Lung Ultrasound for Pleural Line Abnormalities, Confluent B‐Lines, and Consolidation

2021 ◽  
Author(s):  
Ernest A. Fischer ◽  
Taro Minami ◽  
Irene W. Y. Ma ◽  
Kosuke Yasukawa
Keyword(s):  
Lung Ultrasound ◽  
Pleural Line ◽  
B Lines

scholarly journals Advantages of lung ultrasound in triage, diagnosis and monitoring COVID-19 patients: review

2021 ◽  
Vol 67 (2) ◽  
pp. 73-76
Author(s):  
Bianca Emilia Ciurba ◽  
Hédi Katalin Sárközi ◽  
István Adorján Szabó ◽  
Nimród László ◽  
Edith Simona Ianosi ◽  
...  
Keyword(s):  
Lung Ultrasound ◽  
Cost Effective ◽  
Portable Devices ◽  
Standard Protocol ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Pleural Line ◽  
B Lines ◽  
Lung Sliding ◽  
Ventilated Patients

Abstract Over the last decades, especially during the COVID-19 pandemic period, lung ultrasound (LUS) gained interest due to multiple advantages: radiation-free, repeatable, cost-effective, portable devices with a bedside approach. These advantages can help clinicians in triage, in positive diagnostic, stratification of disease forms according to severity and prognosis, evaluation of mechanically ventilated patients from Intensive Care Units, as well as monitoring the progress of COVID-19 lesions, thus reducing the health care contamination. LUS should be performed by standard protocol examination. The characteristic lesions from COVID-19 pneumonia are the abolished lung sliding, presence of multiple and coalescent B-lines, disruption and thickening of pleural line with subpleural consolidations. LUS is a useful method for post-COVID-19 lesions evaluation, highlight the remaining fibrotic lesions in some patients with moderate or severe forms of pneumonia.

scholarly journals Prognostic value of bedside lung ultrasound score in patients with COVID-19

2020 ◽  
Author(s):  
Li Ji ◽  
Chunyan Cao ◽  
Ying Gao ◽  
Wen Zhang ◽  
Yuji Xie ◽  
...  
Keyword(s):  
Prognostic Value ◽  
Troponin I ◽  
Lung Ultrasound ◽  
Invasive Mechanical Ventilation ◽  
Continuous Variable ◽  
Adverse Outcomes ◽  
Cox Models ◽  
Pleural Line ◽  
Specificity And Sensitivity ◽  
B Lines

Abstract Background: Bedside lung ultrasound (LUS) has emerged as a useful and noninvasive tool to detect lung involvement and monitor changes in patients with coronavirus disease 2019 (COVID-19). However, the clinical significance of the LUS score in patients with COVID-19 remains unknown. We aimed to investigate the prognostic value of the LUS score in patients with COVID-19.Methods: The LUS protocol consisted of 12 scanning zones and was performed in 280 consecutive patients with COVID-19. The LUS score based on B-lines, lung consolidation and pleural line abnormalities was evaluated.Results: Patients in the highest LUS score group were more likely to have a lower lymphocyte percentage (LYM%); higher levels of D-dimer, C-reactive protein, hypersensitive troponin I and creatine kinase muscle-brain; more invasive mechanical ventilation therapy; higher incidence of ARDS; and higher mortality than patients in the lowest LUS score group. After a median follow-up of 14 days [IQR, 10-20 days], 37 patients developed ARDS, and 13 died. Patients with adverse outcomes presented a higher rate of bilateral involvement; more involved zones and B-lines, pleural line abnormalities and consolidation; and a higher LUS score than event-free survivors. The Cox models adding the LUS score as a continuous variable (hazard ratio [HR]: 1.05, 95% confidence intervals [CI]: 1.02～1.08; P < 0.001; Akaike Information Criterion [AIC] =272; C-index = 0.903) or as a categorical variable (HR: 10.76, 95% CI: 2.75～42.05; P = 0.001; AIC =272; C-index = 0.902) were found to predict poor outcomes more accurately than the basic model (AIC =286; C-index = 0.866). An LUS score cut-off >12 predicted adverse outcomes with a specificity and sensitivity of 90.5% and 91.9%, respectively.Conclusions: The LUS score devised by our group performs well at predicting adverse outcomes in patients with COVID-19 and is important for risk stratification in COVID-19 patients.

