Lung Ultrasound findings in COVID 19

Text Genevieve Carbonatto

Specific examination ultrasound findings in COVID 19 are not unique to the disease. Lung findings include  pleural line irregularities, pleural thickening, B lines and consolidations. What is striking is the remarkably similar  distribution of lung  pathology from patient to patient. The posterolateral areas are generally affected first bilaterally and then the disease spreads to the whole lung causing changes to appear bilaterally. The patient may be not be experiencing significant shortness of breath  despite widespread ultrasound findings . The following are some examples of patients with COVID 19 who presented with cough and fever. None  required supplemental oxygen.

The lungs can be examined using the 12 zone method seen below.

1.2. 

1. Dr James Rippey Ultrasound village  2. Annals of the American Thoracic Society Volume 10, Issue 6 | December 2013                              

Patient 1

35 year old, fever for 7 days, cough and fatigue. Saturating  95% on room air.

Main lung ultrasound features include B lines bilaterally in R2,R6,L2,L3, L6 (lower zones).  There is  little pleural line abnormality or thickening.

Patient 2 

36 year old, fever for 5 days, cough and fatigue. Not complaining of SOB but clinically increased work of breathing. Saturations 94% on room air

Lung ultrasound shows bilateral lung pathology with extensive B lines (indicating interstitial fluid) and subpleural consolidations. The subpleural consolidations are larger in zones  R6 and L6.

• B lines: R1, L2
• Pleural irregularity and thickening + B lines: R2, L1, R4
• Small subpleural consolidations + irregular and thickened pleural line: R3, L3, L4, L5, L6, R5, R6

B lines with pleural thickening and some irregularity

Subpleural consolidation with very irregular pleural line and B lines

Patient 3

54 year old lady, fever for 4 days, cough,  saturating 93% on room air. Not complaining of SOB but clinically increased work of breathing.

Lung ultrasound shows again shows bilateral lung pathology with widespread B lines and larger consolidations in R6, L6 zones

• Normal lung profile R1
• Pleural irregularity and thickening + B lines R2,R3, L1, L2, L3, L4
• Small and large subpleural consolidations R4, R5, R6, L5 , L6 

Pleural irregularity and thickening as well as small subpleural consolidation in R6

Consolidation > 1cm (1.45 cm) .