scholarly journals Implementing Lung Ultrasound in the Outpatient Management of COVID-19 Pneumonia: A Pilot Study to Update Local Guidelines

2021 ◽  
Vol 8 ◽  
Author(s):  
Chloé Chevallier Lugon ◽  
Aileen Kharat ◽  
Paola M. Soccal ◽  
Idris Guessous ◽  
Hervé Spechbach ◽  
...  
Keyword(s):  
Systematic Approach ◽  
Lung Ultrasound ◽  
High Sensitivity ◽  
Descriptive Statistics ◽  
X Rays ◽  
Single Center ◽  
X Ray ◽  
Ambulatory Patients ◽  
Chest X Ray

Background: Lung ultrasound (LUS) has a good performance with a high sensitivity and specificity for the diagnosis of pneumonia compared with chest X-ray, and it has been extensively used to assess patients during the COVID-19 pandemic. This study aims to evaluate the potential advantages of the regular use of LUS for the assessment of the severity and prognosis of COVID-19 pneumonia and to propose an adapted protocol with its inclusion in current local validated and published guidelines.Methods: This is a single-center prospective study conducted during the first (April–May 2020) and second (October 2020–January 2021) waves of the SARS-CoV2 pandemic in Switzerland. All adult patients presenting to dedicated test centers with a suspicion of mild-to-moderate COVID-19 pneumonia and not requiring hospitalization at the time of diagnosis were included. Patients with confirmed COVID-19 pneumonia were referred to an ambulatory follow-up unit at our institution for reassessment, with the inclusion of the use of LUS in a random selection. Descriptive statistics were calculated for demographics using percentages, means, and standard deviations according to the distribution of variables.Results: Eighty-eight ambulatory patients with a confirmed COVID-19 pneumonia were included (men = 57 [59%]; mean age, 52.1 ± 13.5 years). Among these, 19 (21%) were hospitalized and none died. Twenty-five lung assessments by ultrasound were performed during the follow-up consultation. All were consistent with the clinical examination and confirmed the clinician's opinion.Conclusion: The use of a standardized pleuro-pulmonary ultrasound protocol for ambulatory patients with COVID-19 could help to reduce the use of chest X-rays and improve overall management at the time of referral and eventual follow-up. However, a specific study including LUS in a systematic approach should be performed to evaluate the outcome of patients according to findings.

scholarly journals Effectiveness of Lung Ultrasound in Comparison with Chest X-Ray in Diagnosis of Lung Consolidation

2019 ◽  
Vol 7 (15) ◽  
pp. 2457-2461
Author(s):  
Youssef Ibrahim Haggag ◽  
Karim Mashhour ◽  
Kamal Ahmed ◽  
Nael Samir ◽  
Waheed Radwan
Keyword(s):  
Lung Ultrasound ◽  
Community Acquired Pneumonia ◽  
P Value ◽  
Initial Examination ◽  
X Ray ◽  
Chest Ultrasound ◽  
Lung Consolidation ◽  
Plain Chest ◽  
Chest X Ray

BACKGROUND: Lung ultrasound (US) is an available and inexpensive tool for the diagnosis of community-acquired pneumonia (CAP); it which has no hazards of radiation and can be easily used. AIM: To evaluate the efficacy of lung ultrasound in the diagnosis and follow-up of CAP. PATIENTS AND METHODS: 100 patients aged from 40 to 63 years with a mean age of 52.3 ± 10 years admitted to the Critical Care Department, Cairo University with pictures of CAP. Lung US was performed for all patients initially, then a plain chest X-ray (CXR) was performed. Another lung ultrasound was performed on the 10th day after admission. RESULTS: Initial chest X-ray was correlated with the initial chest ultrasound examination in CAP diagnosis (R-value = 0.629, P < 0.001). Cohen's κ was run to determine if there is an agreement between the findings of the initial chest X-ray findings and those of the initial chest ultrasound in CAP diagnosis. A moderate agreement was found where κ = .567 (95% CI, 0.422 to 0.712) and P < 0.001. Upon initial examination, the CXR diagnosed CAP in 48.0% of patients, while lung US diagnosed the disease in 70% of patients. Moreover, lung US was more sensitive than CXR (P-value < 0.001). Compared to the accuracy of computed tomography (CT) chest (100%) which is the gold standard for CAP diagnosis, the accuracy of lung US was 95.0%, while the accuracy of CXR was 81.0%. CONCLUSION: This study proved the effectiveness of lung ultrasound in CAP diagnosis.