scholarly journals Lung Ultrasound in Pediatric Asthma - Characterizing Baseline Findings Outside of Acute Exacerbations

2021 ◽  
Author(s):  
Noah Marzook ◽  
Francois Gagnon ◽  
Alexandre Deragon ◽  
David Zielinski ◽  
Adam Shapiro ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Lung Ultrasound ◽  
Pediatric Asthma ◽  
Primary Objective ◽  
Asthmatic Children ◽  
Pleural Line ◽  
Acute Exacerbations ◽  
The Right ◽  
B Lines ◽  
Lung Zone

Background: Lung ultrasound (LUS) has been shown to be an effective tool to rapidly diagnose certain causes of pediatric respiratory distress in the emergency department. However, very little is known about LUS findings in pediatric asthma outside of acute exacerbations. Objectives: The primary objective of this study was to characterize LUS findings in a cohort of pediatric patients with a definitive diagnosis of asthma, outside of an asthma exacerbation. Methods: Eligible patients, aged 6 to 17 years old and diagnosed with asthma, underwent LUS during an outpatient visit. LUS was conducted using a six-zone scanning protocol. A positive LUS was defined by one or more of the following: ≥3 B-lines per intercostal space, pulmonary consolidation and/or pleural anomaly. Images were interpreted by an expert sonographer blinded to patient clinical characteristics. Results: 52 patients were included. 10/52 patients had a positive LUS (19.2%, 95CI 8.3-30.1%). Of those with positive LUS findings, 8 had B lines, 7 had consolidations <1cm, 1 had a pleural line abnormality and 1 had a consolidation >1cm. Positive findings were seen in the right anterior and lateral zones in 60% of participants and were limited to 1-2 intercostal spaces within one lung zone in 100% of participants. Conclusion: To our knowledge, this is the first report of LUS findings in outpatient pediatric asthma. Positive LUS findings in asthmatic children can be seen outside of acute exacerbations. Such findings need to be taken into consideration when using LUS for the acute evaluation of a pediatric patient with asthma.

scholarly journals Advances in lung ultrasound

2016 ◽  
Vol 14 (3) ◽  
pp. 443-448 ◽  
Author(s):  
Miguel José Francisco Neto ◽  
Antonio Rahal Junior ◽  
Fabio Augusto Cardillo Vieira ◽  
Paulo Savoia Dias da Silva ◽  
Marcelo Buarque de Gusmão Funari
Keyword(s):  
Lung Ultrasound ◽  
Imaging Modality ◽  
Quantitative Information ◽  
Chest Ultrasonography ◽  
Qualitative And Quantitative ◽  
Lung Consolidation ◽  
Pathological Conditions ◽  
Pleural Line ◽  
Sonographic Patterns ◽  
B Lines

ABSTRACT Ultrasound examination of the chest has advanced in recent decades. This imaging modality is currently used to diagnose several pathological conditions and provides qualitative and quantitative information. Acoustic barriers represented by the aerated lungs and the bony framework of the chest generate well-described sonographic artifacts that can be used as diagnostic aids. The normal pleural line and A, B, C, E and Z lines (also known as false B lines) are artifacts with specific characteristics. Lung consolidation and pneumothorax sonographic patterns are also well established. Some scanning protocols have been used in patient management. The Blue, FALLS and C.A.U.S.E. protocols are examples of algorithms using artifact combinations to achieve accurate diagnoses. Combined chest ultrasonography and radiography are often sufficient to diagnose and manage lung and chest wall conditions. Chest ultrasonography is a highly valuable diagnostic tool for radiologists, emergency and intensive care physicians.

scholarly journals Lung ultrasound and neonatal COVID-19 pneumonia: A case report.

