Point of care lung ultrasound is a useful tool to diagnose Covid-19 pneumonia, according to a retrospective multicenter observational study of patients admitted to the Emergency Department (ED).1This study included 479 patients, who presented to four different EDs in Italy, Portugal and Spain with symptoms suggestive of Covid-19. Many of these patients also had comorbid conditions including COPD, congestive heart failure and diabetes increasing their risk for Covid-19. Along with physical e...
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Point of care lung ultrasound as a diagnostic tool for Covid-19 pneumonia
Dr Surya Kant Professor and Head Department of Respiratory Medicine, KGMU ,UP, Lucknow; National Vice Chairman IMA-AMS., 22 January 2022 #Multispeciality
Point of care lung ultrasound is a useful tool to diagnose Covid-19 pneumonia, according to a retrospective multicenter observational study of patients admitted to the Emergency Department (ED).1
This study included 479 patients, who presented to four different EDs in Italy, Portugal and Spain with symptoms suggestive of Covid-19. Many of these patients also had comorbid conditions including COPD, congestive heart failure and diabetes increasing their risk for Covid-19. Along with physical examination, a lung ultrasound in the ED was performed by the trained emergency physician before a conventional chest x-ray was done or while waiting for the report. The chest x-ray was reported by the ED radiologist. The data was collected retrospectively.
Out of the 479 patients included in the study, 87% were diagnosed with Covid-19.
In Covid-positive patients, the most common findings on lung ultrasound were B-lines seen in 80.1% patients, irregular pleural lines in 59.2% patients and small sub-pleural consolidations in 55.3% patients. When the lung US findings were analyzed in relation to the molecular test results for Covid, only B lines and small sub-pleural consolidation were found to be associated with positive test results, while effusions and irregular pleural lines showed no such association. Irregular pleural lines are common in patients with COVID-19 pneumonia, but they are not a pathognomonic finding. However, only 59% of Covid-positive patients had sub-pleural consolidations. Hence, absence of sub-pleural consolidations alone cannot be used to rule out COVID-19 infection with pulmonary involvement, according to the researchers.
Chest x-ray was normal in nearly 18% of patients, while ground glass, interstitial pattern and small consolidations were reported in 31.6%, 59.7% and 18.6% patients, respectively. Ground glass appearance, pleural effusions and small consolidations were found to be significantly correlated with positive Covid-19 test, while the presence of interstitial pattern and normal chest x-ray did not.
High-resolution computed tomography (HRCT) chest is routinely done to diagnose Covid-19 pneumonia and also to monitor its progression or resolution. It has often been used as a screening test for Covid-19. But it is an expensive test and is also associated with risk of exposure to radiation when used indiscriminately. Moreover, it often cannot be relied upon when there is a surge in cases, when rapid examination and triaging is crucial.
The present study has demonstrated the comparable accuracy of lung ultrasound and chest x-ray in diagnosing Covid-19 pneumonia. The presence of B lines and small subpleural consolidation on lung ultrasound and ground glass appearance, small consolidations, and pleural effusion on chest x-ray had a significant correlation with positive test for COVID-19.
Based on their observations, the study authors suggest point of care lung ultrasound as a low-cost alternative to the more expensive HRCT with added advantages of accuracy and no radiation exposure. Its disinfection is also easy. Besides serving as a diagnostic tool, it is also useful in prognostication of patients.
Costantino Caroselli, et al. Early lung ultrasound findings in patients with COVID-19 pneumonia: a retrospective multicenter study of 479 patients. J Ultrasound Med. 2022 Jan 18. doi: 10.1002/jum.15944. Online ahead of print.
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