scholarly journals Chest X-Ray findings and visual quantitative assessment of COVID-19 pneumonia

2020 ◽  
Author(s):  
Michaela Cellina ◽  
Marcello Orsi ◽  
Marta Panzeri ◽  
Giulia van der Byl ◽  
Giancarlo Oliva
Keyword(s):  
Severity Score ◽  
Quantitative Assessment ◽  
X Rays ◽  
Imaging Findings ◽  
Rt Pcr ◽  
Disease Evolution ◽  
X Ray ◽  
Radiological Score ◽  
Chest X Ray

Abstract AimTo assess the most common chest X-Ray findings and distribution in patients with confirmed diagnosis of COVID-19; to verify the repeatability of a radiological severity score, based on visual quantitative assessment; to assess the evolution of chest X-Ray findings at follow-up; to evaluate chest X-Ray sensitivity.MethodsWe analysed chest X-Rays at baseline of 110 consecutive COVID-19 patients (79 males, 31 females; mean age: 64±16 years) with RT-PCR confirmation, who presented to our ED.Two radiologists evaluated the imaging findings and distribution.A severity score, based on the extension of lung abnormalities, was assigned by two other radiologists, independently, to the baseline and follow-up X-Rays, executed in 77/110 cases; interobserver agreement was calculated. Chest X-Ray sensitivity was assessed, with RT-PCR as gold standard.ResultsInterobserver agreement was excellent for baseline and follow-up X-Rays (Cohen's K=0.989, p<0.001, Cohen's K=0.985, p<0.001, respectively). The mean score at baseline was 2.87±1.7 for readers 1 and 2. We observed radiological worsening in 52/77 (67%) patients, with significantly higher scores at follow-up (mean score: 4.27±2.15 for reader 1 and 4.28±2.14 for reader 2, respectively); p<0.001.Ground glass opacities were the most common findings (97/110, 88%). Abnormalities showed bilateral involvement in 67/110 (61%), with prevalent peripheral distribution (48/110, 43.5%).The X-Ray sensitivity for the detection of COVID-19 infection was 91%.ConclusionChest X-Ray highlighted imaging findings in line with those previously reported for chest CT. The use of a radiological score can result in clearer communication with Clinicians and a more precise assessment of disease evolution.

Lung Ultrasound versus Chest X-Ray for the Detection of Fluid Overload in Critically Ill Children: A Systematic Review

2021 ◽  
Author(s):  
Emily Schapka ◽  
Jerica Gee ◽  
John W. Cyrus ◽  
Gregory Goldstein ◽  
Kara Greenfield ◽  
...  
Keyword(s):  
Systematic Review ◽  
Critically Ill ◽  
Lung Ultrasound ◽  
Fluid Overload ◽  
Volume Overload ◽  
High Sensitivity ◽  
Critically Ill Children ◽  
Eligibility Criteria ◽  
X Ray ◽  
Chest X Ray

AbstractFluid overload is a common complication of critical illness, associated with increased morbidity and mortality. Pulmonary fluid status is difficult to evaluate clinically and many clinicians utilize chest X-ray (CXR) to identify fluid overload. Adult data have shown lung ultrasound (LUS) to be a more sensitive modality. Our objective was to determine the performance of LUS for detecting fluid overload, with comparison to CXR, in critically ill children. We conducted a systematic review using multiple electronic databases and included studies from inception to November 15, 2020. The sensitivity and specificity of each test were evaluated. Out of 1,209 studies screened, 4 met eligibility criteria. Overall, CXR is reported to have low sensitivity (44–58%) and moderate specificity (52–94%) to detect fluid overload, while LUS is reported to have high sensitivity (90–100%) and specificity (94–100%). Overall, the quality of evidence was moderate, and the gold standard was different in each study. Our systematic review suggests LUS is more sensitive and specific than CXR to identify pulmonary fluid overload in critically ill children. Considering the clinical burden of fluid overload and the relative ease of obtaining LUS, further evaluation of LUS to diagnose volume overload is warranted.

