INTRODUCTION. Lung ultrasound has been widely used to diagnose bacterial pneumonia, pulmonary congestion in heart failure, pneumo- and hydrothorax, and other pathological conditions. With the onset of the COVID-19 pandemic, the need for various methods of lung imaging has dramatically increased. AIM. To estimate the value of lung ultrasound in the diagnosis and severity assessment of COVID-19. MATERIAL AND METHODS. Patients with a positive PCR test result for SARS-Cov-2 were included and divided into a moderate, severe, or critical severe group. There were 30 patients involved. All the patients underwent clinical assessment, complete blood count, biochemical blood profile, pulse oxymetry, bedside lung ultrasound, and chest CT scan. To evaluate LUS findings thorax into 16 lung regions and each of these areas was quantitatively scored and summed up in total LUS score. A total severity score for chest CT was compared with the total LUS score. RESULT AND DISCUSSION. All patients had positive LUS findings, as well as positive CT findings. Most common lung ultrasound findings were the following: subpleural consolidations (100.0%, 30/30), large consolidations (73.3%, 22/30) and an irregular pleural line (43.3%, 13/30). A higher total lung ultrasound score was seen in patients with a more severe course of illness and a larger number of lung areas affected; they were older and had a significantly higher incidence of comorbidities and lower SpO2. Spearman correlation coefficient revealed a statistically significant correlation between CT chest scan and lung ultrasound – rs=.52, p= 0.003011. CONCLUSION. During the COVID-19 pandemic, lung ultrasound is a great tool for assessing lung tissue in patients with varying severity of the disease. The advantages of the method are accessibility, ease of implementation and the absence of radiation exposure.
COVID-19, pneumonia, SARS-CoV-2, computer tomography
1. COVID-19 Map - Johns Hopkins Coronavirus Resource Center. Available at: https://coronavirus.jhu.edu/map.html (accessed 11.07.2022).
2. Wiersinga W.J., Rhodes A., Cheng A.C., Peacock S.J., Prescott H.C. Pathophysiology, Transmission, Diagnosis, and Treatment of Coronavirus Disease 2019 (COVID-19): A Review. JAMA. 2020; 324(8): 782-793. https://doi.org/10.1001/jama.2020.12839
3. Ai T., Yang Z., Hou H., Zhan C., Chen C., Lv W., Tao Q., Sun Z., Xia L. Correlation of Chest CT and RT-PCR Testing for Coronavirus Disease 2019 (COVID-19) in China: A Report of 1014 Cases. Radiology. 2020; 296(2): E32-E40. https://doi.org/10.1148/radiol.2020200642
4. Raheja R., Brahmavar M., Joshi D., Raman D. Application of Lung Ultrasound in Critical Care Setting: A Review. Cureus. 2019; 11(7): e5233. https://doi.org/10.7759/cureus.5233
5. Sultan L.R., Sehgal C.M. A Review of Early Experience in Lung Ultrasound in the Diagnosis and Management of COVID-19. Ultrasound in Medicine & Biology. 2020; 46(9): 2530-2545. https://doi.org/10.1016/j.ultrasmedbio.2020.05.012
6. Mohamed M.F.H., Al-Shokri S., Yousaf Z., Danjuma M., Parambil J., Mohamed S., Mubasher M., Dauleh M.M., Hasanain B., AlKahlout M.A., Abubeker I.Y. Frequency of Abnormalities Detected by Point-of-Care Lung Ultrasound in Symptomatic COVID-19 Patients: Systematic Review and Meta-Analysis. The American Journal of Tropical Medicine and Hygiene. 2020; 103(2): 815-821. https://doi.org/10.4269/ajtmh.20-0371
7. Dietrich C.F., Mathis G., Blaivas M., Volpicelli G., Seibel A., Wastl D., Atkinson N.S., Cui X.W., Fan M., Yi D. Lung B-line artefacts and their use. Journal of Thoracic Disease. 2016; 8(6): 1356-65. https://doi.org/10.21037/jtd.2016.04.55
8. Gargani L., Soliman-Aboumarie H., Volpicelli G., Corradi F., Pastore M.C., Cameli M. Why, when, and how to use lung ultrasound during the COVID-19 pandemic: enthusiasm and caution. European Heart Journal - Cardiovascular Imaging. 2020; 21(9): 941-948. https://doi.org/10.1093/ehjci/jeaa163
