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Zimna K, Sobiecka M, Wakuliński J, Wyrostkiewicz D, Jankowska E, Szturmowicz M, Tomkowski WZ. Lung Ultrasonography in the Evaluation of Late Sequelae of COVID-19 Pneumonia-A Comparison with Chest Computed Tomography: A Prospective Study. Viruses 2024; 16:905. [PMID: 38932196 PMCID: PMC11209275 DOI: 10.3390/v16060905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 05/22/2024] [Accepted: 05/29/2024] [Indexed: 06/28/2024] Open
Abstract
The onset of the COVID-19 pandemic allowed physicians to gain experience in lung ultrasound (LUS) during the acute phase of the disease. However, limited data are available on LUS findings during the recovery phase. The aim of this study was to evaluate the utility of LUS to assess lung involvement in patients with post-COVID-19 syndrome. This study prospectively enrolled 72 patients who underwent paired LUS and chest CT scans (112 pairs including follow-up). The most frequent CT findings were ground glass opacities (83.3%), subpleural lines (72.2%), traction bronchiectasis (37.5%), and consolidations (31.9%). LUS revealed irregular pleural lines as a common abnormality initially (56.9%), along with subpleural consolidation >2.5 mm ≤10 mm (26.5%) and B-lines (26.5%). A strong correlation was found between LUS score, calculated by artificial intelligence percentage involvement in ground glass opacities described in CT (r = 0.702, p < 0.05). LUS score was significantly higher in the group with fibrotic changes compared to the non-fibrotic group with a mean value of 19.4 ± 5.7 to 11 ± 6.6, respectively (p < 0.0001). LUS might be considered valuable for examining patients with persistent symptoms after recovering from COVID-19 pneumonia. Abnormalities identified through LUS align with CT scan findings; thus, LUS might potentially reduce the need for frequent chest CT examinations.
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Affiliation(s)
- Katarzyna Zimna
- I Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, 01-138 Warsaw, Poland
| | - Małgorzata Sobiecka
- I Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, 01-138 Warsaw, Poland
| | - Jacek Wakuliński
- Department of Radiology, National Tuberculosis and Lung Diseases Research Institute, 01-138 Warsaw, Poland
| | - Dorota Wyrostkiewicz
- I Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, 01-138 Warsaw, Poland
| | - Ewa Jankowska
- I Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, 01-138 Warsaw, Poland
| | - Monika Szturmowicz
- I Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, 01-138 Warsaw, Poland
| | - Witold Z. Tomkowski
- I Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, 01-138 Warsaw, Poland
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Indolfi C, Klain A, Dinardo G, D’Addio E, Ferrara S, Decimo F, Ciprandi G, Tosca MA, Miraglia del Giudice M. COVID-19 Pediatric Follow-Up: Respiratory Long COVID-Associated Comorbidities and Lung Ultrasound Alterations in a Cohort of Italian Children. CHILDREN (BASEL, SWITZERLAND) 2024; 11:166. [PMID: 38397278 PMCID: PMC10887372 DOI: 10.3390/children11020166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 01/21/2024] [Accepted: 01/25/2024] [Indexed: 02/25/2024]
Abstract
In children, the factors that influence COVID-19 disease and its medium- and long-term effects are little known. Our investigation sought to evaluate the presence of comorbidity factors associated with respiratory long COVID manifestations in children and to study ultrasound abnormalities following SARS-CoV-2 infection. Children, who arrived at the 'Respiratory Diseases of Pediatric Interest Unit' at the Department of Woman, Child, and General and Specialized Surgery of the University of Campania 'Luigi Vanvitelli', were selected during the timeframe from September 2021 to October 2022. The children were diagnosed with a SARS-CoV-2 infection that occurred at least one month before the visit. All patients followed a COVID-19 follow-up protocol, developed by the Italian Society of Pediatric Respiratory Diseases (SIMRI), which included: collection of data regarding SARS-CoV-2 illness and history of known respiratory and allergic diseases; physical examination; BMI assessment; baseline spirometry and after bronchodilation test; six-minute walking test; and lung ultrasound (LUS). In a cohort of 104 participants with respiratory long COVID symptoms (64.7% male, average age 8.92 years), 46.1% had fever with other symptoms, and 1% required hospitalization. BMI analysis showed 58.4% of the cohort was overweight. The LUS was positive in 27.0% of cases. A significant BMI association was observed with COVID-19 symptoms and LUS score (p-value < 0.05). No associations were found with asthma or atopy.