2020 ◽  
Author(s):  
Daniel Ibarra Ríos ◽  
Dina Villanueva García ◽  
Edna Patricia Vázquez Solano ◽  
Alfonso de Jesús Martínez García ◽  
María Yolotzin Valdespino-Vázquez ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Pulmonary Hypertension ◽  
Lung Ultrasound ◽  
Placental Tissue ◽  
Male Infant ◽  
Rt Pcr ◽  
Pleural Line ◽  
Novel Coronavirus ◽  
B Lines

Abstract Introduction: Severe Novel Coronavirus Disease 2019 (COVID-19) infection in neonates is possible but reports are scarce. Lung ultrasound (LUS) has been reported useful for triaging, diagnosing, and monitoring of patients with COVID-19.Material and methods: We describe SARS-CoV-2 confirmed infection on a term newborn that developed pneumonia and pulmonary hypertension requiring mechanical ventilation. Ultrasonographic follow up of COVID-19 pneumonia and pulmonary hypertension was carried out. Histopathological and genetic study of the placenta was performed. Results: A 3,140-g male infant born at 40.3 weeks’ gestation developed progressive respiratory distress (pulmonary hypertension) requiring mechanical ventilation. Real time PCR respiratory tract swabs for SARS COV 2 sampled on day 3 were positive for the baby and both parents. Lung ultrasound showed an irregular pleural line (shred sign), multiple confluent B-lines and bilateral ≥ 0.5 cm subpleural consolidations. Improvement of the lung and cardiac conditions were documented by ultrasound. The newborn was supported 6 days with mechanical ventilation, 3 days on CPAP and 3 days on oxygen. No antibiotics were used. The placenta showed histological findings linked to SARS-CoV-2 infection. RT-PCR from placental tissue showed amplification of viral E gene.Conclusion: Our case represents a severe presentation of COVID-19 pneumonia with pulmonary hypertension requiring mechanical ventilation. LUS showed to be useful for diagnosis and follow up. Transversal infection was possible.

scholarly journals Prognostic value of bedside lung ultrasound score in patients with COVID-19

2020 ◽  
Author(s):  
Li Ji ◽  
Chunyan Cao ◽  
Ying Gao ◽  
Wen Zhang ◽  
Yuji Xie ◽  
...  
Keyword(s):  
Prognostic Value ◽  
Troponin I ◽  
Lung Ultrasound ◽  
Invasive Mechanical Ventilation ◽  
Continuous Variable ◽  
Adverse Outcomes ◽  
Cox Models ◽  
Pleural Line ◽  
Specificity And Sensitivity ◽  
B Lines

Abstract BackgroundBedside lung ultrasound (LUS) has emerged as a useful and noninvasive tool to detect lung involvement and monitor changes in patients with coronavirus disease 2019 (COVID-19). However, the clinical significance of the LUS score in patients with COVID-19 remains unknown. We aimed to investigate the prognostic value of the LUS score in patients with COVID-19.MethodsThe LUS protocol consisted of 12 scanning zones and was performed in 280 consecutive patients with COVID-19. The LUS score based on B-lines, lung consolidation and pleural line abnormalities was evaluated.ResultsPatients in the highest LUS score group were more likely to have a lower lymphocyte percentage (LYM%); higher levels of D-dimer, C-reactive protein, hypersensitive troponin I and creatine kinase muscle-brain; more invasive mechanical ventilation therapy; higher incidence of ARDS; and higher mortality than patients in the lowest LUS score group. After a median follow-up of 14 days [IQR, 10-20 days], 37 patients developed ARDS, and 13 died. Patients with adverse outcomes presented a higher rate of bilateral involvement; more involved zones and B-lines, pleural line abnormalities and consolidation; and a higher LUS score than event-free survivors. The Cox models adding the LUS score as a continuous variable ( hazard ratio [HR] : 1.05, 95% confidence intervals [CI]: 1.02～1.08; P < 0.001; Akaike Information Criterion [AIC] =272; C-index = 0.903) or as a categorical variable (HR: 10.76, 95% CI: 2.75～42.05; P = 0.001; AIC =272; C-index = 0.902) were found to predict poor outcomes more accurately than the basic model ( AIC =286; C-index = 0. 866). An LUS score cut-off >12 predicted adverse outcomes with a specificity and sensitivity of 90.5% and 91.9%, respectively.ConclusionsThe LUS score is a powerful predictor of adverse outcomes in patients with COVID-19 and is important for risk stratification in COVID-19 patients.

