Point-of-care contrast enhanced lung ultrasound and COVID-19. (August 2022)

• Record Type: Journal Article
• Authors: Tee, Alice; Yusuf, Gibran Timothy; Wong, Adrian; Rao, Deepak; Tran, Sa; Sidhu, Paul S
• Is Part Of: Ultrasound. Volume 30:Number 3(2022)
• Page Start: 201
• Page End: 208
• Publication Date: 2022-08
• Subjects: Coronavirus, consolidation, microthrombi, computed tomography, bedside ultrasound, critical care, microbubble; Ultrasonic imaging -- Periodicals; Ultrasonography -- Periodicals; 616.0754305
• DOI: 10.1177/1742271X211047945
• Languages: English
• ISSNs: 1742-271X

Abstract

Objectives: Bedside lung ultrasound has been indispensable during the coronavirus disease 2019 (COVID-19) pandemic, allowing us to rapidly assess critically unwell patients. We demonstrate the unique application of contrast-enhanced ultrasound with the aim of further understanding this disease. Methods: Patient demographics were recorded alongside recent cross-sectional imaging and inflammatory markers. Ultrasound was conducted by experienced operators in a portable setting. Conventional six-point lung ultrasound method was used to evaluate B-lines, small (subpleural) consolidation and the pleura. Areas of small consolidation were targeted after intravenous administration of ultrasound contrast. Results: The areas of small consolidations, a potential sign of pneumonia on B-mode lung ultrasound, usually enhance on contrast-enhanced ultrasound. Our study revealed these areas to be avascular, indicating an underlying thrombotic/infarction process. Findings were present in 100% of the patients we examined. We have also shown that the degree of infarction correlates with CT severity (r = 0.4) and inflammatory markers, and that these areas improve as patients recover. Conclusions: We confirmed the theory of immune thrombus by identifying the presence of microthrombi in the lungs of 100% of our patients, despite 79% having had a recent negative CT pulmonary angiogram study. contrast-enhanced ultrasound can be utilised to add confidence to an uncertain COVID-19 diagnosis and for prognosticating and monitoring progress in confirmed COVID-19 patients. Contrast-enhanced ultrasound is clearly very different to CT, the gold standard, and while there are specific pathologies that can only be detected on CT, contrast-enhanced ultrasound has many advantages, most notability the ability to pick up microthrombi at the periphery of the lungs.