key: cord-0828249-pn9ow804
authors: Zhang, Zhongheng; Ren, Binbin; Fan, Haozhe; Chen, Kun; Chen, Lin
title: The role of lung ultrasound in the assessment of novel coronavirus pneumonia
date: 2020-04-30
journal: J Cardiothorac Vasc Anesth
DOI: 10.1053/j.jvca.2020.04.040
sha: 662c7279bdcf56d860815159f105227a2d394ee4
doc_id: 828249
cord_uid: pn9ow804

nan

COVID-19 are mild (common type) and can recover spontaneously without specific treatment, a substantial proportion will develop severe cases. the management of such severe cases are challenging. Early identification, evaluation of the progress and timely treatment of patients with COVID-19 are the key to reduce the mortality of patients.

As a rapid, convenient, radiation-free, economic, repeatable and bedside visual examination technology for the lung diseases, lung ultrasound plays an essential role in the diagnosis and treatment of critical patients. Lung ultrasound has full advantages in the differential diagnosis of pulmonary exudative diseases, the evaluation of pleural effusion, the recognition of pneumothorax, the evaluation of dyspnea and acute respiratory failure patients, as well as in the monitoring of treatment, the evaluation of curative effect and the guidance of treatment, and has formed a consensus of many experts worldwide. Because of highly infectiousness of the novel coronavirus pneumonia, we should make full use of lung ultrasound to guide diagnosis and treatment during the different stages of the disease.

Line B Linear hyperecho starts from pleura line and is perpendicular to it at the same time radiates longitudinally to the deep part of the lung field. Alveolar interstitial syndrome There are more than two consecutive costal spaces in any scanning area with fusion B line.

White lung Dense B line is found in each scanning area of both lungs.

There are the formation of serous, fibrin exudate and hyaline membrane in the alveoli. The epithelial cells of type II alveoli proliferate significantly. The blood vessels of the alveoli septum are congested and edematous and bleeding and necrotic of the pulmonary tissue is also found. Some alveoli exudates are organized and pulmonary interstitial fibrosis can be found. The beginning of the onset of patients often starts from the lateral zone of the lung, close to the pleura. Therefore, pulmonary ultrasound can more effectively observe the pathological changes and dynamic changes of the lung condition.

Pulmonary consolidation Solid tissue echo is shown after the complete loss of lung tissue gasification, with patchy or "liver like change" of different sizes, which may be accompanied by "sign of broncho inflation " or "sign of broncho fluid filling ". 

There are thickened pleural line (Figure 1) 

We should focus on the presence or absence of abnormal pleura line (smooth, continuous), B line (number and distribution), consolidation (range, bronchiectasis), pleural effusion (nature), and pneumothorax and so on. The sonograms of B line, alveolus interstitial syndrome and white lung reflect the degree of content of lung water from light to heavy.

Sezgin C et al have reported that the sensitivity and specificity of pulmonary ultrasound in the diagnosis of pneumonia are 98.0% and 95.8%, respectively [4] and the diagnostic rate of pneumothorax can reach 100% [7] . The lung ultrasound signs and pathological signs have already been well known by clinicians.

In addition, the novel coronavirus pneumonia is highly infectious. In order to reduce the transmission it is better to perform the examination as less frequently as possible. With the limitation of bedside chest X-ray especially its high radioactive activity which put high danger to the medical workers and patients lung ultrasound is a better choice of the bedside equipment. With its convenient, noninvasive, repeatable, radiation-free and rapid characteristic, lung ultrasound has been widely used in the critical area. The condition of the novel coronavirus pneumonia changes rapidly, combined with the characteristics of the pathology of pneumonia the new coronavirus, we make better use of lung ultrasound to afford full and effective assessment of the lung condition, which can provide sufficient guidance for diagnosis and treatment. Sixth, the evaluation of inferior vena cava and heart by ultrasound will provide great value for the differential diagnosis when the situation of the patient changes rapidly.

Finally, it is easy to acquire and transmit images of the ultrasound, which is essential for remote diagnosis and treatment.

There are also limitations of the lung ultrasound especially pathological changes in deep part of lung field and without pathological changes of the pleural, its advantage of the diagnosis is reduced significantly. However, in order to reduce the probability of transmission, to better perform dynamic diagnosis of the novel coronavirus pneumonia and to provide better protection of the medical workers and patients, the lung ultrasound should be taken better full use of. 

A Novel Coronavirus from Patients with Pneumonia in China

Bedside ultrasonography for diagnosis of pneumothorax

Evaluation of pulmonary B lines by different intensive care physicians using bedside ultrasonography: a reliability study. Rev Bras Ter Intensiva

Diagnostic Value of Bedside Lung Ultrasonography in Pneumonia

Point-of-Care Lung Ultrasound findings in novel coronavirus disease-19 pnemoniae: a case report and potential applications during COVID-19 outbreak

The "lung point": an ultrasound sign specific to pneumothorax