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Affiliation(s)
- Cristiana Indolfi
- Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (C.I.); (G.D.); (E.D.); (S.F.); (F.D.); (M.M.d.G.)
| | - Angela Klain
- Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (C.I.); (G.D.); (E.D.); (S.F.); (F.D.); (M.M.d.G.)
| | - Giulio Dinardo
- Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (C.I.); (G.D.); (E.D.); (S.F.); (F.D.); (M.M.d.G.)
| | - Elisabetta D’Addio
- Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (C.I.); (G.D.); (E.D.); (S.F.); (F.D.); (M.M.d.G.)
| | - Serena Ferrara
- Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (C.I.); (G.D.); (E.D.); (S.F.); (F.D.); (M.M.d.G.)
| | - Fabio Decimo
- Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (C.I.); (G.D.); (E.D.); (S.F.); (F.D.); (M.M.d.G.)
| | - Giorgio Ciprandi
- Department of Medicine, Allergy Clinic, Casa di Cura Villa Montallegro, 16145 Genoa, Italy;
| | - Maria Angela Tosca
- Pediatric Allergy Center, Istituto Giannina Gaslini, 16147 Genoa, Italy;
| | - Michele Miraglia del Giudice
- Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (C.I.); (G.D.); (E.D.); (S.F.); (F.D.); (M.M.d.G.)
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3
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A Systematic Review of Chest Imaging Findings in Long COVID Patients. J Pers Med 2023; 13:jpm13020282. [PMID: 36836515 PMCID: PMC9965323 DOI: 10.3390/jpm13020282] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 01/25/2023] [Accepted: 01/30/2023] [Indexed: 02/04/2023] Open
Abstract
Long COVID is the persistence of one or more COVID-19 symptoms after the initial viral infection, and there is evidence supporting its association with lung damage. In this systematic review, we provide an overview of lung imaging and its findings in long COVID patients. A PubMed search was performed on 29 September 2021, for English language studies in which lung imaging was performed in adults suffering from long COVID. Two independent researchers extracted the data. Our search identified 3130 articles, of which 31, representing the imaging findings of 342 long COVID patients, were retained. The most common imaging modality used was computed tomography (CT) (N = 249). A total of 29 different imaging findings were reported, which were broadly categorized into interstitial (fibrotic), pleural, airway, and other parenchymal abnormalities. A direct comparison between cases, in terms of residual lesions, was available for 148 patients, of whom 66 (44.6%) had normal CT findings. Although respiratory symptoms belong to the most common symptoms in long COVID patients, this is not necessarily linked to radiologically detectable lung damage. Therefore, more research is needed on the role of the various types of lung (and other organ) damage which may or may not occur in long COVID.
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Perrone T, Falaschi F, Meloni F, Ballesio A, Sabatini U, Lenti MV, Melazzini F, Lettieri S, Novati S, Cutti S, Marioli CM, Klersy C, Bruno R, Oltrona Visconti L, Di Sabatino A. A mid-term follow-up with a lung ultrasonographic score correlates with the severity of COVID-19 acute phase. Intern Emerg Med 2023; 18:163-168. [PMID: 36469248 PMCID: PMC9734680 DOI: 10.1007/s11739-022-03144-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 10/21/2022] [Indexed: 12/09/2022]
Abstract
Lung ultrasound (LUS) has rapidly emerged in COVID-19 diagnosis and for the follow-up during the acute phase. LUS is not yet used routinely in lung damage follow-up after COVID-19 infection. We investigated the correlation between LUS score, and clinical and laboratory parameters of severity of SARS-COV-2 damage during hospitalization and at follow-up visit. Observational retrospective study including all the patients discharged from the COVID-19 wards, who attended the post-COVID outpatient clinic of the IRCCS Policlinico San Matteo in April-June 2020. 115 patients were enrolled. Follow-up visits with LUS score measurements were at a median of 38 days (IQR 28-48) after discharge. LUS scores were associated with the length of hospitalization (p < 0.001), patients' age (p = 0.036), use of non-invasive ventilation (CPAP p < 0.001 or HFNC p = 0.018), administration of corticosteroids therapy (p = 0.030), and laboratory parameters during the acute phase (WBC p < 0.001, LDH p < 0.001, CRP p < 0.001, D-dimer p = 0.008, IL-6 p = 0.045), and inversely correlated with lymphocyte count (p = 0.007). We found correlation between LUS score and both LDH (p = 0.001) and the antibody anti-SARS-CoV-2 titers (p value = 0.008). Most of these finding were confirmed by dichothomizing the LUS score (≤ 9 or > 9 points). We found a significantly higher LUS score at the follow-up in the patients with persistent dyspnea (7.00, IQR 3.00-11.00) when compared to eupnoeic patients (3.00, IQR 0-7.00 p < 0.001). LUS score at follow-up visit correlates with more severe lung disease. These findings support the hypothesis that ultrasound could be a valid tool in the follow-up medium-term COVID-19 lung damage.
