COVID-19 Clinical Care: For Poorer Countries With Hospitals Lacking CT Scan Machines, Lung Ultrasound Can Be Used To Show Duration, Severity Of COVID-19
COVID-19 Clinical Care
: A recent study published in American Journal of Roentgenology (AJR),indicates that lung ultrasound (US) was highly sensitive for detecting abnormalities in patients with COVID-19 disease, with B-lines, a thickened pleural line, and pulmonary consolidation the most commonly observed features. https://www.ajronline.org/doi/10.2214/AJR.20.23513
The usage of lung ultrasound to check and assess COVID-19 status could be useful for poorer countries which have hospitals that lack CT Scan machines due to the high costs involved. Most ultrasound machines are only a fraction of the cost of a CT Scan machine.
A and B, Lung ultrasound images obtained with convex (A) and linear (B) probes. Multiple confluent B-lines (arrows), patchy pulmonary consolidation (asterisk, B), and thickened pleural line (between arrowheads, A) are visualized. C, Chest CT image shows reticular and interlobular septal thickening and patchy, focal opacities associated with architectural distortion. This patient was classified in critical group and was assigned to severe group for statistical analysis. Credit: American Journal of Roentgenology (AJR)
Dr Yao Zhang from the department of ultrasound at China's Beijing Ditan Hospital and lead researcher told Thailand Medical News, "Our results indicate that lung ultrasound findings can be used to reflect both the infection duration and disease severity."
During the period from March 3 to March 30, 2020, Dr Zhang and colleagues performed lung ultrasounds on consecutive patients with positive reverse transcriptase polymerase chain reaction (RTPCR) test results for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), using the Fisher exact test to compare the percentages of patients with each ultrasound finding between groups with different symptom durations and disease severity.
It was found that all 28 patients (14 men and 14 women; age range, 21-92 years) had positive findings on both lung ultrasound and chest CT. On ultrasound, B-lines were present in 100% of patients, and 19 (67.9%) patients had pulmonary consolidation. Thickened pleural lines were observed in 17 patients (60.7%), and only one patient (3.6%) showed a small amount of pleural effusion.
Dr Zhang added, "A thickened pleural line was more frequently observed on ultrasound in patients with longer time intervals after the initial onset of symptoms. However pulmonary consolidations visualized as tissue-like hypoechoic regions, reflecting highly reduced air flow and increased quantity of inflammatory cellular exudate were more common in severe and critical cases.
The study team said that compared to CT, ultrasound is portable, less costly, and does not use radiation, making ultrasound a useful tool for triage, particularly in pre-hospital/outpatient settings, and severity stratification and monitoring, especially for critically ill patients who may be challenging to transport and require careful ventilation management.
Dr Zhang further added that portable radiography could be just as useful in evaluating a patient COVID-19 status using either a "a bedside portable, handheld ultrasound system or even a robot-assisted tele-US system (a unique technique for physicians to remotely scan patients) and it further minimizes the number of health care workers and medical devices exposed to COVID-19.
The study team also proposed that severity scoring for lung ultrasound, similar to CT severity scores, should be developed to facilitate more accurate comparisons in future studies.
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