Using Lung Point-of-care Ultrasound in Suspected COVID-19: Case Series and Proposed Triage Algorithm

Introduction: First detected in December 2019, the severe acute respiratory syndrome coronavirus 2 pandemic upended the global community in a few short months. Diagnostic testing is currently limited in availability, accuracy, and efficiency. Imaging modalities such as chest radiograph (CXR), computed tomography, and lung ultrasound each demonstrate characteristic findings of coronavirus disease 2019 (COVID-19). Lung ultrasound offers benefits over other imaging modalities including portability, cost, reduced exposure of healthcare workers as well as decreased contamination of equipment such as computed tomography scanners. Case Series: Here we present a case series describing consistent lung ultrasound findings in patients with confirmed COVID-19 despite variable clinical presentations and CXR findings. We discuss a triage algorithm for clinical applicability and utility of lung point-of-care ultrasound in the setting of COVID-19 and advocate for judicious and targeted use of this tool. Conclusion: Lung point-of-care ultrasound can provide valuable data supporting diagnostic and triage decisions surrounding suspected cases of COVID-19. Prospective studies validating our proposed triage algorithm are warranted.

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Interstitial syndrome-lung ultrasound B lines: a potential marker for pulmonary metastases? A case series

Italian Journal of Medicine ◽

10.4081/itjm.2018.1009 ◽

2018 ◽

Vol 12 (3) ◽

pp. 223-226 ◽

Cited By ~ 1

Author(s):

Maria Viviana Carlino ◽

Costantino Mancusi ◽

Giovanni De Simone ◽

Filomena Liccardi ◽

Mario Guarino ◽

...

Keyword(s):

Lung Ultrasound ◽

Pulmonary Metastases ◽

Lung Metastases ◽

Point Of Care ◽

Case Series ◽

Point Of Care Ultrasound ◽

Interstitial Syndrome ◽

Potential Marker ◽

Bilateral Lung ◽

Enhanced Computed Tomography

Four patients presented to the Emergency Department with dyspnea and they underwent point-of-care ultrasound. Lung ultrasound showed a diffuse bilateral B-profile pattern-interstitial syndrome, they underwent contrast-enhanced computed tomography scan of thorax that showed multiple bilateral lung metastases. The detection, in a dyspneic patient, of a diffuse Bprofile pattern not attributable to traditional interstitial syndrome conditions (pulmonary fibrosis, acute respiratory distress syndrome, acute pulmonary edema, interstitial pneumonia) could be indicative of multiple pulmonary metastases.

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The Role of Lung Ultrasound Before and During the COVID-19 Pandemic: A review article

Current Medical Imaging Formerly Current Medical Imaging Reviews ◽

10.2174/1573405617666211006122842 ◽

2021 ◽

Vol 17 ◽

Author(s):

Mustafa J. Musa ◽

Mohamed Yousef ◽

Mohammed Adam ◽

Awadalla Wagealla ◽

Lubna Boshara ◽

...

Keyword(s):

Lung Ultrasound ◽

Point Of Care ◽

Power Doppler ◽

Doppler Imaging ◽

Point Of Care Ultrasound ◽

Institute Of Medicine ◽

Pubmed Central ◽

Contrast Enhanced ◽

Ultrasound Findings

: Lung ultrasound [LUS] has evolved considerably over the last years. The aim of the current review is to conduct a systematic review reported from a number of studies to show the usefulness of [LUS] and point of care ultrasound for diagnosing COVID-19. A systematic search of electronic data was conducted including the national library of medicine, and the national institute of medicine, PubMed Central [PMC] to identify the articles depended on [LUS] to monitor COVID-19. This review highlights the ultrasound findings reported in articles before the pandemic [11], clinical articles before COVID-19 [14], review studies during the pandemic [27], clinical cases during the pandemic [5] and other varying aims articles. The reviewed studies revealed that ultrasound findings can be used to help in the detection and staging of the disease. The common patterns observed included irregular and thickened A-lines, multiple B-lines ranging from focal to diffuse interstitial consolidation, and pleural effusion. Sub-plural consolidation is found to be associated with the progression of the disease and its complications. Pneumothorax was not recorded for COVID-19 patients. Further improvement in the diagnostic performance of [LUS] for COVID-19 patients can be achieved by using elastography, contrast-enhanced ultrasound, and power Doppler imaging.