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Affiliation(s)
- Tiziano Perrone
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Clinica Medica I, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
| | - Francesco Falaschi
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Clinica Medica I, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
| | - Federica Meloni
- Department of Respiratory Disease, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Alessia Ballesio
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Clinica Medica I, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
| | - Umberto Sabatini
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Clinica Medica I, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
| | - Marco Vincenzo Lenti
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Clinica Medica I, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
| | - Federica Melazzini
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Clinica Medica I, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
| | - Sara Lettieri
- Department of Respiratory Disease, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Stefano Novati
- Department of Infectious Disease, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Sara Cutti
- Direzione Medica di Presidio, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Carola Maria Marioli
- Department of Respiratory Disease, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Catherine Klersy
- Biometry and Clinical Epidemiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Raffaele Bruno
- Department of Infectious Disease, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Luigi Oltrona Visconti
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Antonio Di Sabatino
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Clinica Medica I, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy.
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Kessler D, Dessie A, Kanjanauptom P, Vindas M, Ng L, Youssef MM, Birger R, Shaman J, Dayan P. Lack of Association Between a Quantified Lung Ultrasound Score and Illness Severity in Pediatric Emergency Department Patients With Acute Lower Respiratory Infections. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:3013-3022. [PMID: 35620855 DOI: 10.1002/jum.16023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 04/08/2022] [Accepted: 05/06/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Lung ultrasound (LUS) may help determine illness severity in children with acute lower respiratory tract infections (LRTI) but limited pediatric studies exist. Our objective was to determine the association between LUS findings and illness severity in children with LRTI. METHODS We conducted a prospective study of patients <20 years with LRTI. Trained investigators performed standardized LUS examinations of 12 regions. Blinded sonologists reviewed examinations for individual pathologic features and also calculated a Quantified Lung Ultrasound Score (QLUS). We defined focal severity as QLUS of ≥2 in ≥1 region, and diffuse severity as QLUS of ≥1 in ≥3 regions. The primary outcome was the Respiratory component of the Pediatric Early Warning Score (RPEWS), a 14-item scale measuring respiratory illness severity. Secondary outcomes included hospital admission, length of stay, supplemental oxygen, and antibiotic use. RESULTS We enrolled 85 patients with LRTIs, 46 (54%) whom were hospitalized (5.4% intensive care). Median RPEWS was 1 (interquartile range 2). Neither individual features on ultrasound nor total QLUS were associated with RPEWS, hospitalization, length of stay, or oxygen use. Mean RPEWS was similar for participants regardless of focal (1.46 versus 1.26, P = .57) or diffuse (1.47 versus 1.21, P = .47) severity findings, but those with focal or diffuse severity, or isolated consolidation, had greater antibiotic administration (P < .001). CONCLUSIONS In children with LRTI, neither individual features nor QLUS were associated with illness severity. Antibiotics were more likely in patients with either focal or diffuse severity or presence of consolidation on ultrasound.
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Affiliation(s)
- David Kessler
- Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA
| | - Almaz Dessie
- Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA
| | - Panida Kanjanauptom
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Marc Vindas
- Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA
| | - Lorraine Ng
- Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA
| | - Mariam M Youssef
- Department of Environmental Health Sciences, Columbia University, New York, New York, USA
| | - Ruthie Birger
- Department of Environmental Health Sciences, Columbia University, New York, New York, USA
| | - Jeff Shaman
- Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Peter Dayan
- Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA
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6
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Fratianni G, Malfatto G, Perger E, Facchetti L, Pini L, Bosco M, Cernigliaro F, Perego GB, Facchini M, Badano LP, Parati G. Lung Ultrasound in Patients With SARS-COV-2 Pneumonia: Correlations With Chest Computed Tomography, Respiratory Impairment, and Inflammatory Cascade. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:1465-1473. [PMID: 34533859 PMCID: PMC8662157 DOI: 10.1002/jum.15831] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 08/13/2021] [Accepted: 08/20/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Lung ultrasound (LUS) might be comparable to chest computed tomography (CT) in detecting parenchymal and pleural pathology, and in monitoring interstitial lung disease. We aimed to describe LUS characteristics of patients during the hospitalization for COVID-19 pneumonia, and to compare the extent of lung involvement at LUS and chest-CT with inflammatory response and the severity of respiration impairment. METHODS During a 2-week period, we performed LUS and chest CT in hospitalized patients affected by COVID-19 pneumonia. Dosages of high sensitivity C-reactive protein (HS-CRP), d-dimer, and interleukin-6 (IL-6) were also obtained. The index of lung function (P/F ratio) was calculated from the blood gas test. LUS and CT scoring were assessed using previously validated scores. RESULTS Twenty-six consecutive patients (3 women) underwent LUS 34 ± 14 days from the early symptoms. Among them, 21 underwent CT on the same day of LUS. A fair association was found between LUS and CT scores (R = 0.45, P = .049), which became stronger if the B-lines score on LUS was not considered (R = 0.57, P = .024). LUS B-lines score correlated with IL-6 levels (R = 0.75, P = .011), and the number of involved lung segments detected by LUS correlated with the P/F ratio (R = 0.60, P = .019) but not with HS-CRP and d-Dimer levels. No correlations were found between CT scores and inflammations markers or P/F. CONCLUSION In patients with COVID-19 pneumonia, LUS was correlated with both the extent of the inflammatory response and the P/F ratio.
