COVID-19 on Lung POCUS 1&4: Diffuse B Line pattern with skipped segments and

COVID-19 Lung POCUS This is a POCUS of a patient with COVID-19. No prior pulmonary disease; had mild tachypnea and mildly low SaO2. CXR: diffuse interstitial and patchy airspace densities. US: Irregular pleural line with subpleural nodular consolidation and waterfall B-lines. Eric Abrams, MD @eabramsMD #COVID19 #POCUS #Subpleural #Clinical #Lung #Ultrasound #SARSCoV2 #Coronavirus

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Skip Lesions - COVID-19 Lung POCUS “skip lesion” - Normal pleura adjacent to thickened pleura with focal B lines and a small subpleural consolidation Dr. Dharmesh Shukla @DrShukla14 #SkipLesions #COVID19 #POCUS #Clinical #Lung #Ultrasound #SARSCoV2 #Coronavirus

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COVID-19 on Lung POCUS - B-Lines and Thickened Pleura and Subpleural Consolidations Dr. Cian Mcdermott @cianmcdermott #BLines #Pleural #Thickening #COVID19 #POCUS #Clinical #Lung #Ultrasound #SARSCoV2 #Coronavirus #Subpleural #Consolidations

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Lung ultrasound pathology in a COVID-19 positive patient - Few B-lines (vertical white lines) - Confluent B-lines - Irregular and Thickened Pleura - Subpleural Consolidation - Small Tiny Pleural Effusions Vi Am Dinh, MD @viamdinh #COVID19 #POCUS #Clinical #Lung #Ultrasound #SARSCoV2 #Coronavirus #Table

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COVID19 vs CHF on POCUS Spot the difference. 2 pts presenting with nearly same symptoms. Left COVID pneumonia, right CHF. Note that on left B lines are clustered with spared areas, pleural line shredded with subpleural consolidations. Dr. Marco Garrone @drmarcogarrone Irregularity of pleural line and subpleural consolidations may help distinguish B lines due to #COVID19 vs B lines due to other causes (like CHF) #COVID19 #POCUS #Clinical #Lung #Ultrasound #SARSCoV2 #Coronavirus

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COVID-19 Lung POCUS Common findings -B lines -Subpleural consolidation -Air bronchograms -Irregular pleural line -Localized pleural effusion Dr. Marco Garrone @drmarcogarrone #COVID19 #POCUS #Clinical #Lung #Ultrasound #SARSCoV2 #Coronavirus

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COVID on Lung POCUS 2 zones looked like this, the rest A-lines. Dx infectious and with Hx covid suspect. Subpleural consolidation and B-lines in posterior L upper lung field and R mid axillary Dr. Tom Jelic @TomJelic #COVID19 #POCUS #Clinical #Lung #Ultrasound #SARSCoV2 #Coronavirus

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COVID-19 on POCUS I'm infected COVID19. Lung POCUS day 4 after onset of symptoms. No fever, basal SO2 95%. Right lower posterior lung POCUS almost normal. Left lower posterior lung similar to previous days: pleural line thickening and abundant B lines. Dr. Gonzalo Garcia-Casasola @CasasolaGarcia #COVID19 #POCUS #Clinical #Lung #Ultrasound #SARSCoV2 #Coronavirus

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COVID-19 on Lung POCUS - B-Lines and Pleural Thickening Dr. Cian Mcdermott @cianmcdermott #BLines #Pleural #Thickening #COVID19 #POCUS #Clinical #Lung #Ultrasound #SARSCoV2 #Coronavirus

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Figure 3 HRCT-LUS correlation in normal lung, pulmonary congestion, rheumatoid lung disease, idiopathic pulmonary fibrosis. Notes: (A) Normal lung transparency; (B) A-lines (arrow head) reverberation artifacts from normal interlobular septa; (C) heart failure with extensive ground glass opacities; (D) “white lung” due to alveolar syndrome with multiple long, vertical hyperechoic B-line artifacts (thin arrow) arising from a smooth pleura line (yellow arrow); (E) NSIP fibrotic lung with extensive ground glass opacities and traction bronchiectasis due to pulmonary volume loss; (F) >10 B-lines in one IC with thickened, fragmented pleura line (red arrow) in a fibrotic alveolar syndrome (thin arrow shows B-line artifact); (G) UIP pattern with subpleural, basal reticular abnormalities, traction bronchiectasis, and honeycombing; (H) B-lines with irregular thick pleura line (thin arrows show B-line artifacts). #Clinical #Diagnosis #HRCT #POCUS #Lung #Correlation #Table #ILD #Findings

