Skip to main content

Main menu

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 Articles
  • Authors & Reviewers
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
    • Patient engagement
  • Members & Subscribers
    • Benefits for CMA Members
    • CPD Credits for Members
    • Subscribe to CMAJ Print
    • Subscription Prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2023
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN

User menu

Search

  • Advanced search
CMAJ
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN
CMAJ

Advanced Search

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 Articles
  • Authors & Reviewers
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
    • Patient engagement
  • Members & Subscribers
    • Benefits for CMA Members
    • CPD Credits for Members
    • Subscribe to CMAJ Print
    • Subscription Prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2023
  • Visit CMAJ on Facebook
  • Follow CMAJ on Twitter
  • Follow CMAJ on Pinterest
  • Follow CMAJ on Youtube
  • Follow CMAJ on Instagram
Practice

Lung ultrasound findings in a 64-year-old woman with COVID-19

Adam Thomas, Greg Haljan and Anish Mitra
CMAJ April 14, 2020 192 (15) E399; DOI: https://doi.org/10.1503/cmaj.200414
Adam Thomas
Department of Critical Care Medicine (Thomas, Haljan, Mitra), University of British Columbia, Vancouver, BC; Island Health and Victoria General Emergency Department (Thomas), Victoria, BC; Department of Critical Care (Haljan, Mitra), Fraser Health, Surrey, BC
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Greg Haljan
Department of Critical Care Medicine (Thomas, Haljan, Mitra), University of British Columbia, Vancouver, BC; Island Health and Victoria General Emergency Department (Thomas), Victoria, BC; Department of Critical Care (Haljan, Mitra), Fraser Health, Surrey, BC
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Anish Mitra
Department of Critical Care Medicine (Thomas, Haljan, Mitra), University of British Columbia, Vancouver, BC; Island Health and Victoria General Emergency Department (Thomas), Victoria, BC; Department of Critical Care (Haljan, Mitra), Fraser Health, Surrey, BC
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Tables
  • Related Content
  • Responses
  • Metrics
  • PDF
Loading
Submit a Response to This Article
Compose Response

More information about text formats

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
References
Author Information
First or given name, e.g. 'Peter'.
Your last, or family, name, e.g. 'MacMoody'.
Your email address, e.g. higgs-boson@gmail.com
Your role and/or occupation, e.g. 'Orthopedic Surgeon'. Minimum 7 characters.
Your organization or institution (if applicable), e.g. 'Royal Free Hospital'. Minimum 12 characters.
Your organization, institution's or residential address.
Statement of Competing Interests

Vertical Tabs

Jump to comment:

  • Clarifying the role of lung ultrasound in COVID-19 respiratory disease [RE: Lung ultrasound findings in a 64-year-old woman with COVID-19]
    Cameron W Pierce [B.Sc, M.A., MD, FRCPC internal medicine & respirology]
    Posted on: 02 April 2020
  • RE: Lung ultrasound findings in a 64-year-old woman with Covid-19: This examination could be remote!
    Andrew W Kirkpatrick [MD MHSc FRCSC] and Jessica L Mckee [BA MSc]
    Posted on: 31 March 2020
  • Posted on: (2 April 2020)
    Page navigation anchor for Clarifying the role of lung ultrasound in COVID-19 respiratory disease [RE: Lung ultrasound findings in a 64-year-old woman with COVID-19]
    Clarifying the role of lung ultrasound in COVID-19 respiratory disease [RE: Lung ultrasound findings in a 64-year-old woman with COVID-19]
    • Cameron W Pierce [B.Sc, M.A., MD, FRCPC internal medicine & respirology], respirologist, Vancouver Coastal Health

    Thomas et al(1) describe a patient with COVID-19 pneumonia, in whom lung ultrasound demonstrated "multifocal B-lines, pleural thickening and subpleural consolidation." On the basis of these findings, they propose "that lung ultrasonography may be useful in the workup of patients with suspected COVID-19, even though differentiating between different causes of viral pneumonia is not possible." These comments require further clarification.

