Clinical POCUS Use in COVID-19

Findings Typical of COVID-19

Typical findings in COVID-19 include thickening of the pleural line, B-lines, and subpleural consolidation. Remember, COVID-19 has a wide spectrum of disease and the lung ultrasound findings reflect this. The patient who walks into urgent care with a cough may have normal lungs (A-line pattern) throughout or a focal areas of B-lines. Patients presenting with rapidly worsening disease and meeting criteria for ARDS may have confluent B-lines and subpleural consoldiations. Here are some images so you can be familiar with the findings typical of COVID-19.

Lung

Butterfly has a list of lung ultrasound images.

Cardiac

Our understanding of cardiomyopathies associated with COVID-19 is still evolving. POCUS is uniquely suited to aid in this diagnosis, especially as the pandemic is limiting our use of traditional resources. Specific attention should be paid to both the left and right ventricles (courtesy of the POCUS atlas).

Isolated B-lines (hat tip Dr. Mike Northrop)

Subpleural Consolidation (hat tip POCUS Atlas)

Cases

Starting March 1, Dr. Yale Tung Chen shared his personal story via his twitter feed about his COVID-19 infection and doucmented his lung ultrasound findings.

Review of lung ultrasound findings in a retrospective study of 20 patients with COVID-19. The experts at Ultasound Gel Podcast subsequently reviewed this article in their podcast.

Clinical Care and Algorithms

There are not yet validated protocols for lung ultrasound. Many of these protocols have been generated from data looking lung ultrasound's ability to detect consolidations and follow lung aeration. As with other imaging modalities, ultrasound findings should always be taken into consideration of the clinical context of the patient.

Videos and Webinars

Dr. Joe Minardi made a youtube video with an overview of POCUS in COVID-19.
Dr. Soni has a link for a webinar in both video and pdf format hosted here.
Dr. Blaivas reviews POCUS in COVID-19, including deep discussion about difference between B-line and comet tail artifacts and how these can help providers potentially differentiate pulmonary edema and a viral illness.

Algorithms/Schemas

There is not yet a clinically vetted protocol for the care of patients with ultrasound. Our group believes that ultrasound may offer both diagnostic and prognostic information and that that providers should be thoughtful about its application in the context of careful protection of PPE resources.

Here is our take on a suggested clinical application in the care of both ambulatory and hospitalized patients with suspected or confirmed COVID-19.

Butterfly's Dr. Mike Stone on a lung ultrasound protocol.

EMCrit's Josh Farkas' take on an imaging schema.

Twitter feed for #POCUSforCOVID