Lung ultrasound artifacts in COVID-19 patients
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CASE REPORT
Lung ultrasound artifacts in COVID‑19 patients Christine McElyea1 · Christopher Do1 · Keith Killu1 Received: 18 May 2020 / Accepted: 12 August 2020 © Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB) 2020
Abstract Lung ultrasound is an essential tool in critical care, made more so by the enhanced precautions associated with the Covid-19 pandemic. Here we describe 2 cases of multiple, small shred signs seen on ultrasound of Covid-19 patients. Keywords COVID-19 · Lung ultrasound · Shred sign
Introduction
Case reports
Lung ultrasound is an essential tool in identifying lung disease and most practitioners will be able to identify pathology not visible on chest X-Ray [1]. As of the summer of 2020, there are more than 12.5 million reported cases of COVID19 caused by the Coronavirus 2 (SARS-CoV-2) causing a pandemic that has presented many challenges in the traditional approach to patients with hypoxemia and shortness of breath or respiratory failure. The disease has affected over 188 countries and reported deaths are over 500,000 so far across the globe [2, 3]. Traditional radiologic imaging for patients who present with suspected pneumonia, including chest X-ray or CT chest is not routinely recommended to limit healthcare worker exposure. Using bedside ultrasound, with the appropriate precautions, can help the practitioner significantly in identifying the lung pathology [4]. Studies describing lung ultrasound findings have been increasing over the last 25 years, with more recent articles describing the use of ultrasound in a standardized fashion to identify lung disease in COVID-19 era [5].
Patient A
* Christine McElyea [email protected]
Patient B
1
Department of Pulmonary, Critical Care and Sleep Medicine, University of Southern California, 2020 Zonal Avenue, IRD 723, Los Angeles, CA 90033, USA
We present the case of a 64-year-old woman with a past medical history of developmental delay with associated dementia and schizoaffective disorder, and recurrent urinary tract infections who was sent to the emergency department from her skilled nursing facility for fevers of 38.7 °C. Initial complete blood count demonstrated leukocytosis to 14.5 with 8% bands. A CT of the abdomen and pelvis demonstrated bladder wall thickening concerning for cystitis; she was admitted and treated with ceftriaxone for presumed urinary tract infection. By day 4 of admission, her fevers had failed to remit, and a CT of the chest was obtained which demonstrated bilateral, patchy ground-glass opacities. A SARS CoV-2 PCR was sent and returned positive on day 7 of admission at which time she was started on azithromycin and hydroxychloroquine. She developed worsening hypoxic respiratory failure and was intubated on day 13 of admission and transferred to our facility for further care. Of note, her nursing home roommate was also admitted to our ICU with the novel coronavirus. Lung ultrasound was used in addition to the earlier conventional modalities of chest X-Ray and CT scan. She received one dos
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