and medical decisions, owning a good prognostic value. In the emergency context of the pandemic, several lung ultrasound scores emerged either as new scores or as modifications of pre-existing ones. Our aim is to clarify the key aspects of lung ultrasound and lung ultrasound scores to standardize their clinical use in a non-pandemic context. The authors searched on PubMed for articles related to “COVID-19”, “ultrasound”, and “Score” until 5 May 2023; other keywords were “thoracic”, “lung”, “echography”, and “diaphragm”. A narrative summary of the results was made. Lung ultrasound scores are demonstrated to be an important tool for triage, prediction of severity, and aid in medical decisions. Ultimately, the existence of numerous scores leads to a lack of clarity, confusion, and an absence of standardization.
... In [10], the role of lung ultrasound (LUS) in the diagnosis and prognosis of SARS-CoV-2 pneumonia is discussed through a comparison with High-Resolution Computed Tomography (HRCT). In [11], the considerable versatility of LUS in diagnosis, the framing of the therapeutic route, and follow-up for SARS-CoV-2 interstitial syndrome is highlighted. In [12], the presence of LUS artifacts after SARS-CoV-2 infection in children were evaluated, and the associations between the time elapsed since infection and symptomatology during acute infection were analyzed. ...
Thoracic ultrasound is an important diagnostic tool employed by many clinicians in well-defined applications [...]
... Among the limitations of the study was the sample size because only ultrasounds performed during the first wave of the pandemic that met the aforementioned inclu-sion criteria, performed during the months of March to June 2020, were selected. Lung ultrasound, although having a steep learning curve [16,21], is an operator-dependent technique [16,31,37]; therefore, the interpretation of the results depended on the training and experience of the clinician who performed it. Third, the ultrasound examinations were performed at a time of maximum health system collapse, when the option to perform PCR on all patients in the study was not possible; therefore, not all ultrasound scans could be compared with the diagnostic standard, i.e., PCR test results. ...
Background: Currently, there are few studies that have analyzed the benefits of using
lung ultrasound in the field of primary care, including in homes and nursing homes, for patients with suspected COVID-19 pneumonia and subsequent follow-ups. The aim of this study was to demonstrate that lung ultrasound is a useful technique for triaging these patients. Methods: An observational and retrospective study of individuals who presented with clinical suspicion of SARS-CoV-2 pneumonia was carried out during the months of March to June 2020 in Health Center number 2 of Ciudad Real and in homes of patients and nursing homes belonging to the Health Service of Castilla-La Mancha (Spain). Results: A total of 209 patients, of whom 86 (41.1%) were male, were included in the study. The most frequent ultrasound findings were bilateral B-lines, with a right predominance, specifically in the posterobasal region. Additionally, there was a statistical significance (p < 0.05) correlation between pathological positivity on lung ultrasound and PCR and chest X-ray positivity. When calculating the sensitivity and specificity of ultrasound and X-ray, ultrasound had a sensitivity of 93%, and X-ray had a sensitivity of 75%. Conclusion: Due to its high sensitivity and negative predictive value, lung ultrasound is very useful as a triage tool for patients with suspected SARS-CoV-2 pneumonia.
... The use of LUS has been standardized with the introduction of specific scores based on the different ultrasonographic patterns that have been described in SARS-CoV-2 infection [8,9]. The implementation of LUS and compressive ultrasound (CUS) in the clinical approach to COVID-19 patients has improved the clinical monitoring and differential diagnosis of respiratory failure, in particular in intensive care unit patients [10]. ...