9. Li K., Fang Y., Li W., Pan C., Qin P., Zhong Y., Liu X., Huang M., Liao Y., Li S. CT image visual quantitative evaluation and clinical classification of coronavirus disease (COVID-19). European Radiology. 2020; 30(8): 4407-4416. https://doi.org/10.1007/s00330-020-06817-6
10. Pare J.R., Camelo I., Mayo K.C., Leo M.M., Dugas J.N., Nelson K.P., Baker W.E., Shareef F., Mitchell P.M., Schechter-Perkins E.M. Point-of-care Lung Ultrasound Is More Sensitive than Chest Radiograph for Evaluation of COVID-19. The Western Journal of Emergency Medicine. 2020; 21(4): 771-778. https://doi.org/10.5811/westjem.2020.5.47743
11. Zieleskiewicz L., Markarian T., Lopez A., Taguet C., Mohammedi N., Boucekine M., Baumstarck K., Besch G., Mathon G., Duclos G., Bouvet L., Michelet P., Allaouchiche B., Chaumoître K., Di Bisceglie M., Leone M. Comparative study of lung ultrasound and chest computed tomography scan in the assessment of severity of confirmed COVID-19 pneumonia. Intensive Care Medicine. 2020; 46(9): 1707-1713. https://doi.org/10.1007/s00134-020-06186-0
12. Bonadia N., Carnicelli A., Piano A., Buonsenso D., Gilardi E., Kadhim C., Torelli E., Petrucci M., Di Maurizio L., Biasucci D.G., Fuorlo M., Forte E., Zaccaria R., Franceschi F. Lung Ultrasound Findings Are Associated with Mortality and Need for Intensive Care Admission in COVID-19 Patients Evaluated in the Emergency Department. Ultrasound in Medicine & Biology. 2020; 46(11): 2927-2937. https://doi.org/10.1016/j.ultrasmedbio.2020.07.005
13. Lichter Y., Topilsky Y., Taieb P., Banai A., Hochstadt A., Merdler I., Gal Oz A., Vine J., Goren O., Cohen B., Sapir O., Granot Y., Mann T., Friedman S., Angel Y., Adi N., Laufer-Perl M., Ingbir M., Arbel Y., Matot I., Szekely Y. Lung ultrasound predicts clinical course and outcomes in COVID-19 patients. Intensive Care Medicine. 2020; 46(10): 1873-1883. https://doi.org/10.1007/s00134-020-06212-1
14. Zhao L., Yu K., Zhao Q., Tian R., Xie H., Xie L., Deng P., Xie G., Bao A., Du J. Lung Ultrasound Score in Evaluating the Severity of Coronavirus Disease 2019 (COVID-19) Pneumonia. Ultrasound in Medicine & Biology. 2020; 46(11): 2938-2944. https://doi.org/10.1016/j.ultrasmedbio.2020.07.024
15. Nouvenne A., Ticinesi A., Parise A., Prati B., Esposito M., Cocchi V., Crisafulli E., Volpi A., Rossi S., Bignami E.G., Baciarello M., Brianti E., Fabi M., Meschi T. Point-of-Care Chest Ultrasonography as a Diagnostic Resource for COVID-19 Outbreak in Nursing Homes. Journal of the American Medical Directors Association. 2020; 21(7): 919-923. https://doi.org/10.1016/j.jamda.2020.05.050
16. Shokoohi H., Duggan N.M., García-de-Casasola Sánchez G., Torres-Arrese M., Tung-Chen Y. Lung ultrasound monitoring in patients with COVID-19 on home isolation. The American Journal of Emergency Medicine. 2020; 38(12): 2759.e5-2759.e8. https://doi.org/10.1016/j.ajem.2020.05.079
17. Bar S., Lecourtois A., Diouf M., Goldberg E., Bourbon C., Arnaud E., Domisse L., Dupont H., Gosset P. The association of lung ultrasound images with COVID-19 infection in an emergency room cohort. Anaesthesia. 2020; 75(12): 1620-1625. https://doi.org/10.1111/anae.15175
18. Dargent A., Chatelain E., Kreitmann L., Quenot J.P., Cour M., Argaud L.; COVID-LUS study group. Lung ultrasound score to monitor COVID-19 pneumonia progression in patients with ARDS. PLoS One. 2020; 15(7): e0236312. https://doi.org/10.1371/journal.pone.0236312
19. Alharthy A., Faqihi F., Abuhamdah M., Noor A., Naseem N., Balhamar A., Al Saud A.A.A.S.B.A., Brindley P.G., Memish Z.A., Karakitsos D., Blaivas M. Prospective Longitudinal Evaluation of Point-of-Care Lung Ultrasound in Critically Ill Patients With Severe COVID-19 Pneumonia. Journal of Ultrasound in Medicine. 2021; 40(3): 443-456. https://doi.org/10.1002/jum.15417
