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Diagnostic value of 12-zone lung ultrasound protocol for diagnosing COVID-19-associated pneumonia in outpatients

Dzmitry Haurylenka
Dzmitry Haurylenka
, 
Victar Damantsevich
Victar Damantsevich
, 
Andrey Filustsin
Andrey Filustsin
 and 
Anna Damantsevich
Anna Damantsevich
   | Dec 15, 2021
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Article Category: research-article
Published Online: Dec 15, 2021
Page range: 271 - 276
Received: Apr 30, 2021
Accepted: Jun 28, 2021
DOI: https://doi.org/10.15557/jou.2021.0046
Keywords
© 2021 Polish Ultrasound Society. Published by Medical Communications Sp. z o.o.
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Fig. 1.

Prevalent lung lesions patterns in COVID-19-associated pneumonia in computed tomography: A.Areas of ground-glass opacities, mainly subpleural. B.Different-sized areas of ground-glass opacities with unilateral subpleural consolidation. C.Widespread subpleural infiltration with consolidation. D.Multiple bilateral small areas of ground-glass opacities with consolidation foci
Prevalent lung lesions patterns in COVID-19-associated pneumonia in computed tomography: A.Areas of ground-glass opacities, mainly subpleural. B.Different-sized areas of ground-glass opacities with unilateral subpleural consolidation. C.Widespread subpleural infiltration with consolidation. D.Multiple bilateral small areas of ground-glass opacities with consolidation foci

Fig. 2.

Prevalent profiles of lung lesions in COVID-19-associated pneumonia in lung ultrasound A. Norm (A-lines, score = 0). B. Narrow B-lines, more than 3 in one zone (score = 1). C. Coalescent wide B-lines. Subpleural consolidation, discontinuous pleural line (score = 2). D. Large consolidated area, white lung phenomenon (score = 3)
Prevalent profiles of lung lesions in COVID-19-associated pneumonia in lung ultrasound A. Norm (A-lines, score = 0). B. Narrow B-lines, more than 3 in one zone (score = 1). C. Coalescent wide B-lines. Subpleural consolidation, discontinuous pleural line (score = 2). D. Large consolidated area, white lung phenomenon (score = 3)

Fig. 3.

A, B. Intrapulmonary lymph node: echoscopic image (left) and tomogram (right). C. Area of linear fibrosis. D. Areas of infiltration along the interlobar pleura, not detected by lung ultrasound
A, B. Intrapulmonary lymph node: echoscopic image (left) and tomogram (right). C. Area of linear fibrosis. D. Areas of infiltration along the interlobar pleura, not detected by lung ultrasound

Fig. 4.

Cut-off value for lung ultrasound in detecting pneumonia associated with COVID-19 infection
Cut-off value for lung ultrasound in detecting pneumonia associated with COVID-19 infection

Fig. 5.

Correlation between lung ultrasound score and computed tomography positive zone score
Correlation between lung ultrasound score and computed tomography positive zone score

Basic demographic and clinical data of patients included in the study

Variables Patients, n = 39
Age, years, Me [Q1; Q3] 49 [39; 61]
Gender, male/female (%) 17 (44) / 22 (56)
Symptoms (%; 95% CI):
  fever 35 (90; 76-97)
  cough 26 (67; 50-81)
  sputum 12 (31; 17-48)
  dyspnea 18 (46; 30-63)
  chest pain 7 (18; 8-34)
  anosmia 7 (18; 8-34)
  sweating 5 (13; 4-27)
Oxygen saturation, %, Me [min; max] 98 [82; 90]
Symptom duration, days, Me [min; max] 9 [3; 30]
No comorbidities. (%; 95% CI) 16 (41; 26-58)
Comorbidities, Me [min; max]: 2 [1;5]
 Hypertension: 16
  Stage 1 7
  Stage 2 7
  Stage 3 2
  Obesity 11
  Non-alcoholic fatty liver disease 9
  Cardiovascular disease 6
  Diabetes 4
  Chronic bronchitis 3
  Chronic kidney disease 2
  Post-stroke period 1

Receiver operating characteristic of different cut-off at lung ultrasound score for diagnosis of COVID-19 associated pneumonia

Lung ultrasound score Se, % 95% CI Sp, % 95% CI PPV, % NPV, %
≥0 100.00 86.3-100.0 0.00 0.0-23.2 64.1
>0 100.00 86.3-100.0 57.14 28.9-82.3 80.6 100.0
>1 96.00 79.6-99.9 64.29 35.1-87.2 82.8 90.0
>2 88.00 68.8-97.5 100.00 76.8-100.0 100.0 82.4

Comparative characteristics of some parameters of patients with COVID-19 infection with and without pneumonia

Variables Patients with pneumonia n = 25 Patients without pneumonia n = 14 U/X2 p
Age, years, Me [Ql; Q3] 49 [31; 75] 48 [32; 69] 139.0 0.291
Gender, male/female (%) 10(40)/15(60) 7(50)/7(50) 0,36 0.546
Symptoms duration, days Me [Q1;Q3] 8 [3;23] 12 [6;60] 111.0 0.062
Symptoms:
  fever 23 12 0.608
  dyspnea 11 6 1.23 0.945
  cough 17 7 0.268
  sputum 7 4 0.624
  anosmia 6 0 0.054
Comorbidities 15 8 0.03 0.862

The borders of the examined areas in accordance with the segments anatomical landmarks

Side
posterior lateral anterior
right left right left right left
Upper l. paravertebralis SI, S2, S6 S1, S2, S6 l. axillaris posterior S1, S2, S3, S4 S1, S2, S3, S4, S6 l. axillaris anterior S1, S3 S1, S3, S4 l. parasternalis
VI edge V edge IV edge
Lower S6, S10, S9 S10 S4, S8 S8, S9, S10 S4, S5, S8 S4, S5, S8
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