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

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0256359
Author(s):  
Tatjana Hoffmann ◽  
Peter Bulla ◽  
Lisa Jödicke ◽  
Constantin Klein ◽  
Sarah M. Bott ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Clinical Outcome ◽  
Lung Ultrasound ◽  
Severe Disease ◽  
End Point ◽  
Pleural Line ◽  
B Lines ◽  
Over Time

Purpose To 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 methods In 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. Results Data 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). Conclusion The 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.

scholarly journals Prognostic value of bedside lung ultrasound score in patients with COVID-19

2020 ◽  
Author(s):  
Li Ji ◽  
Chunyan Cao ◽  
Ying Gao ◽  
Wen Zhang ◽  
Yuji Xie ◽  
...  
Keyword(s):  
Prognostic Value ◽  
Troponin I ◽  
Lung Ultrasound ◽  
Invasive Mechanical Ventilation ◽  
Continuous Variable ◽  
Adverse Outcomes ◽  
Cox Models ◽  
Pleural Line ◽  
Specificity And Sensitivity ◽  
B Lines

Abstract Background: Bedside lung ultrasound (LUS) has emerged as a useful and noninvasive tool to detect lung involvement and monitor changes in patients with coronavirus disease 2019 (COVID-19). However, the clinical significance of the LUS score in patients with COVID-19 remains unknown. We aimed to investigate the prognostic value of the LUS score in patients with COVID-19.Methods: The LUS protocol consisted of 12 scanning zones and was performed in 280 consecutive patients with COVID-19. The LUS score based on B-lines, lung consolidation and pleural line abnormalities was evaluated.Results: The median time from admission to LUS examinations was 7 days (interquartile range [IQR] 3-10). Patients in the highest LUS score group were more likely to have a lower lymphocyte percentage (LYM%); higher levels of D-dimer, C-reactive protein, hypersensitive troponin I and creatine kinase muscle-brain; more invasive mechanical ventilation therapy; higher incidence of ARDS; and higher mortality than patients in the lowest LUS score group. After a median follow-up of 14 days [IQR, 10-20 days], 37 patients developed ARDS, and 13 died. Patients with adverse outcomes presented a higher rate of bilateral involvement; more involved zones and B-lines, pleural line abnormalities and consolidation; and a higher LUS score than event-free survivors. The Cox models adding the LUS score as a continuous variable (hazard ratio [HR]: 1.05, 95% confidence intervals [CI]: 1.02～1.08; P < 0.001; Akaike Information Criterion [AIC] =272; C-index = 0.903) or as a categorical variable (HR: 10.76, 95% CI: 2.75～42.05; P = 0.001; AIC =272; C-index = 0.902) were found to predict poor outcomes more accurately than the basic model (AIC =286; C-index = 0.866). An LUS score cut-off >12 predicted adverse outcomes with a specificity and sensitivity of 90.5% and 91.9%, respectively.Conclusions: The LUS score devised by our group performs well at predicting adverse outcomes in patients with COVID-19 and is important for risk stratification in COVID-19 patients.

scholarly journals Lung ultrasound and neonatal COVID-19 pneumonia: A case report.

2020 ◽  
Author(s):  
Daniel Ibarra Ríos ◽  
Dina Villanueva García ◽  
Edna Patricia Vázquez Solano ◽  
Alfonso de Jesús Martínez García ◽  
Horacio Márquez González
Keyword(s):  
Mechanical Ventilation ◽  
Pulmonary Hypertension ◽  
Case Report ◽  
Respiratory Tract ◽  
Lung Ultrasound ◽  
Male Infant ◽  
Pleural Line ◽  
Novel Coronavirus ◽  
B Lines

Abstract Purpose: Severe Novel Coronavirus Disease 2019 (COVID-19) infection in neonates is possible but reports are scarce. Lung ultrasound (LUS) has been reported useful for triaging, diagnosing, and monitoring of patients with COVID-19.Material and methods: We describe SARS-CoV-2 confirmed infection on a term newborn that developed pneumonia and pulmonary hypertension requiring mechanical ventilation. Ultrasonographic follow up of COVID-19 pneumonia and pulmonary hypertension was carried out. Results: A 3,140-g male infant born at 40.3 weeks’ gestation developed progressive respiratory distress requiring mechanical ventilation. Real time PCR respiratory tract swabs for SARS COV 2 sampled on day 3 were positive for the baby and both parents. Lung ultrasound showed an irregular pleural line (shred sign), multiple confluent B-lines and bilateral ≥ 0.5 cm subpleural consolidations. Improvement of the lung and cardiac conditions were documented by ultrasound. Conclusion: Our case represents a severe presentation of COVID-19 pneumonia with pulmonary hypertension requiring mechanical ventilation. LUS showed to be useful for diagnosis and follow up.

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