scholarly journals Lung Ultrasound in COVID-19 pandemic: Why? How? And When?

2020 ◽  
pp. 3-12
Author(s):  
Khrystyna Pronyuk ◽  
Andriy Vysotskyi
Keyword(s):  
Critically Ill ◽  
Computer Tomography ◽  
Critically Ill Patients ◽  
Clinical Decision Making ◽  
Lung Ultrasound ◽  
Clinical Decision ◽  
X Rays ◽  
Lung Involvement ◽  
X Ray ◽  
Chest X Ray

During COVID-19 pandemic Lung ultrasound has rapidly become a tool for diagnosis and monitoring of lung involvement and it’s severity. Accurate evaluation of lung pathologic entities at the bedside, especially in critically ill patients, and those on mechanical ventilation, remains problematic. CT should not be frequently repeated and is not available everywhere, especially for critically ill patients. Limitations of bedside chest X-ray have been well described and lead to poor-quality X-ray films with low sensitivity.The lung ultrasound has been shown to be a useful tool in intensive care patients with adult respiratory distress syndrome (ARDS) and can be used forassessing severity of lung involvement in COVID-19. In this paper the accuracy of bedside LUS, chest X-ray and computer tomography are compared based on clinical cases, typical for COVID-19 lung ultrasound appearance is evaluated. There have been shown that lung ultrasound can predict the deterioration of the patient's conditionand can be used for risk stratification and clinical decision making, reducethe use of both chest x‐rays and computer tomography, what is very important especially in limited resources settings.

scholarly journals Chest X-Ray Findings and Temporal Lung Changes in Patients with COVID-19 Pneumonia

2020 ◽  
Author(s):  
Liqa A Rousan ◽  
Eyhab Elobeid ◽  
Musaab Karrar ◽  
Yousef Khader
Keyword(s):  
Ct Scan ◽  
Chest Ct ◽  
Common Finding ◽  
X Rays ◽  
Radiographic Findings ◽  
X Ray ◽  
Abnormal Chest ◽  
Chest X Ray ◽  
Chest Ct Scan

Abstract Background: Chest CT scan and chest x-rays show characteristic radiographic findings in patients with COVID-19 pneumonia. Chest x-ray can be used in diagnosis and follow up in patients with COVID-19 pneumonia. The study aims at describing the chest x-ray findings and temporal radiographic changes in COVID-19 patients.Methods: From March 15 to April 20, 2020 patients with positive reverse transcription polymerase chain reaction (RT-PCR) for COVID-19 were retrospectively studied. Patients’ demographics, clinical characteristics, and chest x-ray findings were reported. Radiographic findings were correlated with the course of the illness and patients’ symptoms.Results: A total of 88 patients (50 (56.8%) females and 38 (43.2%) males) were admitted to the hospital with confirmed COVID-19 pneumonia. Their age ranged from 3-80 years (35.2 ±18.2 years). 48/88 (45%) were symptomatic, only 13/88 (45.5%) showed abnormal chest x-ray findings. A total of 190 chest x-rays were obtained for the 88 patients with a total of 59/190 (31%) abnormal chest x-rays. The most common finding on chest x-rays was peripheral ground glass opacities (GGO) affecting the lower lobes. In the course of illness, the GGO progressed into consolidations peaking around 6-11 days (GGO 70%, consolidations 30%). The consolidations regressed into GGO towards the later phase of the illness at 12-17 days (GGO 80%, consolidations 10%). There was increase in the frequency of normal chest x-rays from 9% at days 6- 11 up to 33% after 18 days indicating a healing phase. The majority (12/13, 92.3%) of patients with abnormal chest x-rays were symptomatic (P=0.005).Conclusion: The chest x-ray findings were similar to those reported on chest CT scan in patients with COVID-19, Chest x-ray can be used in diagnosis and follow up in patients with COVID-19 pneumonia.