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Affiliation(s)
- Gerardina Fratianni
- Department of CardiologyIstituto Auxologico Italiano IRCCS, Ospedale S. LucaMilan
| | - Gabriella Malfatto
- Department of CardiologyIstituto Auxologico Italiano IRCCS, Ospedale S. LucaMilan
| | - Elisa Perger
- Department of CardiologyIstituto Auxologico Italiano IRCCS, Ospedale S. LucaMilan
- Dipartimento di Medicina e Chirurgia, Università di Milano‐BicoccaMilan
| | - Luca Facchetti
- Department of Radiology, ASST Spedali Civili di BresciaBresciaItaly
| | - Laura Pini
- Respiratory Medicine Unit, ASST Spedali Civili di BresciaBresciaItaly
- Department of Clinical and Experimental SciencesUniversity of BresciaBresciaItaly
| | - Miriam Bosco
- Department of CardiologyIstituto Auxologico Italiano IRCCS, Ospedale S. LucaMilan
| | - Franco Cernigliaro
- Department of CardiologyIstituto Auxologico Italiano IRCCS, Ospedale S. LucaMilan
| | - Giovanni B. Perego
- Department of CardiologyIstituto Auxologico Italiano IRCCS, Ospedale S. LucaMilan
| | - Mario Facchini
- Department of CardiologyIstituto Auxologico Italiano IRCCS, Ospedale S. LucaMilan
| | - Luigi P. Badano
- Department of CardiologyIstituto Auxologico Italiano IRCCS, Ospedale S. LucaMilan
- Dipartimento di Medicina e Chirurgia, Università di Milano‐BicoccaMilan
| | - Gianfranco Parati
- Department of CardiologyIstituto Auxologico Italiano IRCCS, Ospedale S. LucaMilan
- Dipartimento di Medicina e Chirurgia, Università di Milano‐BicoccaMilan
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Gil-Rodríguez J, Pérez de Rojas J, Aranda-Laserna P, Benavente-Fernández A, Martos-Ruiz M, Peregrina-Rivas JA, Guirao-Arrabal E. Ultrasound findings of lung ultrasonography in COVID-19: A systematic review. Eur J Radiol 2022; 148:110156. [PMID: 35078136 PMCID: PMC8783639 DOI: 10.1016/j.ejrad.2022.110156] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 01/05/2022] [Accepted: 01/07/2022] [Indexed: 02/06/2023]
Abstract
PURPOSE To identify the defining lung ultrasound (LUS) findings of COVID-19, and establish its association to the initial severity of the disease and prognostic outcomes. METHOD Systematic review was conducted according to the PRISMA guidelines. We queried PubMed, Embase, Web of Science, Cochrane Database and Scopus using the terms ((coronavirus) OR (covid-19) OR (sars AND cov AND 2) OR (2019-nCoV)) AND (("lung ultrasound") OR (LUS)), from 31st of December 2019 to 31st of January 2021. PCR-confirmed cases of SARS-CoV-2 infection, obtained from original studies with at least 10 participants 18 years old or older, were included. Risk of bias and applicability was evaluated with QUADAS-2. RESULTS We found 1333 articles, from which 66 articles were included, with a pooled population of 4687 patients. The most examined findings were at least 3 B-lines, confluent B-lines, subpleural consolidation, pleural effusion and bilateral or unilateral distribution. B-lines, its confluent presentation and pleural abnormalities are the most frequent findings. LUS score was higher in intensive care unit (ICU) patients and emergency department (ED), and it was associated with a higher risk of developing unfavorable outcomes (death, ICU admission or need for mechanical ventilation). LUS findings and/or the LUS score had a good negative predictive value in the diagnosis of COVID-19 compared to RT-PCR. CONCLUSIONS The most frequent ultrasound findings of COVID-19 are B-lines and pleural abnormalities. High LUS score is associated with developing unfavorable outcomes. The inclusion of pleural effusion in the LUS score and the standardisation of the imaging protocol in COVID-19 LUS remains to be defined.
