Lung ultrasound: a valuable tool for the assessment of dialysis patients with COVID-19
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LETTER TO THE EDITOR
Lung ultrasound: a valuable tool for the assessment of dialysis patients with COVID‑19 Nathaniel Reisinger1 · Abhilash Koratala2 Received: 8 April 2020 / Accepted: 10 May 2020 © Japanese Society of Nephrology 2020
To the Editor, Patients on maintenance hemodialysis face unique challenges during Coronavirus disease 2019 (COVID-19) pandemic due to frequent contact with health care facilities as well as high comorbidity burden subjecting them to increased risk of serious complications from the disease. With an ongoing surge in COVID-related hospitalizations exhausting resources, outpatient dialysis units are preparing to manage patients suspected to have or tested positive for COVID-19 with mild symptoms. In addition to exploring the options to safely dialyze these patients, timely recognition of clinical deterioration and referral to the hospital are crucial [1]. Symptom recognition is not straightforward as these patients often have multiple etiologies for dyspnea especially given concomitant pulmonary congestion due to fluid overload. In some of the severely affected parts of the world, triage protocols have been developed using computed tomography (CT) scan of the chest as the primary imaging modality to identify dialysis patients that need hospitalization. Repeated studies were often performed in those with positive findings, exposing patients to significant ionizing radiation [2]. In contrast, lung ultrasound (LUS) is a bedside diagnostic tool that emits no ionizing radiation and has comparable diagnostic accuracy to that of CT scan in detecting most lung pathologies. Moreover, LUS has a proven track record Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10157-020-01903-x) contains supplementary material, which is available to authorized users. * Abhilash Koratala [email protected] 1
University of Pennsylvania Health System, Philadelphia, PA, USA
Division of Nephrology, Room A 7633, Medical College of Wisconsin, 8701 W Watertown Plank Rd, Wauwatosa, WI 53226, USA
2
in dialysis patients to assess extravascular lung water, and nephrologists at some centers use it routinely for this purpose [3]. Lung imaging findings of COVID-19 are non-specific on both CT scan and LUS and cannot differentiate among viral pneumonias. Preliminary data suggest that the sonographic features of this disease correlate well with chest CT features. In fact, the detection of focal B-lines on LUS may be more sensitive than CT findings in early disease [4]. Other characteristic features of COVID-19 disease on LUS include a thickened or irregular pleural line, subpleural consolidations, and multifocal or confluent B-lines. Translobar consolidation and pleural effusions are relatively uncommon [5]. We herein present a brief case study to illustrate the role of LUS in this context. A 79-year-old woman with a history of end-stage kidney disease on maintenance hemodialysis and hypertension was found to be hypoxemic with an oxygen saturation of 90% on room air. Bed
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