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. 2022 Jun;25(2):333-338.
doi: 10.1007/s40477-020-00526-y. Epub 2020 Aug 25.

Lung ultrasound artifacts in COVID-19 patients

Christine McElyea  1 , Christopher Do  2 , Keith Killu  2
Affiliations

Lung ultrasound artifacts in COVID-19 patients

Christine McElyea et al. J Ultrasound. 2022 Jun.

Abstract

Lung ultrasound is an essential tool in critical care, made more so by the enhanced precautions associated with the Covid-19 pandemic. Here we describe 2 cases of multiple, small shred signs seen on ultrasound of Covid-19 patients.

Keywords: COVID-19; Lung ultrasound; Shred sign.

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Figures

Fig. 1
Fig. 1
Lung zones in a supine position. L1 Upper anterior lung zone. L2 Lower anterior lung zone. L3 Upper lateral lung zone. L4 Lower lateral lung zone
Fig. 2
Fig. 2
a, a’ Patient A and B chest X-ray prior to lung ultrasound with bibasilar infiltrates. b, b’ Pleural lines for patients A and B with multiple small shred signs (arrows). c, c’ illustrating the grainy appearance of the pleural line resembling pebbles in patients A and B, identified by the arrows. d Showing skip areas of normal to mildly thickened pleural line with multiple B-Lines (arrow heads)
Fig. 2
Fig. 2
a, a’ Patient A and B chest X-ray prior to lung ultrasound with bibasilar infiltrates. b, b’ Pleural lines for patients A and B with multiple small shred signs (arrows). c, c’ illustrating the grainy appearance of the pleural line resembling pebbles in patients A and B, identified by the arrows. d Showing skip areas of normal to mildly thickened pleural line with multiple B-Lines (arrow heads)
Fig. 3
Fig. 3
Illustration of the pathophysiology of the different ultrasound signs including the pebbles resembling artifacts. Note areas of normal lung parenchyma and air-filled alveoli with poor transmission to ultrasound, reflecting and scattering the waves (Arrows) as bright pebbles like artifacts. Also, areas of lung tissue with early buildup and accumulation of alveolar secretions, mucous and inflammatory cells, leading to transmission of the ultrasound beam and its refraction to deeper tissues (arrow heads). Thickening of the interstitial layer with fluid accumulation can lead to the reverberation of the ultrasound beam between the pleural line and the interlobular septa, leading to the development of the comet tail, or B Lines on the ultrasound screen
See this image and copyright information in PMC

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