Lung Ultrasound in the Diagnosis of COVID-19 Pneumonia: Not Always and Not Only What Is COVID-19 “Glitters”

Frontiers in Medicine

article

Carla Maria Irene Quarato¹  Gaetano Rea³  Annalisa Simeone⁴  Beatrice Feragalli⁵  Valentina Massa⁶  Antonio Greco⁶  Salvatore De Cosmo⁷  Marco Sperandeo⁸  Antonio Mirijello⁷  Michele Maria Maggi^1,10  Cristina Borelli⁴  Raffaele Russo^1,11  Donato Lacedonia¹  Maria Pia Foschino Barbaro¹  Giulia Scioscia¹  Pasquale Tondo¹ 

[1] Institute of Respiratory Diseases, COVID-19 Center, Policlinico Universitario “Riuniti” di Foggia;Department of Medical and Surgical Sciences, University of Foggia;Department of Radiology, “Vincenzo Monaldi” Hospital-Association of periOperative Registered Nurses (AORN) Ospedale Dei Colli;Department of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Casa Sollievo della Sofferenza;Department of Medical, Oral and Biotechnological Sciences - Radiology Unit “G. D'Annunzio, ” University of Chieti-Pescara;Department of Medical Sciences, Geriatric and COVID-19 Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Casa Sollievo della Sofferenza;Department of Internal Medicine, COVID-19 Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Casa Sollievo della Sofferenza;Department of Medical Sciences, Unit of Interventional and Diagnostic Ultrasound of Internal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Casa Sollievo della Sofferenza;Diagnostic and Interventional Lung Ultrasonology at the Bachelor in Medicine and Surgery and the Postgraduate School of Respiratory Disease, University of Foggia;Department of Emergency Medicine and Critical Care, Emergency Medicine Unit, COVID-19 Center, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Casa Sollievo Della Sofferenza;Department of Emergency Medicine and Critical Care, Intensive Care Unit, COVID-19 Center, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Casa Sollievo Della Sofferenza

关键词: lung ultrasound;    computed tomography;    COVID-19;    comorbidities;    screening method;    sensitivity;    specificity;   

DOI  :  10.3389/fmed.2021.707602

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Background: In the current coronavirus disease-2019 (COVID-19) pandemic, lung ultrasound (LUS) has been extensively employed to evaluate lung involvement and proposed as a useful screening tool for early diagnosis in the emergency department (ED), prehospitalization triage, and treatment monitoring of COVID-19 pneumonia. However, the actual effectiveness of LUS in characterizing lung involvement in COVID-19 is still unclear. Our aim was to evaluate LUS diagnostic performance in assessing or ruling out COVID-19 pneumonia when compared with chest CT (gold standard) in a population of SARS-CoV-2-infected patients. Methods: A total of 260 consecutive RT-PCR confirmed SARS-CoV-2-infected patients were included in the study. All the patients underwent both chest CT scan and concurrent LUS at admission, within the first 6–12 h of hospital stay. Results: Chest CT scan was considered positive when showing a “typical” or “indeterminate” pattern for COVID-19, according to the RSNA classification system. Disease prevalence for COVID-19 pneumonia was 90.77%. LUS demonstrated a sensitivity of 56.78% in detecting lung alteration. The concordance rate for the assessment of abnormalities by both methods increased in the case of peripheral distribution and middle-lower lung location of lesions and in cases of more severe lung involvement. A total of nine patients had a “false-positive” LUS examination. Alternative diagnosis included chronic heart disease (six cases), bronchiectasis (two cases), and subpleural emphysema (one case). LUS specificity was 62.50%. Collateral findings indicative of overlapping conditions at chest CT were recorded also in patients with COVID-19 pneumonia and appeared distributed with increasing frequency passing from the group with mild disease (17 cases) to that with severe disease (40 cases). Conclusions: LUS does not seem to be an adequate tool for screening purposes in the ED, due to the risk of missing some lesions and/or to underestimate the actual extent of the disease. Furthermore, the not specificity of LUS implies the possibility to erroneously classify pre-existing or overlapping conditions as COVID-19 pneumonia. It seems more safe to integrate a positive LUS examination with clinical, epidemiological, laboratory, and radiologic findings to suggest a “virosis.” Viral testing confirmation is always required.

【 授权许可】

CC BY