scholarly journals One year of SARS-CoV-2 and lung ultrasound: what has been learned and future perspectives

2021 ◽  
Author(s):  
Andrea Boccatonda ◽  
Giulio Cocco ◽  
Eugenia Ianniello ◽  
Marco Montanari ◽  
Damiano D’Ardes ◽  
...  
Keyword(s):  
Lung Ultrasound ◽  
Relevant Information ◽  
Pulmonary Involvement ◽  
Future Perspectives ◽  
Interstitial Syndrome ◽  
Current Infection ◽  
Good Diagnostic Accuracy ◽  
One Year ◽  
B Lines ◽  
Over Time

AbstractA first screening by ultrasound can be relevant to set a specific diagnostic and therapeutic route for a patient with a COVID-19 infection. The finding of bilateral B-lines and white lung areas with patchy peripheral distribution and sparing areas is the most suggestive ultrasound picture of COVID-19 pneumonia. Failure to detect bilateral interstitial syndrome (A pattern) on ultrasound excludes COVID-19 pneumonia with good diagnostic accuracy, but does not exclude current infection. The use of shared semiotic and reporting schemes allows the comparison and monitoring of the COVID-19 pulmonary involvement over time. This review aims to summarise the main data on pulmonary ultrasound and COVID-19 to provide accurate and relevant information for clinical practice.

scholarly journals Prevalence and significance of pulmonary disease on lung ultrasonography in outpatients with SARS-CoV-2 infection

2021 ◽  
Vol 8 (1) ◽  
pp. e000947
Author(s):  
Robert M Fairchild ◽  
Audra Horomanski ◽  
Diane A Mar ◽  
Gabriela R Triant ◽  
Rong Lu ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Pulmonary Disease ◽  
Lung Ultrasound ◽  
Pulmonary Involvement ◽  
Adverse Outcomes ◽  
Shortness Of Breath ◽  
Severity Scores ◽  
High Prevalence ◽  
Risk Stratification Tool ◽  
B Lines

BackgroundThe majority of patients with SARS-CoV-2 infection are diagnosed and managed as outpatients; however, little is known about the burden of pulmonary disease in this setting. Lung ultrasound (LUS) is a convenient tool for detection of COVID-19 pneumonia. Identifying SARS-CoV-2 infected outpatients with pulmonary disease may be important for early risk stratification.ObjectivesTo investigate the prevalence, natural history and clinical significance of pulmonary disease in outpatients with SARS-CoV-2.MethodsSARS-CoV-2 PCR positive outpatients (CV(+)) were assessed with LUS to identify the presence of interstitial pneumonia. Studies were considered positive based on the presence of B-lines, pleural irregularity and consolidations. A subset of patients underwent longitudinal examinations. Correlations between LUS findings and patient symptoms, demographics, comorbidities and clinical outcomes over 8 weeks were evaluated.Results102 CV(+) patients underwent LUS with 42 (41%) demonstrating pulmonary involvement. Baseline LUS severity scores correlated with shortness of breath on multivariate analysis. Of the CV(+) patients followed longitudinally, a majority showed improvement or resolution in LUS findings after 1–2 weeks. Only one patient in the CV(+) cohort was briefly hospitalised, and no patient died or required mechanical ventilation.ConclusionWe found a high prevalence of LUS findings in outpatients with SARS-CoV-2 infection. Given the pervasiveness of pulmonary disease across a broad spectrum of LUS severity scores and lack of adverse outcomes, our findings suggest that LUS may not be a useful as a risk stratification tool in SARS-CoV-2 in the general outpatient population.

scholarly journals THU0534 LUNG ULTRASOUND IN PATIENTS WITH SECONDARY INTERSTITIAL LUNG DISEASES

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 506.2-507
Author(s):  
E. Kirillova ◽  
N. Shamsutdinova ◽  
G. Nurullina
Keyword(s):  
Rheumatic Diseases ◽  
Lung Ultrasound ◽  
Systemic Vasculitis ◽  
Damage Index ◽  
Clinical Manifestations ◽  
Pulmonary Involvement ◽  
Gas Diffusion ◽  
Lung Involvement ◽  
Activity Scale ◽  
B Lines

