key: cord-0715805-st79vmyz
authors: Soliman-Aboumarie, Hatem; Miglioranza, Marcelo Haertel
title: COVID-19 Front Line - Why Focused Lung and Cardiovascular Ultrasound?
date: 2020-10-12
journal: JACC Case Rep
DOI: 10.1016/j.jaccas.2020.09.030
sha: 1e3704d43e14fb9953a1644415cbe30ada35d2f0
doc_id: 715805
cord_uid: st79vmyz

[Figure: see text]

(1) For this group, an improper evaluation could lead to a delay in the institution of medical support and, therefore, a higher probability for adverse outcomes.

Although the diagnosis of SARS-CoV2 infection is the mainstay for patient's categorization, the rapid antibody test starts to be reliable around 7 days after the symptom's onset. Definitive SARS-CoV-2 diagnosis requires a positive RT-PCR assay. Although RT-PCR is considered highly specific in the first days of symptoms, it has a high false-negative rate.

Nevertheless, it is not widely available, and the results usually take around 24 to 48 hours to be processed. Therefore, the assessment of the pulmonary involvement could be an alternative screening method, and it could guide the clinician as to whether the patient needs admission to the hospital, intensive care unit, or they could be discharged safely with an outpatient follow-up.

Chest X-ray (CXR) is the most widely available imaging modality, but it has shown only a little benefit for the initial evaluation in non-emergency situations. In early stages, almost 60% of the COVID-19 patients have normal CXR, and 90% have either normal or mildly abnormal CXR despite the initial presentation with severe symptoms.(2) The most frequent findings on CXR often appear around 10-12 days from symptom onset and are frequently described as bilateral lower patchy infiltrates or consolidations.(2) Due to its higher sensitivity to detect the early degrees of pulmonary involvement: ground-glass opacification, patchy bilateral consolidations, or peripheral interstitial changes (found in 97% of confirmed COVID-19 patients), a chest Computed Tomography (CT) scan has been proposed as the gold standard imaging modality and J o u r n a l P r e -p r o o f has been incorporated in different triaging protocols. (3, 4) However, this approach also has several limitations; CT scan is not readily available in most limited-resource settings, it requires the patient's transport to the radiology department, which increases the risk of SARS-CoV-2 dissemination and staff exposure. Critically ill patients might also be too unwell to embark on a journey to the CT scanner. Cardiovascular ultrasound has become essential in COVID-19 patient's management and stratification. It was found useful to diagnose several cardiac abnormalities that could be seen in those patients. Right Ventricular (RV) dilatation and dysfunction have been seen in many patients with COVID-19 patients which could be attributed to the requirement for positive pressure ventilation with high positive end-expiratory pressure (PEEP), which increases RV afterload and therefore induces RV strain. The occurrence of venous thromboembolism in COVID-19 patients has led to the discovery of a significant proportion of them having variable degrees of pulmonary thromboembolism, which could also lead to RV strain. Myocarditis has also been reported in COVID-19 patients with one case report describing the presence of viral particles within the myocardium;(7) however, there is no clear evidence that the viral particles directly invade the myocardium. (8) However, challenges exist in using POCUS in acute care settings; proper training and accreditation are essential. The implementation of POCUS data should always be done in the J o u r n a l P r e -p r o o f

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