Hypercoagulability and endothelial dysfunction related to inflammation have been clearly demonstrated in COVID-19. However, their influence on thromboembolism, lung alterations and mortality in low-intensity-care patients with COVID-19 is not completely clarified. Our aims were to evaluate the prevalence of deep vein thrombosis (DVT) with compressive ultrasound (CUS); to describe lung ultrasound (LUS) features; and to study coagulation, inflammatory and endothelial perturbation biomarkers in COVID-19 patients at low-intensity care unit admission. The predictive value of these biomarkers on mortality, need for oxygen support and duration of hospitalization was also evaluated. Of the 65 patients included, 8 were non-survivors. CUS was negative for DVT in all patients. LUS Soldati and Vetrugno scores were strongly correlated (rho = 0.95) with each other, and both significantly differed in patients who needed oxygen therapy vs. those who did not (Soldati p = 0.017; Vetrugno p = 0.023), with coalescent B lines as the most prevalent pattern in patients with a worse prognosis. Mean (SD) levels of thrombomodulin and VCAM-1 were higher in non-survivors than in survivors (7283.9 pg/mL (3961.9 pg/mL) vs. 4800.7 pg/mL (1771.0 pg/mL), p = 0.004 and 2299 ng/mL (730.35 ng/mL) vs. 1451 ng/mL (456.2 ng/mL), p < 0.001, respectively). Finally, in a multivariate analysis model adjusted for age, sex and Charlson score, VCAM-1 level increase was independently associated with death [OR 1.31 (1.06, 1.81; p = 0.036)]. In conclusion, in a cohort of mild COVID-19 patients, we found no DVT events despite the highly abnormal inflammatory, endothelial and coagulation parameters. The presence of lung alterations at admission could not predict outcome. The endothelial perturbation biomarker VCAM-1 emerged as a promising prognostic tool for mortality in COVID-19.
... 39,154,235,236 Furthermore, the recent COVID-19 pandemic has determined an exponential growth of research that confirmed the role of LUS as a useful point-ofcare tool for diagnosis support, prognostic stratification and monitoring of COVID-19 pneumonias. 24,25,101,237 The pathologies that benefit most from LUS examination are dyspnea, thoracic trauma, COVID-19, pneumonia, pleural pathology (effusions and pneumothorax), and heart failure. 56,[228][229][230]238 The role of bedside US is relevant both in the diagnostic and in patient monitoring phases. ...
Following the innovations and new discoveries of the last 10 years in the field of lung ultrasound (LUS), a multidisciplinary panel of international LUS experts from six countries and from different fields (clinical and technical) reviewed and updated the original international consensus for point‐of‐care LUS, dated 2012. As a result, a total of 20 statements have been produced. Each statement is complemented by guidelines and future developments proposals. The statements are furthermore classified based on their nature as technical (5), clinical (11), educational (3), and safety (1) statements.
... On the other hand, point-of-care lung ultrasound (LUS) has been proposed and used as an alternative to chest radiography for diagnosis and monitoring of COVID-19-related interstitial pneumonia and acute respiratory distress syndrome, with the advantages of easier bedside use, easy repeatability, immediate availability, fewer operators exposed to the virus and to ionizing radiations during the single exam [16,17]. Several studies have proved that in SARS-CoV-2 infection LUS is predictive of pneumonia severity, as assessed by chest computed tomography and clinical features [16][17][18], and its use as a diagnostic and monitoring tool is supported by the newest consensus statements [19]. ...
... On the other hand, point-of-care lung ultrasound (LUS) has been proposed and used as an alternative to chest radiography for diagnosis and monitoring of COVID-19-related interstitial pneumonia and acute respiratory distress syndrome, with the advantages of easier bedside use, easy repeatability, immediate availability, fewer operators exposed to the virus and to ionizing radiations during the single exam [16,17]. Several studies have proved that in SARS-CoV-2 infection LUS is predictive of pneumonia severity, as assessed by chest computed tomography and clinical features [16][17][18], and its use as a diagnostic and monitoring tool is supported by the newest consensus statements [19]. Furthermore, in COVID-19 hospitalized patients, the LUS score is strongly associated with the need for invasive or non-invasive mechanical ventilation and is a good predictor of mortality [18][19][20][21]. ...