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Early Multi-organ Point-of-Care Ultrasound Evaluation of Respiratory Distress During SARS-CoV-2 Outbreak: Case Report

Clinical Practice and Cases in Emergency Medicine ◽

10.5811/cpcem.2020.4.47524 ◽

2020 ◽

Vol 4 (2) ◽

Author(s):

Robert Farrow ◽

Graham Becherer-Bailey ◽

Daniel Mantuani ◽

Arun Nagdev

Keyword(s):

Emergency Department ◽

Case Report ◽

Respiratory Distress ◽

Clinical Decision Making ◽

Lung Ultrasound ◽

Point Of Care ◽

Case Series ◽

Disease Process ◽

Point Of Care Ultrasound ◽

Care Assessment

Introduction: Coronavirus disease 2019 (COVID-19) is caused by the virus known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Several case series from Italy and China have highlighted the lung ultrasound findings of this disease process and may demonstrate its clinical utility during the current pandemic. Case Report: We present a case of a COVID-19 patient who presented to the emergency department twice within a 24-hour period with rapidly progressing illness. A multi-organ point-of-care ultrasound (POCUS) evaluation was used on the return visit and assisted clinical decision-making. Discussion: A multi-organ POCUS exam allows for quick assessment of acute dyspnea in the emergency department. As the lung involvement of COVID-19 is primarily a peripheral process it is readily identifiable via lung ultrasound. We believe that when applied efficiently and safely a POCUS exam can reduce clinical uncertainty and potentially limit the use of other imaging modalities when treating patients with COVID-19. Conclusion: This case highlights the utility of an early multiorgan point-of-care assessment for patients presenting with moderate respiratory distress during the severe SARS-CoV-2 pandemic.

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Abnormal Lung Point-of-Care Ultrasound (POCUS) in Suspected Cases of COVID-19 pneumonia with Normal Plain Chest Radiographs – A Case Series

Acute Medicine Journal ◽

10.52964/amja.0822 ◽

2020 ◽

Vol 19 (3) ◽

pp. 162-167

Author(s):

Daniel Owen Mort ◽

◽

Dipraj Limbu ◽

Joseph Nunan ◽

Andrew P. Walden ◽

...

Keyword(s):

Lung Ultrasound ◽

Point Of Care ◽

Case Series ◽

Chest Radiographs ◽

Nasopharyngeal Swab ◽

Point Of Care Ultrasound ◽

Testing Strategy ◽

Plain Chest ◽

Timely Access ◽

Diagnostic Role

COVID-19 pneumonia produces a heterogeneous array of clinical, biochemical, and radiological findings. Over the last few months of global hurry to optimize a testing strategy, it has been suggested that bedside point-of-care lung ultrasound may have a diagnostic role. We present 3 patients with RT-PCR nasopharyngeal swab-confirmed COVID-19 pneumonia, who had an admission plain chest film reported to be normal by a consultant radiologist, but with significant sonographic abnormalities on bedside ultrasound performed within 24 hours of the chest radiograph. Lung ultrasound may better correlate with the oxygen requirement and overall condition of the patient than chest radiographs – a pertinent consideration given the imminent advance of the pandemic into resource-poor zones where timely access to roentgenological imaging may be sparse.

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Computed tomography and point‐of‐care ultrasound findings in 2 COVID‐19 patients

Journal of the American College of Emergency Physicians Open ◽

10.1002/emp2.12080 ◽

2020 ◽

Vol 1 (3) ◽

pp. 309-311 ◽

Cited By ~ 2

Author(s):

Kevin R. Roth ◽

Joseph B. Zackary ◽

Lauren M. Crowley ◽

Marna Rayl Greenberg

Keyword(s):

Computed Tomography ◽

Point Of Care ◽

Point Of Care Ultrasound ◽

Ultrasound Findings

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Signs and lines in lung ultrasound

Journal of Ultrasonography ◽

10.15557/jou.2021.0036 ◽

2021 ◽

Vol 21 (86) ◽

pp. e225-e233

Author(s):

Rohit Bhoil ◽

◽

Ajay Ahluwalia ◽

Rajesh Chopra ◽

Mukesh Surya ◽

...

