Point-of-care lung ultrasound imaging in pediatric COVID-19

Abstract

Background: There has been limited data regarding the usefulness of lung ultrasound (US) in children with COVID-19.

Objective: To describe lung US imaging findings and aeration score of 34 children with COVID-19.

Methods: This study included 0-16-year-old patients with confirmed COVID-19, who were admitted between April 19 and June 18, 2020 in two hospitals in the city of Sao Paulo, Brazil. Lung US was performed as part of the routine evaluation by a skilled Pediatric Emergency physician. Clinical and laboratory data were collected and severity classifications were done according to an available clinical definition. The lung US findings were described for each lung field and a validated ultrasound lung aeration score was calculated. Data obtained was correlated with clinical information and other imaging modalities available for each case.

Results: Thirty-four confirmed COVID-19 patients had a lung US performed during this period. Eighteen (18/34) had abnormalities on the lung US, but eight of them (8/18) had a normal chest radiograph. Ultrasound lung aeration score medians for severe/critical, moderate, and mild disease were 17.5 (2-30), 4 (range 0-14), 0 (range 0-15), respectively (p = 0.001). Twelve patients (12/34) also had a chest computed tomography (CT) performed; both the findings and topography of lung compromise on the CT were consistent with the information obtained by lung US.

Conclusion: Point-of-care lung US may have a key role in assessing lung injury in children with COVID-19.

Keywords: COVID-19; Children; Lung ultrasound; Point-of-care.

Fig. 1

Eleven-year-old male with respiratory failure and shock. Lung US (a–c) was performed on the 5th day after symptom onset and chest CT (d) on the 15th day. There was a pleural effusion (PE in a–d) and subpleural consolidations (stars in a–d). Confluent B-lines (CBL in a and c) were also present in the lung US, corresponding to the chest CT ground-glass pattern

Fig. 2

Two-week-old male full-term newborn with fever and mild respiratory symptoms. Lung US showed multiple vertical B-lines on all the lung fields bilaterally (arrows in a). Coalescent B-lines could be seen on the posterior and inferior lung fields (stars in b), as well as an irregularity of the pleural line and a tiny subpleural consolidation (circle in b)

Fig. 3

Thirteen-day-old male preterm newborn, presented with hypoxemia, tachypnea and high D-dimer level. Lung US (a–d) showed irregularities of the pleural line and small subpleural consolidations in the posterior right lung field (circles in a, b). Confluent B-lines (stars in a–d) were also present in the bilateral posterior and inferior lung fields corresponding to the chest CT (e) ground-glass pattern (stars in e). Chest CT showed good correlation with lung ultrasound findings (arrows in a–e)