CT and ultrasonographic features of COVID-19 pneumonia Lung CT: - Thickened pleura - Ground glass shadow and effusion - Pulmonary infiltrating shadow - Subpleural consolidation - Translobar consolidation - Pleural effusion is rare. - More than two lobes affected - Negative or atypical in lung CT images in the super-early stage, then diffuse scattered or ground glass shadow with the progress of the disease, further lung consolidation Lung ultrasound - Thickened pleural line - B lines (multifocal, discrete, or confluent) - Confluent B lines - Small (centomeric) consolidations) - Both non-translobar and translobar consolidation - Pleural effusion is rare - Multilobar distribution of abnormalities - Focal B lines is the main feature in the early stage and in mild infection; alveolar interstitial syndrome is the main feature in the progressive stage and in critically ill patients; A lines can be found in the convalescence; pleural line thickening with uneven B lines can be seen in patients with pulmonary fibrosis #COVID19 #pneumonia #ChestCT #Ultrasound #POCUS #features #Radiology #Lung

COVID-19 POCUS 96 yrs old, discharged 3 wks ago for CAP, treated with amox/clav then cefixime. Returns for dyspnea. CXR with consolidation and likely effusion. High WBC, no leukopenia. No likely exposure to COVID19. But this ultrasound bilateral pattern. Test done: positive. US strikes again Dr. Marco Garrone @drmarcogarrone #COVID19 #POCUS #Clinical #Lung #Ultrasound #SARSCoV2 #Coronavirus

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COVID-19 on Lung POCUS Dr. Anna Colclough @drspando #COVID19 #POCUS #Clinical #Lung #Ultrasound #SARSCoV2 #Coronavirus

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COVID on Lung POCUS POCUS in primary care in Madrid - Making decisions with lung ultrasound in COVID19 patients with auscultation and normal oxygen saturation. Change attitude if there is lung involvement Dr. Rafael Alonso @RafaAlonso61 #COVID19 #POCUS #Clinical #Lung #Ultrasound #SARSCoV2 #Coronavirus

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COVID-19 on Lung POCUS Initially PCR negative with compatible symptoms, normal xray. Clinically worsened in 48h and repeat PCR positive. Dr. Javier Perez Pallares @jpallaresneumo #COVID19 #POCUS #Clinical #Lung #Ultrasound #SARSCoV2 #Coronavirus

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COVID-19 Findings on Lung ultrasound - Thickened pleural line - B lines (multifocal, discrete, or confluent) - Confluent B lines - Small (centomeric) consolidations - Both non-translobar and translobar consolidation - Pleural effusion is rare - Multilobar distribution of abnormalities - Focal B lines is the main feature in the early stage and in mild infection; alveolar interstitial syndrome is the main feature in the progressive stage and in critically ill patients; A lines can be found in the convalescence; pleural line thickening with uneven B lines can be seen in patients with pulmonary fibrosis Elena Segura-Grau @GrauSegura #COVID19 #Lung #ultrasound #POCUS #Diagnosis #Signs

Lung POCUS: Irregular, thickened pleural line with diffuse B-lines and subpleural consolidation. Seen in viral (including COVID19) and bacterial pneumonia. Curvilinear probe used. Dr. Robert Jones @RJonesSonoEM #BLines #Viral #Pneumonia #Lung #POCUS #Pulmonary #Ultrasound #Clinical

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Bilateral B-Lines in case of Pneumonia on Lung POCUS Young healthy pt with fever/dyspnea. POCUS lung exam done. States has bilat B profile with lung sliding-must be pulm edema not PNA according to Blue Protocol, right? No PMH, immunosuppression, travel hx, home meds. No smoking or vaping. Progressive URI over 7-10 days. Differential Bilat B lines/lung sliding: Pulmonary edema, ARDS, interstitial lung disease, interstitial diffuse infections. This patient had Mycoplasma pneumonia. Lung POCUS shows a lot of B lines bilaterally. Also has partially seen shred sign Rt Zone 1. Lung POCUS invaluable but need to know how to apply. Bilateral B-lines DOES NOT definitively diagnose Pulm Edema. - Dr. Robert Jones @RJonesSonoEM #BLines #Bilateral #Pneumonia #Lung #POCUS #clinical #ultrasound

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COVID-19 Lung POCUS Pt with COVID admitted with nearly normal EF, troponin increase with repeat normal ECG during stay, no CP. My guess: viral myocarditis. Really wicked virus. Dr. Marco Garrone @drmarcogarrone #COVID19 #POCUS #Clinical #Lung #Ultrasound #SARSCoV2 #Coronavirus

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Point of Care Ultrasound (POCUS) in COVID-19 - Dr. Devpriyo Pal @drdevradiology #COVID19 #Ultrasound #POCUS #Lung #diagnosis #coronavirus #sarscov2