    First, the sonographic findings described here are highly nonspecific, being found not only in other viral pneumonias, but also in non-viral pneumonias, as well as a wide spectrum of noninfectious processes, including interstitial lung disease and ARDS.(2)

    Secondly and consequently, the nature of this patient's sonographic findings must be further qualified, particularly her 'multifocal' B-lines. If by this term three or more B-lines per acoustic window is designated, an 'interstitial' (or 'alveolar-interstitial') pattern is identified (whereas occasional B-lines, especially dependently, can be normal).(3) However, if by this term a certain global distribution of interstitial pattern is designated, diagnostic implications follow: whereas a homogeneous interstitial pattern favours cardiogenic edema, a heterogeneous interstitial pattern, particularly combined with subpleural consolidation, pleural thickening, and reduced lung sliding, is consistent with pneumonia and/or AR...

    Show More

    Thomas et al(1) describe a patient with COVID-19 pneumonia, in whom lung ultrasound demonstrated "multifocal B-lines, pleural thickening and subpleural consolidation." On the basis of these findings, they propose "that lung ultrasonography may be useful in the workup of patients with suspected COVID-19, even though differentiating between different causes of viral pneumonia is not possible." These comments require further clarification.

    First, the sonographic findings described here are highly nonspecific, being found not only in other viral pneumonias, but also in non-viral pneumonias, as well as a wide spectrum of noninfectious processes, including interstitial lung disease and ARDS.(2)

    Secondly and consequently, the nature of this patient's sonographic findings must be further qualified, particularly her 'multifocal' B-lines. If by this term three or more B-lines per acoustic window is designated, an 'interstitial' (or 'alveolar-interstitial') pattern is identified (whereas occasional B-lines, especially dependently, can be normal).(3) However, if by this term a certain global distribution of interstitial pattern is designated, diagnostic implications follow: whereas a homogeneous interstitial pattern favours cardiogenic edema, a heterogeneous interstitial pattern, particularly combined with subpleural consolidation, pleural thickening, and reduced lung sliding, is consistent with pneumonia and/or ARDS.(4) Presuming a heterogeneous interstitial pattern, this patient's overall presentation suggests concomitant COVID-19 pneumonia and ARDS.

    In sum, the findings on lung ultrasound of COVID-19 respiratory disease appear to be nonspecific, and likely on par with similar non-COVID respiratory diseases; the need for microbiological confirmation remains. In general, lung ultrasound in critical illness provides data that are probably best regarded as complementary to chest radiography; its unique benefit in the current context includes bedside feasibility, particularly when advanced chest imaging is unavailable or contraindicated for infection control.(5)

    Show Less
    Competing Interests: None declared.

    References

    • (1). Clarifying the role of lung ultrasound in COVID-19 respiratory disease [RE: Lung ultrasound findings in a 64-year-old woman with COVID-19]. 2020;:-.
    • (2) Mojoli F, Bouhemad B, Mongodi S, Lichtenstein D. Lung ultrasound for critically ill patients. Am J Respir Crit Care Med 2019;199:701-714.
    • (3) Doerschug KC, Schmidt GA. Intensive Care Ultrasound: III. Lung and pleural ultrasound for the intensivist. Ann Am Thorac Soc 2013;10:708-712.
    • (4) Copetti R, Soldati G, Copetti P. Chest sonography: a useful tool to differentiate acute cardiogenic pulmonary edema from acute respiratory distress syndrome. Cardiovasc Ultrasound 2008:6:16.
    • (5) See KC, Ong V, Tan YL, Sahagun J, Taculod J. Chest radiography versus lung ultrasound for identification of acute respiratory distress syndrome: a retrospective observational study. Crit Care 2018;22:203.
  • Posted on: (31 March 2020)
    Page navigation anchor for RE: Lung ultrasound findings in a 64-year-old woman with Covid-19: This examination could be remote!
    RE: Lung ultrasound findings in a 64-year-old woman with Covid-19: This examination could be remote!
    • Andrew W Kirkpatrick [MD MHSc FRCSC], Acute Care, Trauma, and General Surgery and Critical Care Medicine, TeleMedical Ultrasound Enhanced Medical Interventions (TMUSMI) Group of the University of Calgary
    • Other Contributors:
      • Jessica L Mckee, Project Manager