Background:Currently, lung ultrasound (LUS) is increasingly used in rheumatology.Objectives:To evaluate the relationship between lung ultrasound and pulmonary function and disease activity in patients with rheumatic diseases with secondary lung involvement.Methods:Thirty patients with rheumatic diseases were included in the study, who, according to the data of the high-resolution RCT of lungs (64-slice CT system Philips Diamond Select Brilliance), showed interstitial lung involvement as a type of nonspecific interstitial pneumonia. In 4 patients, mixed connective tissue disease (MCTD) was diagnosed, 20 had systemic vasculitis (SV), and 6 had rheumatoid arthritis (RA). The mean age of the patients was 56,55 ± 10,59, the duration of the disease was 2,3 ± 1,2 years. All patients underwent a standard clinical examination, the following indices and scales were used to assess the activity of the underlying disease: VDI damage index, Bermingham systemic vasculitis activity scale (BVAS), RA activity scale (DAS 28-CRP). The functional state of the lungs was assessed using spirometry, bodipletismography, gas diffusion “single breath”. LUS was carried out for the evaluation of the location and number of B-lines on both right and left hemithoraces using commercially available echographic equipment with a 5-12 MHz linear transducer (Accuvix A30, Samsung Medison).Results:Most patients had an average number of B-lines 24,5[11,5;34,0]. Тhere were no significant differences in the number of В-lines between groups of patients of different nosologies. The total number of В-lines correlated with the index of activity of systemic vasculitis BVAS (р<0,05; r=0,83). There were no statistically significant correlations with clinical manifestations of pulmonary involvement.Conclusion:Lung ultrasound may be useful in screening secondary lung involvement in patients with rheumatic diseases with high activity.References:[1]Dietrich CF, Mathis G, Blaivas M, Volpicelli G, Seibel A, Wastl D, Atkinson NS, Cui XW, FanM, Yi D. Lung B-line artefacts and their use. J Thorac Dis 2016;8(6):1356-1365. doi: 10.21037/jtd.2016.04.55[2]Tatiana Barskova, Luna Gargani, Serena Guiducci, et al. Lung ultrasound for the screening of interstitial lung disease in very early systemic sclerosis Ann Rheum Dis 2013 72: 390-395 originally published online May 15 2012 doi: 10.1136/annrheumdis-2011-201072Disclosure of Interests:None declared

scholarly journals OP0167 THE ROLE OF LUNG ULTRASOUND IN THE DIAGNOSIS OF INTERSTITIAL LUNG DISEASE IN CHILDREN WITH DERMATOMYOSISTIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 100.3-100
Author(s):  
R. Dertkgil ◽  
C. Cappello ◽  
S. Dertkigil ◽  
R. Marini ◽  
S. Appenzeller
Keyword(s):  
Computed Tomography ◽  
High Resolution ◽  
Interstitial Lung Disease ◽  
Lung Disease ◽  
Gold Standard ◽  
Lung Ultrasound ◽  
Pulmonary Involvement ◽  
High Resolution Computed Tomography ◽  
B Lines ◽  
Transthoracic Ultrasound

Background:Dermatomyositis is a multi organ autoimmune disease wich is commonly complicated with interstitial lung disease. Chest high-resolution computed tomography (HRCT) is still considered the diagnostic gold standard for interstitial lung disease and is quantification, however he increasing use of lung ultrasound may play an important role in the future.Objectives:The aim of our study was to determine the diagnostic value of lung ultrasound in the detection and progression of interstitial pulmonary disease in patients with dermatomyositis.Methods:Twenty two subjects with dermatomyositis diagnosed according to the American College of Rheumatology criteria were enrolled (6 males, 16 females; mean age: 15,8 ± 8.8 years; range: 6 to 29 years). All subjects underwent high resolution computed tomography followed by transthoracic ultrasound for comet tail sign detection and pleural irregularity in order to predict the degree of interstitial lung disease. The modified transthoracic ultrasound assessment was performed at 06 thoracic regions each side. The Warrick score was calculated according standard high-resolution chest computed tomography images that were evaluated independently from each other by two thoracics radiologists.Results:A significantly positive correlation between transthoracic ultrasound and the severity of pulmonary involvement, as seen by the number of B lines (Spearman ‘s correlation coefficient = 0.80, p < 0.001), and the number of positive areas (regions wih more than 3 B lines) (Spearman ‘s correlation coefficient = 0.75, p < 0.001) were found. When compared with high-resolution chest computed tomography as the gold standard method, the sensitivity, specificity, of transthoracic ultrasound was 96.4%, 83,3% respectively. Addicionally the number of B lines (sum of 35 or more B lines) and a number of B lines positive areas (7 or more regions with at least 3 B lines) cut of allowed to discriminate the inflamatory pattern (ground glass) to those with structural pattern (honeycomb and pulmonary cysts).Conclusion:Our study showed that transthoracic ultrasound comet tails scoring system could be useful in the assessment of the pulmonary involvement in patients with dermatomyositis, and should be considered as a primary screening exam to exclude lung involvement, rather than routine chest CT scans in assimptomatic patients.Disclosure of Interests:None declared