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Affiliation(s)
- Jaime Gil-Rodríguez
- Internal Medicine Unit, San Cecilio University Hospital, Avenida del Conocimiento s/n, 18016 Granada, Spain,Corresponding author
| | - Javier Pérez de Rojas
- Preventive Medicine and Public Health Unit, San Cecilio University Hospital, Avenida del Conocimiento s/n, 18016 Granada, Spain
| | - Pablo Aranda-Laserna
- Internal Medicine Unit, San Cecilio University Hospital, Avenida del Conocimiento s/n, 18016 Granada, Spain
| | | | - Michel Martos-Ruiz
- Internal Medicine Unit, San Cecilio University Hospital, Avenida del Conocimiento s/n, 18016 Granada, Spain
| | | | - Emilio Guirao-Arrabal
- Infectious Diseases Unit, San Cecilio University Hospital, Avenida del Conocimiento s/n, 18016 Granada, Spain
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8
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Orlandi D, Battaglini D, Robba C, Viganò M, Bergamaschi G, Mignatti T, Radice ML, Lapolla A, Turtulici G, Pelosi P. Coronavirus Disease 2019 Phenotypes, Lung Ultrasound, Chest Computed Tomography and Clinical Features in Critically Ill Mechanically Ventilated Patients. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:3323-3332. [PMID: 34551862 PMCID: PMC8302846 DOI: 10.1016/j.ultrasmedbio.2021.07.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 06/17/2021] [Accepted: 07/19/2021] [Indexed: 05/12/2023]
Abstract
Chest computed tomography (CT) may provide insights into the pathophysiology of coronavirus disease 2019 (COVID-19), although it is not suitable for a timely bedside dynamic assessment of patients admitted to intensive care unit (ICU); therefore, lung ultrasound (LUS) has been proposed as a complementary diagnostic tool. The aims of this study were to investigate different lungs phenotypes in patients with COVID-19 and to assess the differences in CT and LUS scores between ICU survivors and non-survivors. We also explored the association between CT and LUS, and oxygenation (arterial partial pressure of oxygen [PaO2]/fraction of inspired oxygen [FiO2]) and clinical parameters. The study included 39 patients with COVID-19. CT scans revealed types 1, 2 and 3 phenotypes in 62%, 28% and 10% of patients, respectively. Among survivors, pattern 1 was prevalent (p < 0.005). Chest CT and LUS scores differed between survivors and non-survivors both at ICU admission and 10 days after and were associated with ICU mortality. Chest CT score was positively correlated with LUS findings at ICU admission (r = 0.953, p < 0.0001) and was inversely correlated with PaO2/FiO2 (r = -0.375, p = 0.019) and C-reactive protein (r = 0.329, p = 0.041). LUS score was inversely correlated with PaO2/FiO2 (r = -0.345, p = 0.031). COVID-19 presents distinct phenotypes with differences between survivors and non-survivors. LUS is a valuable monitoring tool in an ICU setting because it may correlate with CT findings and mortality, although it cannot predict oxygenation changes.
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Affiliation(s)
- Davide Orlandi
- Department of Radiology, Ospedale Evangelico Internazionale, Genoa, Italy.