    We applaud the efforts of Thomas and colleagues, in recognizing the utility of lung ultrasound as a valuable tool in the workup of patients with suspected COVID-19. They report multi-focal B-lines, pleural thickening, and subpleural consolidation, similar to findings of Peng(1), who noted that lung ultrasound gives similar results to Chest CT, but with markedly simplified logistics. Both examinations may show findings even before PCR results. Beyond this we wish to also stress the logistical attributes of lung ultrasound that include ease of performance and interpretation, and the fact that it can be interpreted far physically removed from the site of examination using telemedicine. Front-line health care providers are increasingly succumbing to COVID-19, and there are world-wide concerns regarding inadequate personal protective equipment. Remote telementored ultrasound (RTMUS) is just one format of telemedical communication, but provides a wealth of anatomic and physiologic information that can be remotely interpreted from anywhere in the world with Internet Connectivity. We have previously demonstrated that lung ultrasound can be performed accurately with economical mobile equipment in the hands of non-physicians when remotely guided(2, 3), a paradigm largely initiated to support Space Medicine(4). In addition to augmenting diagnosis, we also suggest that RTMUS might aid ongoing screening in their own homes of self-isolating adults at risk of, or with self-limited...

    Show More

    We applaud the efforts of Thomas and colleagues, in recognizing the utility of lung ultrasound as a valuable tool in the workup of patients with suspected COVID-19. They report multi-focal B-lines, pleural thickening, and subpleural consolidation, similar to findings of Peng(1), who noted that lung ultrasound gives similar results to Chest CT, but with markedly simplified logistics. Both examinations may show findings even before PCR results. Beyond this we wish to also stress the logistical attributes of lung ultrasound that include ease of performance and interpretation, and the fact that it can be interpreted far physically removed from the site of examination using telemedicine. Front-line health care providers are increasingly succumbing to COVID-19, and there are world-wide concerns regarding inadequate personal protective equipment. Remote telementored ultrasound (RTMUS) is just one format of telemedical communication, but provides a wealth of anatomic and physiologic information that can be remotely interpreted from anywhere in the world with Internet Connectivity. We have previously demonstrated that lung ultrasound can be performed accurately with economical mobile equipment in the hands of non-physicians when remotely guided(2, 3), a paradigm largely initiated to support Space Medicine(4). In addition to augmenting diagnosis, we also suggest that RTMUS might aid ongoing screening in their own homes of self-isolating adults at risk of, or with self-limited COVID-19. We propose that a family member and/or the patient themselves could be guided to examine their lung fields as an early warning of COVID-19 progression, allowing earlier rescue to a higher level of assessment for the minority who will deteriorate during home isolation.

    Andrew W Kirkpatrick MD Andrew.kirkpatrick@ahs.ca
    Jessica L McKee jlb9@ualberta.ca
    TeleMedical Ultrasound Enhanced Medical Interventions (TMUSMI) Group of the University of Calgary

    1. Peng, INtensive Care Med 2020
    2. McBeth, J Trauma 2011
    3. McBeth Telemed J e-heath 2013
    4. Sargsyan, J Trauma 2005

    Show Less
    Competing Interests: The authors have no direct conflicts of interest regarding this article. Unrelated potential conflicts of interest are that AW Kirkpatrick is the PI of the COOL trial ( https://clinicaltrials.gov/ct2/show/NCT03163095).) with partial unrestricted funding from the Acelity Corporation. AW Kirkpatrick has also consulted for the Innovative Trauma Care and SAM Medical Corporations. JL McKee is the Research Director of Innovative Trauma Care and has consulted for the Aceso, SAM, and Acelity Corporations. AW Kirkpatrick and JL McKee also disclose a personal relationship.