Lung Ultrasound Predicts Interstitial Syndrome and Hemodynamic Profile in Parturients with Severe Preeclampsia

2014 ◽  
Vol 120 (4) ◽  
pp. 906-914 ◽  
Author(s):  
Laurent Zieleskiewicz ◽  
Claire Contargyris ◽  
Clément Brun ◽  
Maxime Touret ◽  
Armand Vellin ◽  
...  
Keyword(s):  
Pulmonary Edema ◽  
Lung Ultrasound ◽  
Left Ventricular ◽  
Severe Preeclampsia ◽  
Interstitial Edema ◽  
Interstitial Syndrome ◽  
Level 3 ◽  
Hemodynamic Profile ◽  
B Lines

Abstract Background: The role of lung ultrasound has never been evaluated in parturients with severe preeclampsia. The authors’ first aim was to assess the ability of lung ultrasound to detect pulmonary edema in severe preeclampsia. The second aim was to highlight the relation between B-lines and increased left ventricular end-diastolic pressures. Methods: This prospective cohort study was conducted in a level-3 maternity during a 12-month period. Twenty parturients with severe preeclampsia were consecutively enrolled. Both lung and cardiac ultrasound examinations were performed before (n = 20) and after delivery (n = 20). Each parturient with severe preeclampsia was compared with a control healthy parturient. Pulmonary edema was determined using two scores: the B-pattern and the Echo Comet Score. Left ventricular end-diastolic pressures were assessed by transthoracic echocardiography. Results: Lung ultrasound detected interstitial edema in five parturients (25%) with severe preeclampsia. A B-pattern was associated to increased mitral valve early diastolic peak E (116 vs. 90 cm/s; P = 0.05) and to increased E/E’ ratio (9.9 vs. 6.6; P &lt; 0.001). An Echo Comet Score of greater than 25 predicted an increase in filling pressures (E/E’ ratio &gt;9.5) with a sensitivity and specificity of 1.00 (95% CI, 0.69 to 1.00) and 0.82 (95% CI, 0.66 to 0.92), respectively. Conclusions: In parturients with severe preeclampsia, lung ultrasound detects both pulmonary edema and increased left ventricular end-diastolic pressures. The finding of a B-pattern should restrict the use of fluid. However, these preliminary results are associations from a single sample. They need to be replicated in a larger, definitive study.

scholarly journals A single-center comparative study of lung ultrasound versus chest computed tomography during the COVID-19 era

2021 ◽  
Vol 16 ◽  
Author(s):  
Kobalava Zhanna Davidovna ◽  
Ayten Fuad Safarova ◽  
Flora Elisa Cabello Montoya ◽  
Maria Vasilevna Vatsik-Gorodetskaya ◽  
Karaulova Yulia Leonidovna ◽  
...  
Keyword(s):  
Lung Ultrasound ◽  
Area Under The Curve ◽  
Pulmonary Involvement ◽  
Chest Ct ◽  
Imaging Tool ◽  
Visual Scoring ◽  
Ct Findings ◽  
Severity Scores ◽  
Bilateral Distribution ◽  
B Lines