| | - Denise Battaglini
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, Scientific Institute for Research, Hospitalization and Healthcare (IRCCS) for Oncology and Neurosciences, Genoa, Italy; Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Chiara Robba
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, Scientific Institute for Research, Hospitalization and Healthcare (IRCCS) for Oncology and Neurosciences, Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostic (DISC), University of Genoa, Genoa, Italy
| | - Marco Viganò
- Orthopedics Biotechnology Laboratory, Scientific Institute for Research, Hospitalization and Healthcare (IRCCS) Istituto Ortopedico Galeazzi, Milan, Italy
| | - Giulio Bergamaschi
- Department of Radiology, Ospedale Evangelico Internazionale, Genoa, Italy
| | - Tiziana Mignatti
- Department of Radiology, Ospedale Evangelico Internazionale, Genoa, Italy
| | - Maria Luisa Radice
- Anesthesia and Intensive Care, Ospedale Evangelico Internazionale, Genoa, Italy
| | - Antonio Lapolla
- Anesthesia and Intensive Care, Ospedale Evangelico Internazionale, Genoa, Italy
| | - Giovanni Turtulici
- Department of Radiology, Ospedale Evangelico Internazionale, Genoa, Italy
| | - Paolo Pelosi
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, Scientific Institute for Research, Hospitalization and Healthcare (IRCCS) for Oncology and Neurosciences, Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostic (DISC), University of Genoa, Genoa, Italy
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9
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Fairchild RM, Horomanski A, Mar DA, Triant GR, Lu R, Lu D, Guo HH, Baker MC. Prevalence and significance of pulmonary disease on lung ultrasonography in outpatients with SARS-CoV-2 infection. BMJ Open Respir Res 2021; 8:8/1/e000947. [PMID: 34385149 PMCID: PMC8361701 DOI: 10.1136/bmjresp-2021-000947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 07/21/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The majority of patients with SARS-CoV-2 infection are diagnosed and managed as outpatients; however, little is known about the burden of pulmonary disease in this setting. Lung ultrasound (LUS) is a convenient tool for detection of COVID-19 pneumonia. Identifying SARS-CoV-2 infected outpatients with pulmonary disease may be important for early risk stratification. OBJECTIVES To investigate the prevalence, natural history and clinical significance of pulmonary disease in outpatients with SARS-CoV-2. METHODS SARS-CoV-2 PCR positive outpatients (CV(+)) were assessed with LUS to identify the presence of interstitial pneumonia. Studies were considered positive based on the presence of B-lines, pleural irregularity and consolidations. A subset of patients underwent longitudinal examinations. Correlations between LUS findings and patient symptoms, demographics, comorbidities and clinical outcomes over 8 weeks were evaluated. RESULTS 102 CV(+) patients underwent LUS with 42 (41%) demonstrating pulmonary involvement. Baseline LUS severity scores correlated with shortness of breath on multivariate analysis. Of the CV(+) patients followed longitudinally, a majority showed improvement or resolution in LUS findings after 1-2 weeks. Only one patient in the CV(+) cohort was briefly hospitalised, and no patient died or required mechanical ventilation. CONCLUSION We found a high prevalence of LUS findings in outpatients with SARS-CoV-2 infection. Given the pervasiveness of pulmonary disease across a broad spectrum of LUS severity scores and lack of adverse outcomes, our findings suggest that LUS may not be a useful as a risk stratification tool in SARS-CoV-2 in the general outpatient population.
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Affiliation(s)
- Robert M Fairchild
- Department of Immunology & Rheumatology, Stanford University, Stanford, California, USA
| | - Audra Horomanski
- Department of Immunology & Rheumatology, Stanford University, Stanford, California, USA
| | - Diane A Mar
- Department of Immunology & Rheumatology, Stanford University, Stanford, California, USA
| | - Gabriela R Triant
- Department of Immunology & Rheumatology, Stanford University, Stanford, California, USA
| | - Rong Lu
- Quantitative Sciences Unit, Division of Biomedical Informatics Research, Stanford University, Stanford, California, USA
| | - Di Lu
- Quantitative Sciences Unit, Division of Biomedical Informatics Research, Stanford University, Stanford, California, USA
| | - Haiwei Henry Guo
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Matthew C Baker
- Department of Immunology & Rheumatology, Stanford University, Stanford, California, USA
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10
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Barssoum K, Victor V, Salem A, Kumar A, Mubasher M, Hassib M, Magdi M, Renjithlal S, Abdelazeem M, Shariff M, Idemudia O, Ibrahim M, Mohamed A, Thakkar S, Patel H, Diab M, Szeles A, Ibrahim F, Jha R, Chowdhury M, Akula N, Kalra A, Nanda NC. Echocardiography, lung ultrasound, and cardiac magnetic resonance findings in COVID-19: A systematic review. Echocardiography 2021; 38:1365-1404. [PMID: 34236091 PMCID: PMC8444724 DOI: 10.1111/echo.15152] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/25/2021] [Accepted: 06/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The manifestations of COVID-19 as outlined by imaging modalities such as echocardiography, lung ultrasound (LUS), and cardiac magnetic resonance (CMR) imaging are not fully described. METHODS We conducted a systematic review of the current literature and included studies that described cardiovascular manifestations of COVID-19 using echocardiography, CMR, and pulmonary manifestations using LUS. We queried PubMed, EMBASE, and Web of Science for relevant articles. Original studies and case series were included. RESULTS This review describes the most common abnormalities encountered on echocardiography, LUS, and CMR in patients infected with COVID-19.