    References

    • Adam Thomas, Greg Haljan, Anish Mitra. Lung ultrasound findings in a 64-year-old woman with COVID-19. CMAJ 2020;10.1503/cmaj.200414.
    • Qian-Yi Peng, Xiao-Ting Wang, Li-Na Zhang and the Chinese Critical Care Ultrasound Study Group (CCUSG). Findings of lung ultrasonography of novel corona virus pneumonia during the 2019-2020 epIntensive Care Med 2020 Mar 12. doi: 10.1007/s00134-020-05996-6
    • Paul McBeth, Innes Crawford, Michael Blaivas, Trevor Hamilton, Kim Musselwhite, Nova Pannebianco, et al.,Simple, almost anywhere, with almost anyone: remote low-cost telementored resuscitative lung ultrasound. J Trauma. 2011;71(6):1528-35.
    • Paul McBeth, Innes Crawford, Corina Tiruta, James Xiao, George Qiaohao Zhu, Michael Shuster, et al.,Help is in your pocket: the potential accuracy of smartphone- and laptop-based remotely guided resuscitative teleson Telemed J e-health 2013;19(12):924-30.
    • Ashot Sargsyan, Douglas Hamilton, Jeff Jones, Shannon Melton, Peggy Whitson, Andrew Kirkpatrick. FAST at MACH 20: clinical ultrasound aboard the International Space Station. J Trauma. 2005;58(1):35-9.
PreviousNext
Back to top

In this issue

Canadian Medical Association Journal: 192 (15)
CMAJ
Vol. 192, Issue 15
14 Apr 2020
  • Table of Contents
  • Index by author

Article tools

Respond to this article
Print
Download PDF
Article Alerts
To sign up for email alerts or to access your current email alerts, enter your email address below:
Email Article

Thank you for your interest in spreading the word on CMAJ.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Lung ultrasound findings in a 64-year-old woman with COVID-19
(Your Name) has sent you a message from CMAJ
(Your Name) thought you would like to see the CMAJ web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Lung ultrasound findings in a 64-year-old woman with COVID-19
Adam Thomas, Greg Haljan, Anish Mitra
CMAJ Apr 2020, 192 (15) E399; DOI: 10.1503/cmaj.200414

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
‍ Request Permissions
Share
Lung ultrasound findings in a 64-year-old woman with COVID-19
Adam Thomas, Greg Haljan, Anish Mitra
CMAJ Apr 2020, 192 (15) E399; DOI: 10.1503/cmaj.200414
Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like

Jump to section

  • Article
    • Footnotes
    • References
  • Figures & Tables
  • Related Content
  • Responses
  • Metrics
  • PDF

Related Articles

  • Lung ultrasonography in a woman with COVID-19: This examination could be remote
  • Clarifying the role of lung ultrasonography in COVID-19 respiratory disease
  • Échographie pulmonaire d’une femme de 64 ans atteinte de la COVID-19
  • PubMed
  • Google Scholar

Cited By...

  • Point of care lung ultrasound is useful when screening for CoVid-19 in Emergency Department patients
  • Principes de soins cliniques aux patients atteints de la COVID-19 dans les unites medicales
  • Principles for clinical care of patients with COVID-19 on medical units
  • Lung ultrasonography in a woman with COVID-19: This examination could be remote
  • Clarifying the role of lung ultrasonography in COVID-19 respiratory disease
  • Google Scholar

More in this TOC Section

  • A blistering variant of phlegmasia cerulea dolens from underlying squamous cell lung cancer
  • Parechovirus infections in infants
  • Radiation dermatitis in a patient treated for hepatocarcinoma
Show more Practice

Similar Articles

Collections

  • Article Types
    • Clinical Images
  • Topics
    • Critical & intensive care
    • Emergency medicine
    • Health services
    • Infectious diseases
    • Infectious diseases: COVID-19
    • Respiratory medicine

 

View Latest Classified Ads

Content

  • Current issue
  • Past issues
  • Collections
  • Sections
  • Blog
  • Podcasts
  • Alerts
  • RSS
  • Early releases

Information for

  • Advertisers
  • Authors
  • Reviewers
  • CMA Members
  • CPD credits
  • Media
  • Reprint requests
  • Subscribers

About

  • General Information
  • Journal staff
  • Editorial Board
  • Advisory Panels
  • Governance Council
  • Journal Oversight
  • Careers
  • Contact
  • Copyright and Permissions
  • Accessibiity
  • CMA Civility Standards
CMAJ Group

Copyright 2023, CMA Impact Inc. or its licensors. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p)

All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association or its subsidiaries.

To receive any of these resources in an accessible format, please contact us at CMAJ Group, 500-1410 Blair Towers Place, Ottawa ON, K1J 9B9; p: 1-888-855-2555; e: cmajgroup@cmaj.ca

Powered by HighWire