Background: Lung ultrasound (LUS) is a bedside imaging tool that has proven useful in identifying and assessing the severity of pulmonary pathology. The aim of this study was to determine LUS patterns, their clinical significance, and how they compare to CT findings in hospitalized patients with coronavirus infection.Methods: This observational study included 62 patients (33 men, age 59.3±15.9 years), hospitalized with pneumonia due to COVID-19, who underwent chest CT and bedside LUS on the day of admission. The CT images were analyzed by chest radiographers who calculated a CT visual score based on the expansion and distribution of ground-glass opacities and consolidations. The LUS score was calculated according to the presence, distribution, and severity of anomalies.Results: All patients had CT findings suggestive of bilateral COVID-19 pneumonia, with an average visual scoring of 8.1±2.9%. LUS identified 4 different abnormalities, with bilateral distribution (mean LUS score: 26.4±6.7), focal areas of non-confluent B lines, diffuse confluent B lines, small sub-pleural micro consolidations with pleural line irregularities, and large parenchymal consolidations with air bronchograms. LUS score was significantly correlated with CT visual scoring (rho = 0.70; p<0.001). Correlation analysis of the CT and LUS severity scores showed good interclass correlation (ICC) (ICC =0.71; 95% confidence interval (CI): 0.52–0.83; p<0.001). Logistic regression was used to determine the cut-off value of ≥27 (area under the curve: 0.97; 95% CI: 90-99; sensitivity 88.5% and specificity 97%) of the LUS severity score that represented severe and critical pulmonary involvement on chest CT (CT: 3-4).Conclusion: When combined with clinical data, LUS can provide a potent diagnostic aid in patients with suspected COVID-19 pneumonia, reflecting CT findings.

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 Lung ultrasound artifacts in a case of P. Jirovecii pneumonia : Coexistence of A and B lines

2014 ◽  
Vol 1 (1) ◽  
pp. 31 ◽  
Author(s):  
Maxime Valois ◽  
David Gruber ◽  
Jean-Francois Lanctot
Keyword(s):  
Interstitial Pneumonia ◽  
Lung Ultrasound ◽  
Original Description ◽  
Lung Pathology ◽  
Interstitial Syndrome ◽  
Formal Criterion ◽  
Ultrasound Findings ◽  
Proven Case ◽  
B Lines

This article presents lung ultrasound findings in a proven case of P. Jirovecii pneumonia. Ultrasound-based diagnoses of lung pathology are largely based on the patterns of artifacts encountered. The expected finding in an interstitial pneumonia is a B profile (multiple B lines). The original description of B lines stated that they should erase A lines, thus A and B lines where tought as being mutually exclusive. This case is a clear example of interstitial syndrome presenting with both A and B lines on lung ultrasound. It suggests that the absence of A lines should not be a formal criterion for the identification of B-lines. 

P341 Prognostic value of pulmonary congestion assessed by lung ultrasound to predict decompensation in heart failure patients

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A Bidaut ◽  
A Hubert ◽  
E Donal
Keyword(s):  
Heart Failure ◽  
Lung Ultrasound ◽  
Global Longitudinal Strain ◽  
Systolic Pressure ◽  
Pulmonary Congestion ◽  
Kaplan Meier ◽  
Significant Difference ◽  
One Year ◽  
B Lines