Keyword(s):

Critical Care ◽

Pleural Effusion ◽

Lung Ultrasound ◽

Point Of Care ◽

Point Of Care Ultrasound ◽

Colour Doppler ◽

Lung Density ◽

Pathological Conditions ◽

B Lines ◽

Lung Point

Point-of-care ultrasound has become firmly established in acute and critical care settings, and is now increasingly being used as an important tool in the assessment of the lungs. In this article, we briefly describe the technique of lung ultrasound and the various lines and signs commonly encountered during sonography of the lung, namely the normally visualised A- and T-lines and the bat sign, sliding sign (power slide sign on colour Doppler), sea-shore sign, curtain sign, and the lung pulse. We have also described signs seen in various pathological conditions like B-lines seen in cases of increased lung density; the quad sign, sinusoid sign, thoracic spine sign, plankton sign and the jelly fish sign seen in pleural effusion; the stratosphere sign and the lung point sign seen in pneumothorax; the shred/fractal sign and tissue-like sign in consolidation, and the double lung point sign seen in transient tachypnoea of the newborn. With adequate and appropriate training, lung ultrasound can be effectively utilised as a pointof-care investigation.

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Diagnostic accuracy of point-of-care ultrasound for pulmonary tuberculosis: A systematic review

PLoS ONE ◽

10.1371/journal.pone.0251236 ◽

2021 ◽

Vol 16 (5) ◽

pp. e0251236

Author(s):

Jacob Bigio ◽

Mikashmi Kohli ◽

Joel Shyam Klinton ◽

Emily MacLean ◽

Genevieve Gore ◽

...

Keyword(s):

Systematic Review ◽

Diagnostic Accuracy ◽

Lung Ultrasound ◽

Point Of Care ◽

Risk Of Bias ◽

Reference Standards ◽

Sputum Smear ◽

Smear Microscopy ◽

Point Of Care Ultrasound ◽

Ultrasound Findings

The advent of affordable, portable ultrasound devices has led to increasing interest in the use of point-of-care ultrasound (POCUS) for the detection of pulmonary TB (PTB). We undertook a systematic review of the diagnostic accuracy of POCUS for PTB. Five databases were searched for articles published between January 2010 and June 2020. Risk of bias was assessed using QUADAS-2. Data on sensitivity and specificity of individual lung ultrasound findings were collected, with variable reference standards including PCR and sputum smear microscopy. Six of 3,919 reviewed articles were included: five in adults and one in children, with a total sample size of 564. Studies had high risk of bias in many domains. In adults, subpleural nodule and lung consolidation were the lung ultrasound findings with the highest sensitivities, ranging from 72.5% to 100.0% and 46.7% to 80.4%, respectively. Only one study reported specificity data. Variability in sensitivity may be due to variable reference standards or may imply operator dependence. There is insufficient evidence to judge the diagnostic accuracy of POCUS for PTB. There is also no consensus on the optimal protocols for acquiring and analysing POCUS images for PTB. New studies which minimise potential sources of bias are required to further assess the diagnostic accuracy of POCUS for PTB.

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Multi-organ point-of-care ultrasound for COVID-19 (PoCUS4COVID): international expert consensus

Critical Care ◽

10.1186/s13054-020-03369-5 ◽

2020 ◽

Vol 24 (1) ◽

Author(s):

Arif Hussain ◽

Gabriele Via ◽

Lawrence Melniker ◽

Alberto Goffi ◽

Guido Tavazzi ◽

...

Keyword(s):

Lung Ultrasound ◽

Expert Panel ◽

Point Of Care ◽

Expert Consensus ◽

Future Research ◽

Point Of Care Ultrasound ◽

The Past ◽

Modified Delphi ◽

Grade Methodology

AbstractCOVID-19 has caused great devastation in the past year. Multi-organ point-of-care ultrasound (PoCUS) including lung ultrasound (LUS) and focused cardiac ultrasound (FoCUS) as a clinical adjunct has played a significant role in triaging, diagnosis and medical management of COVID-19 patients. The expert panel from 27 countries and 6 continents with considerable experience of direct application of PoCUS on COVID-19 patients presents evidence-based consensus using GRADE methodology for the quality of evidence and an expedited, modified-Delphi process for the strength of expert consensus. The use of ultrasound is suggested in many clinical situations related to respiratory, cardiovascular and thromboembolic aspects of COVID-19, comparing well with other imaging modalities. The limitations due to insufficient data are highlighted as opportunities for future research.

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