Background. To evaluate relationships between lung aeration assessed by lung ultrasound (LUS) with viscoelastic profiles obtained by thromboelastography (TEG) in COVID-19 respiratory failure. Methods. Retrospective analysis in a tertiary ICU in Rome, Italy. Forty invasively ventilated adults with COVID-19 underwent LUS and TEG assessment. A simplified LUS protocol consisting in scanning six areas, three per side, was adopted. A score from 0 to 3 was assigned to each area. TEG®6s was used to obtain viscoelastic hemostatic assay parameters which were compared to LUS score. Results. There was a significant inverse correlation between LUS score and static compliance of the respiratory system (Crs, rs -0.75; p < 0.001). We found a significant association between LUS and functional fibrinogen maximum amplitude (FF-MA): among 18 patients with LUS score ≤ 12, median FF-MA was 31 mm [IQR 28-39] whilst, among 22 patients with LUS score > 12, it was 46.3 mm [IQR 40-53], p = 0.0004. Median of the citrated recalcified kaolin-activated maximum amplitude (CK-MA) was 66.1 mm [64.4-68] in the LUS score ≤ 12 group, and 69.6 [68.5-70.7] when LUS score > 12, p < 0.002. Conclusions. The hypercoagulable profile as defined by elevated FF-MA and CK-MA may be associated with a low degree of lung aeration as assessed by LUS.
... These findings add to the body of evidence in favor of the value of POCUS in assessing and managing patients with COVID-19 [17][18][19][20]. Among the several arguments for performing lung ultrasonography in the setting of COVID-19 infection, one is that lung ultrasound is performed at the bedside, by the treating clinician, without the need to move a potentially critically ill patient to the radiology suite [21]. ...
Background
Point-of-care ultrasound (POCUS) is an indispensable tool in emergency medicine. With the emergence of the coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a need for improved diagnostic capabilities and prognostic indicators for patients who are symptomatic for COVID-19 has become apparent. POCUS has been demonstrated to be a useful diagnostic and prognostic tool in the emergency department (ED) in assessing other lung complications. Still, limited data regarding its utility in assessing COVID-19 are available. This study sought to evaluate whether POCUS findings in the ED were correlated with vital signs or laboratory abnormalities typically seen among patients with COVID-19.
Methods
A retrospective study was conducted that included 39 patients who presented with COVID-19 and systemic inflammatory response syndrome (SIRS) to a large, urban tertiary care ED. The study population was limited to adults aged 18 and above who came to the ED with the primary complaint of respiratory symptoms, met SIRS criteria on admission, and had images of at least one anterior and one posterior intercostal space per lung and a minimum of four intercostal spaces. POCUS images were obtained by trained operators in the ED using portable ultrasound machines, recorded in an image database, and reviewed by ultrasound fellowship-trained emergency physicians. Clinical data (e.g., acute phase reactants and vital signs) were obtained through a chart review of patients’ electronic medical records.
Results
Both the percentage of intercostal spaces with B-lines and the percentage of merging B-lines were correlated with decreased oxygen saturation on presentation. No other statistically significant correlations were observed between these sonographic findings and other vital signs or acute phase reactants, nor between these clinical data and the percentage of intercostal spaces that were positive for the shred sign.
Conclusions
With the emergence of the COVID-19 pandemic, emergency medicine physicians are on the frontline of identifying and caring for patients affected by the virus. This study found that sonographic findings associated with interstitial pneumonitis, notably merging B-lines, and the overall percentage of intercostal spaces with B-lines, were clearly associated with worsening oxygen saturation, now thought to be one of the driving causes of morbidity and mortality in COVID-19. As ultrasound has become a ubiquitous and indispensable tool in the ED, this study demonstrated its utility in assessing and managing patients with COVID-19. Bedside ultrasound is a cheap, fast, and non-invasive tool that healthcare providers can use as an essential adjunct in addition to laboratory markers and other imaging modalities for the diagnosis and prognosis of COVID-19.
