Lung ultrasonography as an alternative to chest computed tomography in COVID-19 pneumonia?
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EDITORIAL
Lung ultrasonography as an alternative to chest computed tomography in COVID‑19 pneumonia? Antoine Vieillard‑Baron1,2, Alberto Goffi3,4 and Paul Mayo5* © 2020 Springer-Verlag GmbH Germany, part of Springer Nature
A letter recently published by Yang et al. in this journal raises the important question as to whether lung ultrasonography (LUS) may be an useful alternative to chest computed tomography (CT) for the evaluation of COVID-19 pneumonia [1]. The information in the study is particularly relevant to a situation in which an overwhelming volume of COVID-19 patients may exceed CT performance and processing capacity. What is new and provocative in Yang’s study is the reported higher sensitivity of LUS compared to CT for the detection of alveolar-interstitial syndrome (AIS), consolidation, and pleural effusion in patients with COVID-19 pneumonia. The authors found weak or very weak agreement between LUS and CT for alveolar-interstitial findings, consolidation, and pleural effusion, with CT not able to identify a significant proportion of these findings. This editorial comments on the controversy engendered by the letter with the intent of furthering the discussion on LUS and CT as imaging modalities for SARS-CoV-2 pneumonia. Lung ultrasonography offers the clinician an alternative imaging modality to CT for management of COVID-19. We already know that LUS is more accurate than chest radiography to detect pneumothorax, pleural effusion, AIS, and consolidation [2, 3]. In acute respiratory distress syndrome (ARDS), LUS has been reported to be effective for evaluating the extent of pulmonary edema [4] and identifying poorly aerated areas [5]. LUS also allows for assessment of the effects of prone position [6] and positive end-expiratory pressure on lung re-aeration [7], *Correspondence: [email protected] 5 Division of Pulmonary, Critical Care, and Sleep Medicine, Northwell LIJ/ NSUH, New Hyde Park, NY, USA Full author information is available at the end of the article
although it does not identify over-inflation. For all these reasons, it is reasonable to consider LUS as useful for the management of COVID-19 patients with ARDS (Table 1). How is it possible that LUS might be a more sensitive test than CT for detection of findings that are typical of COVID-19 pneumonia? Two key aspects of the study conducted by Yang et al. may explain the high sensitivity described by the authors: misalignment between the definitions used to describe LUS and CT findings and the lack of a reference standard. An alveolar-interstitial pattern was reported in 60% of LUS images versus in only 38.5% of CT areas. Yang et al. equated the presence of more than three B-lines to the exclusive presence of ground glass opacities (GGOs) on CT. This decision may explain the lack of correlation between the two imaging modalities. The GGOs seen on CT in COVID-19 are associated with coalescent B line pattern (light beams”), whereas discrete B lines may be associated with other findings on CT such as interstitial abnormalities [8, 9]. A si
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