scholarly journals Limitations of bedside lung ultrasound in neonatal lung diseases

2021 ◽  
Author(s):  
Xiaolei Liu ◽  
Shuyu Si ◽  
Yiyi Guo ◽  
Hui Wu
Keyword(s):  
Lung Diseases ◽  
Neonatal Intensive Care ◽  
Lung Ultrasound ◽  
Clinical Symptoms ◽  
Low Cost ◽  
High Sensitivity ◽  
Ct Scanning ◽  
X Ray ◽  
Neonatal Lung ◽  
Chest X Ray

Lung ultrasound is a technique that has rapidly developed in recent years. It is a low-cost, radiation-free, and easy-to-operate tool that can be repeatedly performed at the bedside. Compared to chest X-ray, lung ultrasound has high sensitivity and specificity in the diagnosis of neonatal respiratory distress syndrome, transient tachypnoea of newborns and pneumothorax. Lung ultrasound has been widely used in neonatal intensive care units. However, it has limitations in some other lung diseases and cannot fully substitute for chest X-ray or CT. This review describes these limitations in detail and highlights that if clinical symptoms are not effectively alleviated after medical treatment or the clinical presentation is not compatible with the ultrasound appearances, then chest X-ray or CT scanning should be performed to avoid misdiagnosis and mistreatment.

Hemodialysis Catheter Insertion Without Chest X-Ray: Review of a 24-Month Study

2018 ◽  
Vol 23 (4) ◽  
pp. 216-220
Author(s):  
Chuck Ramirez ◽  
Shannon Miranda ◽  
Erica Sager
Keyword(s):  
Acute Care ◽  
Catheter Insertion ◽  
Catheter Placement ◽  
Positioning System ◽  
X Rays ◽  
X Ray ◽  
Hemodialysis Catheter ◽  
Dual Vector ◽  
Chest X Ray

Abstract Acute care hemodialysis catheters have traditionally been validated for use through chest X-ray interpretation. This study was implemented to evaluate if hemodialysis catheters can be placed safely and accurately, utilizing an electrocardiogram plus doppler or dual vector positioning system to validate for use. Over a 24-month period hemodialysis catheters were inserted and validated by utilizing a dual vector positioning system instead of chest X-ray. During the study period, 260 hemodialysis catheters were inserted without chest X-ray and validated for use via the dual vector positioning system. An additional 74 inserted catheters required follow-up chest X-rays because of failure to obtain technological validation. During the study period, no patients had a pneumothorax or hemothorax complication subsequent to catheter placement. The use of a dual vector positioning system in this study demonstrated optimal hemodialysis catheter insertion can be done with no X-ray and no increase in mechanical complications.

scholarly journals Chest x-ray findings and temporal lung changes in patients with COVID-19 pneumonia

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Liqa A. Rousan ◽  
Eyhab Elobeid ◽  
Musaab Karrar ◽  
Yousef Khader
Keyword(s):  
Common Finding ◽  
X Rays ◽  
Radiographic Findings ◽  
Course Of Illness ◽  
X Ray ◽  
Abnormal Chest ◽  
Healing Phase ◽  
Normal Chest ◽  
Chest X Ray