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Affiliation(s)
- Kirolos Barssoum
- Department of Internal MedicineRochester Regional HealthUnity HospitalRochesterNew YorkUSA
| | - Varun Victor
- Department of Internal MedicineCanton Medical Education FoundationCantonOhioUSA
| | - Ahmad Salem
- Department of Internal MedicineRochester Regional HealthUnity HospitalRochesterNew YorkUSA
| | - Ashish Kumar
- Section of Cardiovascular ResearchHeartVascular and Thoracic DepartmentCleveland Clinic Akron GeneralAkronOhioUSA
- Department of Internal MedicineCleveland Clinic Akron GeneralAkronOhioUSA
| | - Mahmood Mubasher
- Department of Internal MedicineRochester Regional HealthUnity HospitalRochesterNew YorkUSA
| | | | - Mohamed Magdi
- Department of Internal MedicineRochester Regional HealthUnity HospitalRochesterNew YorkUSA
| | - Sarathlal Renjithlal
- Department of Internal MedicineRochester Regional HealthUnity HospitalRochesterNew YorkUSA
| | - Mohamed Abdelazeem
- Department of Internal MedicineSt. Elizabeth Medical CenterBrightonMassachusettsUSA
| | | | - Osarenren Idemudia
- Department of Internal MedicineRochester Regional HealthUnity HospitalRochesterNew YorkUSA
| | - Mounir Ibrahim
- Department of Internal MedicineHackensack Meridian Health Palisades Medical CenterNorth BergenNew JerseyUSA
| | - Amr Mohamed
- Department of Internal MedicineRochester General HospitalRochesterNew YorkUSA
| | | | - Harsh Patel
- Department of Internal MedicineLouis A Weiss Memorial HospitalChicagoIllinoisUSA
| | - Mohamed Diab
- Department of Internal MedicineRochester Regional HealthUnity HospitalRochesterNew YorkUSA
| | - Andras Szeles
- Department of Internal MedicineRochester Regional HealthUnity HospitalRochesterNew YorkUSA
| | - Fadi Ibrahim
- American University of AntiguaAntigua and Barbuda
| | - Roshan Jha
- Department of Internal MedicineHackensack Meridian Health Palisades Medical CenterNorth BergenNew JerseyUSA
| | - Medhat Chowdhury
- Department of Internal MedicineRochester General HospitalRochesterNew YorkUSA
| | - Navya Akula
- Department of Internal MedicineRochester Regional HealthUnity HospitalRochesterNew YorkUSA
| | - Ankur Kalra
- Section of Cardiovascular ResearchHeartVascular and Thoracic DepartmentCleveland Clinic Akron GeneralAkronOhioUSA
- Department of Cardiovascular MedicineHeart, Vascular, and Thoracic InstituteCleveland ClinicClevelandOhioUSA
| | - Navin C. Nanda
- Division of Cardiovascular DiseaseDepartment of MedicineUniversity of Alabama at BirminghamBirminghamAlabamaUSA
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11
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Mafort TT, Rufino R, da Costa CH, da Cal MS, Monnerat LB, Litrento PF, Parra LLZ, Marinho ADSEDS, Lopes AJ. One-month outcomes of patients with SARS-CoV-2 infection and their relationships with lung ultrasound signs. Ultrasound J 2021; 13:19. [PMID: 33835273 PMCID: PMC8033556 DOI: 10.1186/s13089-021-00223-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 03/30/2021] [Indexed: 12/13/2022] Open
Abstract
Background The role of lung ultrasound (LUS) in evaluating the mid- and long-term prognoses of patients with COVID-19 pneumonia is not yet known. The objectives of this study were to evaluate associations between LUS signs at the time of screening and clinical outcomes 1 month after LUS and to assess LUS signs at the time of presentation with known risk factors for COVID-19 pneumonia. Methods This was a retrospective study of data prospectively collected 1 month after LUS screening of 447 adult patients diagnosed with COVID-19 pneumonia. Sonographic examination was performed in screening tents with the participants seated. The LUS signs (B-lines > 2, coalescent B-lines, and subpleural consolidations) were captured in six areas of each hemithorax and a LUS aeration score was calculated; in addition, the categories of disease probability based on patterns of LUS findings (high-probability, intermediate-probability, alternate, and low-probability patterns) were evaluated. The LUS signs at patients’ initial evaluation were related to the following outcomes: symptomatology, the need for hospitalization or invasive mechanical ventilation (IMV), and COVID-19-related death. Results According to the evaluations performed 1 month after LUS screening, 36 patients were hospitalised, eight of whom required intensive care unit (ICU) admission and three of whom died. The presence of coalescent B-lines was associated with the need for hospitalization (p = 0.008). The presence of subpleural consolidations was associated with dyspnoea (p < 0.0001), cough (p = 0.003), the need for hospitalization (p < 0.0001), the need for ICU admission (p < 0.0001), and death (p = 0.002). A higher aeration score was associated with dyspnoea (p < 0.0001), the need for hospitalization (p < 0.0001), the need for ICU admission (p < 0.0001), and death (p = 0.003). In addition, patients with a high-probability LUS pattern had a higher aeration score (p < 0.0001) and more dyspnoea (p = 0.024) and more often required hospitalization (p < 0.0001) and ICU admission (p = 0.031). Conclusions In patients with COVID-19 pneumonia, LUS signs were related to respiratory symptoms 1 month after LUS screening. Strong relationships were identified between LUS signs and the need for hospitalization and death.
