Lung ultrasound findings in patients with novel SARS-CoV-2.

Background: Over 2 million people worldwide have been infected with severe acute respiratory distress syndrome-coronavirus-2 (SARS CoV-2). Lung ultrasound has been proposed to diagnose and monitor it, despite the fact that little is known about the ultrasound appearance due to the novelty of the illness. The aim of this manuscript is to characterise the lung ultrasonographic appearance of critically ill patients with SARS-CoV-2 pneumonia, with particular emphasis on its relationship with the time course of the illness and clinical parameters.
Methods: Adult patients from the intensive care unit of two academic hospitals who tested positive for SARS-CoV-2 were included. Images were analysed using internationally recognised techniques which included assessment of the pleura, number of B-lines, pathology in the PLAPS (posterolateral alveolar and/or pleural syndrome) point, bedside lung ultrasound in emergency profiles, and the lung ultrasound score. The primary outcomes were frequencies, percentages and differences in lung ultrasound findings overall and between short (≤14 days) and long (>14 days) durations of symptoms and their correlation with clinical parameters.
Results: In this pilot observational study, 61 patients were included with 76 examinations available for analysis. 26% of patients had no anterior lung abnormalities, while the most prevalent pathological ultrasound findings were thickening of the pleura (42%), ≥3 B-lines per view (38%) and presence of PLAPS (74%). Patients with "long" duration of symptoms presented more frequently with a thickened and irregular pleura (32 (21%) versus 11 (9%)), C-profile (18 (47%) versus 8 (25%)) and pleural effusion (14 (19%) versus 3 (5%)), compared to patients with short duration of symptoms. Lung ultrasound findings did not correlate with arterial oxygen tension/inspiratory oxygen fraction ratio, fluid balance or dynamic compliance.
Conclusion: SARS-CoV-2 results in significant, but not specific, ultrasound changes, with decreased lung sliding, thickening of the pleura and a B-profile being the most commonly observed. With time, a thickened and irregular pleura, C-profile and pleural effusion become more common findings. When screening patients, a comprehensive ultrasound protocol might be necessary.
Competing Interests: Conflict of interest: M.E. Haaksma has nothing to disclose. Conflict of interest: M.L.A. Heldeweg has nothing to disclose. Conflict of interest: J.E. Lopez Matta has nothing to disclose. Conflict of interest: J.M. Smit has nothing to disclose. Conflict of interest: J.D. van Trigt has nothing to disclose. Conflict of interest: J.S. Nooitgedacht has nothing to disclose. Conflict of interest: C.V. Elzo Kraemer has nothing to disclose. Conflict of interest: M. van de Wiel has nothing to disclose. Conflict of interest: A.R.J. Girbes has nothing to disclose. Conflict of interest: L. Heunks has nothing to disclose. Conflict of interest: D.J. van Westerloo has nothing to disclose. Conflict of interest: P.R. Tuinman has nothing to disclose.
(Copyright ©ERS 2020.)