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

Mark E Haaksma; Micah L A Heldeweg; Jorge E Lopez Matta; Jasper M Smit; Jessica D van Trigt; Jip S Nooitgedacht; Carlos V Elzo Kraemer; Mark van de Wiel; Armand R J Girbes; Leo Heunks; David J van Westerloo; Pieter R Tuinman

doi:10.1183/23120541.00238-2020

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

ERJ Open Res. 2020 Nov 16;6(4):00238-2020. doi: 10.1183/23120541.00238-2020. eCollection 2020 Oct.

Authors

Mark E Haaksma^{1

2

3}, Micah L A Heldeweg^{1

2

3}, Jorge E Lopez Matta^{3

4}, Jasper M Smit^{1

2

3}, Jessica D van Trigt^{1

2}, Jip S Nooitgedacht^{1

2}, Carlos V Elzo Kraemer^{3

4}, Mark van de Wiel⁵, Armand R J Girbes^{1

2}, Leo Heunks^{1

2}, David J van Westerloo^{3

4}, Pieter R Tuinman^{1

2

3}

Affiliations

¹ Dept of Intensive Care Medicine, Amsterdam University Medical Centers, VUmc, Amsterdam, The Netherlands.
² Amsterdam Cardiovascular Sciences Research Institute, Amsterdam University Medical Centers, Amsterdam, The Netherlands.
³ Amsterdam Leiden Intensive Care Focused Echography, Amsterdam, The Netherlands.
⁴ Dept of Intensive Care Medicine, Leiden University Medical Center, Leiden, The Netherlands.
⁵ Dept of Epidemiology and Data Science, Amsterdam University Medical Centers, VUmc, Amsterdam, The Netherlands.

Abstract

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.