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

Antonio Nouvenne, Marco Davìd Zani, Gianluca Milanese, Alberto Parise, Marco Baciarello, Elena Giovanna Bignami, Anna Odone, Nicola Sverzellati, Tiziana Meschi, Andrea Ticinesi, Antonio Nouvenne, Marco Davìd Zani, Gianluca Milanese, Alberto Parise, Marco Baciarello, Elena Giovanna Bignami, Anna Odone, Nicola Sverzellati, Tiziana Meschi, Andrea Ticinesi

Abstract

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.

Keywords: Chest ultrasound; Coronavirus pneumonia; Point-of-care ultrasonography; SARS-CoV-2; Thoracic ultrasound.

Conflict of interest statement

The authors have no conflict of interest to declare.

© 2020 S. Karger AG, Basel.

Figures

Fig. 1
Fig. 1
Appearance of COVID-19-related alveolar-interstitial pneumonia at bedside lung ultrasound. a Nonconfluent B lines (comet-tail artifacts) with spared areas of normal lung parenchyma showing A lines (horizontal artifacts). b Confluent B lines with “white lung” pattern and spared areas of normal lung parenchyma showing A lines. c Diffuse, nonconfluent B lines reflecting homogeneous interstitial involvement of lung parenchyma. d Subpleural microconsolidations with indentation of pleural line, associated with a nonconfluent focal B-line pattern. e Overt subpleural consolidation with air bronchograms. f Spared area showing A lines corresponding to a region of normally ventilated lung parenchyma without alveolar-interstitial involvement.
Fig. 2
Fig. 2
Spearman correlation between lung ultrasound (LUS) score and CT visual scoring (a). The CT visual score was significantly different (p = 0.016) between patients with LUS score below and above the median value (b). The LUS score was also significantly different (p = 0.005) in patients who exhibited consolidation and/or diffuse ground-glass opacities (GGO) at chest CT versus those who had a patchy GGO pattern (c).

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