Lung Ultrasound Findings in Patients with COVID-19

Our plain-English summary of Lung Ultrasound Findings in Patients with COVID-19, by D.T. Marggrander, F. Borgans, V. Jacobi, et al (SN Comprehensive Clinical Medicine, 2020).

The study

• Authors: D.T. Marggrander, F. Borgans, V. Jacobi, H. Neb, T. Wolf
• Journal: SN Comprehensive Clinical Medicine
• Published: 2020;2(11):2151-2157
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

The current SARS-CoV-2 outbreak leads to a growing need of point-of-care thoracic imaging that is compatible with isolation settings and infection prevention precautions. We retrospectively reviewed 17 COVID-19 patients who received point-of-care lung ultrasound imaging in our isolation unit. Lung ultrasound was able to detect interstitial lung disease effectively; severe cases showed bilaterally distributed B-Lines with or without consolidations; one case showed bilateral pleural plaques. Corresponding to CT scans, interstitial involvement is accurately depicted as B-Lines on lung ultrasound. Lung ultrasound might be suitable for detecting interstitial involvement in a bedside setting under high security isolation precautions.

© The Author(s) 2020.

In plain English

This article was a retrospective case series. The authors were based at University Hospital Frankfurt, Germany. They reviewed bedside lung ultrasound examinations done in their isolation unit on 17 patients who tested positive for SARS-CoV-2 between 6 February and 1 April 2020. Where available, they compared the ultrasound with chest X-ray (13 patients) and chest CT (8 patients). It was a COVID-19 study, not a study of asbestos exposure. Three patients showed no lung abnormalities on ultrasound. In 9 patients the authors found three or more B-Lines, an ultrasound sign of interstitial lung involvement, in at least two rib spaces, always on both sides. Of the 7 patients with an abnormal CT, ultrasound showed corresponding abnormalities in 5. One patient had bilateral pleural plaques that were seen on ultrasound but not on chest X-ray. The authors reported that this patient had no history of exposure to asbestos, silica or other dusts. They described this as, to their knowledge, the first report of pleural plaques associated with COVID-19, but stated they could not conclude whether the viral disease caused them. They concluded that lung ultrasound might be suitable for detecting interstitial involvement at the bedside under isolation precautions.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: retrospective descriptive case series
• Who was studied: 17 patients with COVID-19, aged 30 to 68 years (median 51), examined in the authors' isolation unit (authors based at University Hospital Frankfurt, Germany) between 6 February and 1 April 2020
• Exposure: SARS-CoV-2 infection confirmed by PCR of oral and nasal swabs. Asbestos exposure was not studied. It is mentioned only as absent from the history of the one patient with pleural plaques.
• Main results:
  • Of the 17 patients, 3 showed no lung abnormalities at all on ultrasound.
  • In 9 patients, three or more B-Lines were found in at least two intercostal spaces, always on both sides.
  • These findings of three or more B-Lines in at least two intercostal spaces were seen only in symptomatic patients, never in asymptomatic patients who tested positive.
  • Among the 7 patients whose chest CT was abnormal, ultrasound showed abnormalities corresponding to the CT in 5.
  • Pleural effusion was detected in three patients, and was always small.
  • One patient (a 58-year-old man, per Table 1) had bilateral pleural plaques on ultrasound. These were not seen on chest X-ray. He had no history of exposure to asbestos, silica or other dusts, and no signs of interstitial involvement.
  • The authors called this, to their knowledge, the first report of pleural plaques associated with COVID-19. They stated they could not conclude whether the viral disease caused the plaques.
• The authors' conclusion: The authors concluded that lung ultrasound might be suitable for detecting interstitial involvement at the bedside under high-security isolation precautions.
• Limitations the authors state:
  • The report was very limited, and not every imaging method was performed in every patient, so the authors could not say which method is superior.
  • Lung ultrasound cannot detect abnormalities that do not reach the pleura.
  • Ultrasound is operator-dependent and requires a learning period.
  • The very small consolidations seen in asymptomatic patients may have been pre-existing and unrelated to COVID-19.

Topics

Medical terms in this study, explained in our Lexicon: Ultrasound, Interstitial Lung Disease, Consolidation, Bilateral, Pleural Plaques, CT Scan, Interstitial.

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