Abstract Background Chest CT scan and chest x-rays show characteristic radiographic findings in patients with COVID-19 pneumonia. Chest x-ray can be used in diagnosis and follow up in patients with COVID-19 pneumonia. The study aims at describing the chest x-ray findings and temporal radiographic changes in COVID-19 patients. Methods From March 15 to April 20, 2020 patients with positive reverse transcription polymerase chain reaction (RT-PCR) for COVID-19 were retrospectively studied. Patients’ demographics, clinical characteristics, and chest x-ray findings were reported. Radiographic findings were correlated with the course of the illness and patients’ symptoms. Results A total of 88 patients (50 (56.8%) females and 38 (43.2%) males) were admitted to the hospital with confirmed COVID-19. Their age ranged from 3 to 80 years (35.2 ± 18.2 years). 48/88 (45%) were symptomatic, only 13/88 (45.5%) showed abnormal chest x-ray findings. A total of 190 chest x-rays were obtained for the 88 patients with a total of 59/190 (31%) abnormal chest x-rays. The most common finding on chest x-rays was peripheral ground glass opacities (GGO) affecting the lower lobes. In the course of illness, the GGO progressed into consolidations peaking around 6–11 days (GGO 70%, consolidations 30%). The consolidations regressed into GGO towards the later phase of the illness at 12–17 days (GGO 80%, consolidations 10%). There was increase in the frequency of normal chest x-rays from 9% at days 6–11 up to 33% after 18 days indicating a healing phase. The majority (12/13, 92.3%) of patients with abnormal chest x-rays were symptomatic (P = 0.005). Conclusion Almost half of patients with COVID-19 have abnormal chest x-ray findings with peripheral GGO affecting the lower lobes being the most common finding. Chest x-ray can be used in diagnosis and follow up in patients with COVID-19 pneumonia.

Diagnostic value of ultrasound in cases of pneumonia admitted at intensive care unit: A comparative study with chest x-ray

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Sherif Farouk Ibrahim ◽  
Waleed Abdalla Ibrahim ◽  
Hossam Mohamed Khalaf Ahmed
Keyword(s):  
Lung Ultrasound ◽  
Acute Infection ◽  
Retrospective Chart Review ◽  
Diagnostic Algorithm ◽  
High Sensitivity ◽  
Diagnostic Value ◽  
Adequate Treatment ◽  
X Ray ◽  
Diagnostic Uncertainty ◽  
Chest X Ray

Abstract Background Pneumonia is consistently among the leading causes of morbidity and mortality worldwide. Defined as acute infection of the lung parenchyma, it is caused by a wide variety of microorganisms, including bacteria, viruses, and fungi. However, pneumonia is often misdiagnosed even now. Early and effective antibiotic treatment is important. An adequate treatment is thus reliant on an early diagnosis of pneumonia, yet the diagnosis is not always clear at presentation to the emergency department (ED). In a retrospective chart review of patients admitted with pneumonia, 22% of patients presented some reason for diagnostic uncertainty that could result in delayed antibiotics delivery. Objective The aim of the study was to evaluate the efficacy of LUS in the diagnosis of pneumonia. Methods This is a prospective observational study which was conducted on 36 consecutive patients with suspected pneumonia. All patients were admitted to the Hospital, in the period from May 2019 to January 2020. Results Chest x-ray diagnosed pneumonia in 66.7% of patients, while lung U/S diagnosed pneumonia in 75% of patients. Lung ultrasound was more sensitive and highly specific for diagnosis of pneumonia as sensitivity and specificity of lung ultrasound was 96.3% and 88.9% respectively while for chest xray was 81.5% and 77.8% respectively. Accuracy of lung ultrasound was 94.4% and that of chest x-ray was 80.6% in relation to CT chest the gold standard with accuracy 100%. Superiority of lung US findings over CXR findings could be explained by high sensitivity & specificity of lung US in diagnosing pneumonia in comparison with chest x ray as high resolution CT is a gold standred for the study. Conclusion LUS is a sensitive and highly specific diagnostic tool in pneumonia. Therefore, we hypothesize that Lung US may be considered as the first imaging test inpatients with suspicion of pneumonia. It should be noted, however, that the ability of LUS to detect lung consolidations located in peri-hilar regions is limited. A diagnostic algorithm of pneumonia which includes Lung US should be validated in prospective studies. Monitoring there solution of pneumonia can be another application of Lung US inpatients with pneumonia.

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