Andrew Lee, DO | EM PGY3
The Article:
The Idea:
To observe the ultrasonic manifestations of peripulmonary lesions in non-critical COVID-19 so as to provide reference for clinical diagnosis and efficacy evaluation
The Study:
A retrospective analysis of the color doppler ultrasound information of peripulmonary lesions in early and progressive COVID-19. Ultrasound findings of twenty patents (11 male, 9 female) who had the following criteria were involved in the analysis:
history of travel in Wuhan, China or areas with COVID-19 transmission within 14 days of prior to onset of illness
exposure to patients with fever or respiratory symptoms who were from Wuhan or other areas with COVID-19 transmission within 14 days prior to the onset of disease,
Clusters or epidemiological associations with COVID-19 infections
Fever
Radiographic features of pneumonia with ground glass opacity or patchy consolidation in the lungs
Normal or decreased WBC count
Decreased lymphocyte count in the early stage of disease
Positive nucleic acid of SARS-Cov-2 detected by real time fluorescence
Highly homologous virus gene sequencing with SARS-Cov-2
Each lung was divided into six sonographic regions: an upper and lower anterior area, an upper and lower axillary area, and an upper and lower posterior area. The areas were scanned by two physicians, each with more than 5 years of ultrasound experience, with a linear array probe or with a convex array probe. They observed for:
A smooth, continuous, or interrupted pleural line
The distribution, number, and fusion of B lines in the peripulmonary area of both lungs
The echo, location, shape and range of peripulmonary lesions
The presence of absence of air bronchograms in the consolidation
The presence of absence of blood flow in the consolidation
The presence of absence of pleural effusion around the lesion
The presence of absence of localized pleural thickening
The Findings:
Many of the sonographic manifestations seen with typical pneumonia were identified, such as interrupted pleural lines, B lines, air bronchograms, and subpleural consolidations. Peripulmonary lesions were mostly located in the posterior fields of both lungs. Multiple B lines under the pleural line were visible. Unique to COVID-19 patients, B lines could be discontinuous or continuous, however, they were more likely to be continuous, fixed and fused (waterfall sign) rather than discontinuous as is typically seen in cardiogenic pulmonary edema. Localized pleural thickening with a local pleural effusion around the subpleural lesion was identified. Also unique to COVID-19 patients, color doppler showed poor blood flow in the subpleural consolidation.
The Takeaway:
Ultrasound can show typical findings associated with any pneumonia in COVID-19 pneumonia. However, if poor blood flow in the subpleural consolidation is found by doppler and B lines are fused, this may suggest atypical/COVID pneumonia. However, ultrasound is limited to evaluation of peripulmonary lesions, and cannot replace CT in evaluation of intrapulmonary and apical lesions.