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With a lung ultrasound (LUS) the typical findings are interstitial pneumonia. COVID-19 pneumonia is often manifested in sub-pleural areas, which is preferably detected by sonography. An RT-PCR test cannot always ensure a safe differentiation of COVID-19- and non-diseased cases. Clinically challenging is that a reliable and time efficient decision regarding COVID-19 suspects requiring isolation. Therefore, this study was aimed at evaluating the significance of LUS in symptomatic patients with COVID-19 suspicion at hospital admission. A total of 101 patients admitted to a suspect ward with COVID-19-typical symptoms were assessed. All patients received prospectively a standardized LUS at admission. Patients were classified as LUS-positive and -negative cases based on a specific LUS score. The RT-PCR test in combination with the clinical findings served as a reference. Correctly classified were 14/15 COVID-19 diseased suspects as LUS-positive (sensitivity: 93.3%). Twenty-seven out of 61 non-positive cases were classified as false positive with LUS (specificity: 55.7%). In 34/35 patients who were assessed as LUS negative, no COVID-19 disease was detected during the hospitalization. The PPV and NPV of the LUS were 34.1% and 97.1%. LUS is a valuable tool in symptomatic patients for the assessment of COVID-19-disease. The high negative predictive value of LUS is helpful to rule out the disease.

Lung ultrasound (LUS) is a practical tool for lung diagnosis when computer tomography (CT) is not available. Recent findings suggest that LUS diagnosis is highly advantageous because of its mobility and correlation with radiological findings for viral pneumonia. Simple models for both educational evaluation and technical evaluation are needed. Therefore, this work investigates the usability of a large animal model under aspects of LUS features of viral pneumonia using saline one lung flooding. Six pigs were intubated with a double-lumen tube, and the left lung was instilled with saline. During the instillation of up to 12.5 ml/kg, the sonographic features were assessed. All features present during viral pneumonia were found, such as B-lines, white lung syndrome, pleural thickening, and the formation of pleural consolidations. Sonographic findings correlate well with current LUS scores for COVID19. The scores of 1, 2, and 3 were dominantly present at 1-4-, 4-8-, and 8-12-ml/kg saline instillation, respectively. The noninfective animal model can be used for further investigation of the LUS features and can serve in education, by helping with the appropriate handling of LUS in clinical practice during management of viral pneumonia.

Unlabelled: Intrarenal handling of 99mTc-DMSA is still controversial, particularly in the existence of tubular reabsorption from the tubular fluid. Experiments were performed with micropuncture technique on the rat kidney in an attempt to elucidate this question., Methods: The concentration profile of 99mTc-DMSA along the nephron was measured in fluid from Bowman's space of surface glomeruli and from the proximal and distal tubules collected by micropuncture. Superficial loops of proximal tubules were micropunctured and microperfused with 99mTc-DMSA or [99mTc] pertechnetate for 10 or 20 min at physiological flow rates; the recovery of activity was measured in the final urine., Results: Bowman's space urine contained only 14% of the 99mTc activity of arterial plasma, indicating low filtration of 99mTc-DMSA, likely due to high plasma protein binding. Tubular fluid-to-plasma activity ratios of 0.31 in the proximal tubules and 1.31 in the distal tubules suggest that 99mTc-DMSA is neither secreted nor reabsorbed along the nephron. Ninety-eight percent of the 99mTc-DMSA activity was recovered in the final ipsilateral urine, while only 0.5% was found in the urine of the contralateral kidney., Conclusion: A low fraction of 99mTc-DMSA enters the tubule by glomerular filtration and is not reabsorbed from the tubular fluid. Thus, only peritubular extraction by the tubular cell is responsible for renal uptake of 99mTc-DMSA.