20. García-Cruz E., Manzur-Sandoval D., Rascón-Sabido R., Gopar-Nieto R., Barajas-Campos R.L., Jordán-Ríos A., Sierra-Lara Martínez D., Jiménez- Rodríguez G.M., Murillo-Ochoa A.L., Díaz-Méndez A., Lazcano-Díaz E., Araiza-Garaygordobil D., Cabello-López A., Melano-Carranza E., Bucio-Reta E., González-Ruiz F.J., Cota-Apodaca L.A., Santos-Martínez L.E., Fernández-de la Reguera G., Ramos-Enríquez Á., Rojas-Velasco G., Álvarez-Álvarez R.J., Baranda-Tovar F. Critical care ultrasonography during COVID-19 pandemic: The ORACLE protocol. Echocardiography. 2020; 37(9): 1353-1361. https://doi.org/10.1111/echo.14837
21. Liu H., Liu F., Li J., Zhang T., Wang D., Lan W.. Clinical and CT imaging features of the COVID-19 pneumonia: Focus on pregnant women and children. The Journal of Infection. 2020; 80(5): e7-e13. https://doi.org/10.1016/j.jinf.2020.03.007
22. Gaspardone C., Meloni C., Preda A., Romagnolo D., Brugliera L., Castellazzi P., Tettamanti A., Conte C., Secchi A., Maranta F., Iannaccone S., Cianflone D. Lung Ultrasound in COVID-19 A Role Beyond the Acute Phase? Journal of Ultrasound in Medicine. 2021; 40(3): 503-511. https://doi.org/10.1002/jum.15425
23. Carsana L., Sonzogni A., Nasr A., Rossi R.S., Pellegrinelli A., Zerbi P., Rech R., Colombo R., Antinori S., Corbellino M., Galli M., Catena E., Tosoni A., Gianatti A., Nebuloni M. Pulmonary post-mortem findings in a series of COVID-19 cases from northern Italy: a two-centre descriptive study. The Lancet. Infectious Diseases. 2020; 20(10): 1135-1140. https://doi.org/10.1016/S1473-3099(20)30434-5
24. Chung M., Bernheim A., Mei X., Zhang N., Huang M., Zeng X., Cui J., Xu W., Yang Y., Fayad Z.A., Jacobi A., Li K., Li S., Shan H. CT Imaging Features of 2019 Novel Coronavirus (2019-nCoV). Radiology. 2020; 295(1): 202-207. https://doi.org/10.1148/radiol.2020200230
25. Shi H., Han X., Jiang N., Cao Y., Alwalid O., Gu J., Fan Y., Zheng C. Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study. The Lancet. Infectious Diseases. 2020; 20(4): 425-434. https://doi.org/10.1016/S1473-3099(20)30086-4
26. Ji L., Cao C., Gao Y., Zhang W., Xie Y., Duan Y., Kong S., You M., Ma R., Jiang L., Liu J., Sun Z., Zhang Z., Wang J., Yang Y., Lv Q., Zhang L., Li Y., Zhang J., Xie M. Prognostic value of bedside lung ultrasound score in patients with COVID-19. Critical care. 2020; 24(1): 700 p. https://doi.org/10.1186/s13054-020-03416-1
27. Jackson K., Butler R., Aujayeb A. Lung ultrasound in the COVID-19 pandemic. Postgraduate Medical Journal. 2021; 97(1143): 34-39. https://doi.org/10.1136/postgradmedj-2020-138137
28. Zhang Y., Xue H., Wang M., He N., Lv Z.., Cui L. Lung Ultrasound Findings in Patients With Coronavirus Disease (COVID-19). American Journal of Roentgenology. 2021; 216(1): 80-84. https://doi.org/10.2214/AJR.20.23513
29. Volpicelli G., Gargani L. Sonographic signs and patterns of COVID-19 pneumonia. The Ultrasound Journal. 2020; 12(1): 22 p. https://doi.org/10.1186/s13089-020-00171-w
30. Soldati G., Smargiassi A., Inchingolo R., Buonsenso D., Perrone T., Briganti D.F., Perlini S., Torri E., Mariani A., Mossolani E.E., Tursi F., Mento F., Demi L. Proposal for International Standardization of the Use of Lung Ultrasound for Patients With COVID-19: A Simple, Quantitative, Reproducible Method. Journal of Ultrasound in Medicine. 2020; 39(7): 1413-1419. https://doi.org/10.1002/jum.15285
31. Alzahrani S.A., Al-Salamah M.A., Al-Madani W.H., Elbarbary M.A. Systematic review and meta-analysis for the use of ultrasound versus radiology in diagnosing of pneumonia. Critical Ultrasound Journal. 2017; 9(1): 6 p. https://doi.org/10.1186/s13089-017-0059-y