Clinical role of lung ultrasound for diagnosis and monitoring of COVID-19 pneumonia in pregnant women

Abstract

Lung ultrasound has been suggested recently by the Chinese Critical Care Ultrasound Study Group and Italian Academy of Thoracic Ultrasound as an accurate tool to detect lung involvement in COVID-19. Although chest computed tomography (CT) represents the gold standard to assess lung involvement, with a specificity superior even to that of the nasopharyngeal swab for diagnosis, lung ultrasound examination can be a valid alternative to CT scan, with certain advantages, particularly for pregnant women. Ultrasound can be performed directly at the bed-side by a single operator, reducing the risk of spreading the disease among health professionals. Furthermore, it is a radiation-free exam, making it safer and easier to monitor those patients who require a series of exams. We report on four cases of pregnant women affected by COVID-19 who were monitored with lung ultrasound examination. All patients showed sonographic features indicative of COVID-19 pneumonia at admission: irregular pleural lines and vertical artifacts (B-lines) were observed in all four cases, and patchy areas of white lung were observed in two. Lung ultrasound was more sensitive than was chest X-ray in detecting COVID-19. In three patients, we observed almost complete resolution of lung pathology on ultrasound within 96 h of admission. Two pregnancies were ongoing at the time of writing, and two had undergone Cesarean delivery with no fetal complications. Reverse transcription polymerase chain reaction analysis of cord blood and newborn swabs was negative in both of these cases. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.

Keywords: COVID-19; POCUS; lung ultrasound; pregnancy.

Figure 1

Lung ultrasound images from patient with COVID‐19 pneumonia who required admission to intensive care unit (Patient 1). (a) Initial examination showed subpleural consolidations (arrowheads) with posterior white areas. (b,c) During follow‐up imaging at 72–96 h and on day 14, consolidation size reduced progressively (arrowheads) and vertical artifacts appeared (arrows).

Figure 2

Lung ultrasound images from patient with COVID‐19 pneumonia (Patient 2). (a) Initial examination showed patchy area of white lung (double‐headed arrow) and normal A‐pattern was not visible. During follow‐up at 72–96 h, concomitant with patient improvement, multiple vertical artifacts (arrows) were visible (b), which had become progressively more isolated by day 5 (c).

Figure 3

Lung ultrasound images from patient with COVID‐19 pneumonia (Patient 3). (a) Initial examination showed areas with multiple vertical artifacts (arrows). (b,c) During follow‐up at 72–96 h and on day 5, concomitant with patient improvement, vertical artifacts became more isolated.

Figure 4

Lung ultrasound images from patient with COVID‐19 pneumonia (Patient 4). (a) Initially, isolated thick vertical artifacts were visible (arrow). (b) During follow‐up at 72–96 h, patient developed transitory clinical worsening, and lung ultrasound showed patchy area of white lung (double‐headed arrow). (c) Patient then improved and lung pattern normalized by day 5, with A‐lines visible (arrows).