Abstract INTRODUCTION : Lung ultrasound (LUS) evaluation of B lines is a valid tool for the assessment of pulmonary congestion in heart failure (HF) patients. The aim of this study was to evaluate the prognosis of HF patients presenting with B lines, with a primary endpoint of rehospitalization for heart failure and/or death at one year. METHOD : 93 patients presenting with significant dyspnea (NYHA ≥ 2) underwent an initial analysis of LUS for B-lines, complete TTE, and were propectively followed up for one year. RESULTS : Data on follow up was obtained for 88 patients. 8 patients presented with HF, and 5 patients died. ROC analysis showed an optimal cutoff of B-lines at 6. Kaplan Meier curves showed a significant difference in rehospitalization for heart failure at 1 year (p = 0,047 for B-lines ≥ 6). There was no significant difference for death. Patients with ≥ 6 B-lines had an OR at 13,7 for HF rehospitalization at 1 year (IC95% , p = 0,017). CONCLUSION : B-lines assessment by LUS identifies patients more likely to be admitted for decompensated HF in the following year. This tool should be considered in a multi-parametric approach in patients with heart failure to optimize treatment and follow up. Baseline characteristics Rehospitalization for HF n = 8 No rehospitalization for HF n = 80 p value Age 75,5 +/-8 71,9 +/-9,7 0,325 BMI 23,6 +/- 2,1 26,8 +/- 5,4 0,005 HF history 8 (100%) 35 (43,8%) &lt;0,001 Significant valvulopathy 8 (100%) 45 (56,3%) &lt;0,001 Renal insufficiency 5 (62,5%) 19 (23,8%) 0,019 NYHA ≥3 7 (87,5%) 17 (21,3%) &lt;0,001 Total B-lines 16,1 +/- 9,5 6,8 +/- 9,7 0,012 B-lines ≥ 6 7 (87,5%) 27 (33,8%) 0,003 LVEF 39,3 +/- 11,7 48,5 +/- 15,5 0,109 GLS -9,4 +/- 3,2 -13,3 +/- 5,5 0,018 Mitral S average 4,5 +/- 1,1 6,1 +/- 1,8 0,017 E/A ratio 3 +/- 1,8 1,2 +/- 0,84 0,05 Peak TR velocity (m/s) 3 +/- 0,47 2,5 +/- 0,5 0,018 PASP (mmhg) 52,6 +/- 16 35,8 +/- 14 0,002 HF : heart failure, BMI : body mass index, NYHA : new york heart association, LVEF : left ventricule ejection fraction, GLS : global longitudinal strain, TR : tricuspid regurgitation, PASP : pulmonary artery systolic pressure Abstract P341 Figure. Kaplan Meier survival curve

scholarly journals The Role of B-Line Artifacts on Lung Ultrasound in Critically Ill Patients

2020 ◽  
Keyword(s):  
Differential Diagnosis ◽  
Clinical Practice ◽  
Cardiac Failure ◽  
Lung Ultrasound ◽  
Lung Density ◽  
Everyday Clinical Practice ◽  
Interstitial Syndrome ◽  
Hospital Wards ◽  
B Lines

Lung ultrasound (LUS) is becoming a valuable tool in assessing patients in the ER, ICU, and on the hospital wards because it is a simple, fast and harmless technique. One of the most distinct artefacts seen with LUS are B-lines, hyperechoic laser-like lines that form in the presence of thickened interlobular septa due to alveo-interstitial syndrome. Many researches have been conducted recently with a goal of correlating B-lines to specific known parameters such as EVLW, PAOP, lung density, and parameters of cardiac failure, either in quantitative or semiquantitative manner. This paper is a short overview of the present known correlations, shortcomings of conducted investigations and differential diagnosis problems and exceptions of B-line artefacts in everyday clinical practice.

Tax-Advantaged Trust Use Among IPO Executives: Determinants and Implications for Valuation and Future Performance

2019 ◽  
Vol 95 (3) ◽  
pp. 145-175 ◽  
Author(s):  
Michael J. Dambra ◽  
Matthew Gustafson ◽  
Phillip J. Quinn
Keyword(s):  
Stock Price ◽  
Relevant Information ◽  
Data Availability ◽  
Market Prices ◽  
The Public ◽  
Future Performance ◽  
Estate Taxes ◽  
Price Appreciation ◽  
One Year ◽  
Jel Classifications

ABSTRACT We examine the prevalence and determinants of CEOs' use of tax-advantaged trusts prior to their firm's IPO. Twenty-three percent of CEOs use tax-advantaged pre-IPO trusts, and share transfers into tax-advantaged trusts are positively associated with CEO equity wealth, estate taxes, and dynastic preferences. We project that pre-IPO trust use increases CEOs' dynastic wealth by approximately $830,000, on average. We next examine a simple model's prediction that trust use will be positively related to IPO-period stock price appreciation. We find that trust use is associated with 12 percent higher one-year post-IPO returns, but is not significantly related to the IPO's valuation, filing price revision, or underpricing. This evidence is consistent with CEOs' personal finance decisions prior to the IPO containing value-relevant information that is not immediately incorporated into market prices. JEL Classifications: D14; G12; G32; M21; M41. Data Availability: Data are available from the public sources cited in the text.

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