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Affiliation(s)
- Thiago Thomaz Mafort
- Department of Pulmonology, Piquet Carneiro Policlinic, State University of Rio de Janeiro, Av. Mal. Rondon, 381, São Francisco Xavier, Rio de Janeiro, 20950-003, Brazil.,Postgraduate Programme in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro, Av. Prof. Manuel de Abreu, 444, 2° andar, Vila Isabel, Rio de Janeiro, 20550-170, Brazil
| | - Rogério Rufino
- Department of Pulmonology, Piquet Carneiro Policlinic, State University of Rio de Janeiro, Av. Mal. Rondon, 381, São Francisco Xavier, Rio de Janeiro, 20950-003, Brazil.,Postgraduate Programme in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro, Av. Prof. Manuel de Abreu, 444, 2° andar, Vila Isabel, Rio de Janeiro, 20550-170, Brazil
| | - Claudia Henrique da Costa
- Department of Pulmonology, Piquet Carneiro Policlinic, State University of Rio de Janeiro, Av. Mal. Rondon, 381, São Francisco Xavier, Rio de Janeiro, 20950-003, Brazil.,Postgraduate Programme in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro, Av. Prof. Manuel de Abreu, 444, 2° andar, Vila Isabel, Rio de Janeiro, 20550-170, Brazil
| | - Mariana Soares da Cal
- Department of Pulmonology, Piquet Carneiro Policlinic, State University of Rio de Janeiro, Av. Mal. Rondon, 381, São Francisco Xavier, Rio de Janeiro, 20950-003, Brazil
| | - Laura Braga Monnerat
- Department of Pulmonology, Piquet Carneiro Policlinic, State University of Rio de Janeiro, Av. Mal. Rondon, 381, São Francisco Xavier, Rio de Janeiro, 20950-003, Brazil
| | - Patrícia Frascari Litrento
- Department of Pulmonology, Piquet Carneiro Policlinic, State University of Rio de Janeiro, Av. Mal. Rondon, 381, São Francisco Xavier, Rio de Janeiro, 20950-003, Brazil
| | - Laura Lizeth Zuluaga Parra
- Department of Pulmonology, Piquet Carneiro Policlinic, State University of Rio de Janeiro, Av. Mal. Rondon, 381, São Francisco Xavier, Rio de Janeiro, 20950-003, Brazil
| | - Arthur de Sá Earp de Souza Marinho
- Department of Pulmonology, Piquet Carneiro Policlinic, State University of Rio de Janeiro, Av. Mal. Rondon, 381, São Francisco Xavier, Rio de Janeiro, 20950-003, Brazil
| | - Agnaldo José Lopes
- Department of Pulmonology, Piquet Carneiro Policlinic, State University of Rio de Janeiro, Av. Mal. Rondon, 381, São Francisco Xavier, Rio de Janeiro, 20950-003, Brazil. .,Postgraduate Programme in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro, Av. Prof. Manuel de Abreu, 444, 2° andar, Vila Isabel, Rio de Janeiro, 20550-170, Brazil. .,Rehabilitation Sciences Post-Graduation Programme, Augusto Motta University Centre (UNISUAM), Rua Dona Isabel, 94, Bonsucesso, Rio de Janeiro, 21032-060, Brazil.
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