Case Study: Subacute Ultrasound Findings in COVID-19 Patient

Bedside ultrasound appears to be a valuable method of rapidly assessing lung involvement and monitoring disease progression in patients with COVID-19 infections.

This elderly male presents with progressive cough and dyspnea two weeks after initial COVID-19 diagnosis.  He was noted to drop to 90% O₂ saturation during coughing bouts.

Integrating Ultrasound Findings into Medical Decision Making

• High-frequency linear-array transducer reveals diffuse B-lines in both right and left anterior and posterior lung fields. No pleural effusion was noted. Focused cardiac ultrasound (FoCUS) reveals normal LVEF.
• While diffuse, bilateral B-lines may represent cardiogenic pulmonary edema, the normal cardiac ultrasound does not support this conclusion.
• Diffuse B-lines found across both lung fields in a COVID-positive patient is suggestive of advanced pulmonary involvement.
• Differentiating viral versus bacterial etiologies of pneumonia exclusively based upon radiographic findings is difficult (Korppi et al., Nambu et al.). However, solitary lobar, segmental, or round consolidations are more suggestive of bacterial pneumonias, while viral pneumonias more often display diffuse, bilateral interstitial findings (Berce et al., Biswas et al.).

Berce V, Tomazin M, Gorenjak M, et al. The usefulness of lung ultrasound for the aetiological diagnosis of community-acquired pneumonia in children. Sci Rep. 2019 Nov 29;9(1):17957. doi: 10.1038/s41598-019-54499-y.

Biswas A, Lascano JE, Mehta HJ, et al. the utility of the “shred sign” in the diagnosis of acute respiratory distress syndrome resulting from multifocal pneumonia. Am J Respir Crit Care Med. 2017 Jan 15;195(2):e20-e22. doi: 10.1164/rccm.201608-1671IM.

Korppi M, Kiekara O, Heiskanen-Kosma T, Soimakallio S. Comparison of radiological findings and microbial aetiology of childhood pneumonia. Acta Paediatr. 1993 Apr;82(4):360-363.

Nambu A, Ozawa K, Kobayashi N, Tago M. Imaging of community-acquired pneumonia: Roles of imaging examinations, imaging diagnosis of specific pathogens and discrimination from noninfectious diseases. World J Radiol. 2014;6(10):779–793. doi:10.4329/wjr.v6.i10.779

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