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Review
. 2022 Mar;50(3):326-338.
doi: 10.1002/jcu.23160. Epub 2022 Feb 26.

COVID-19 pathophysiology and ultrasound imaging: A multiorgan review

Giovana N W Ito  1 , Vinícius A C Rodrigues  1 , Juliana Hümmelgen  1 , Gustavo S P G Meschino  1 , Gustavo M Abou-Rejaile  1 , Isadora D Brenny  1 , Carlos R de Castro Júnior  1 , Rafaela C Artigas  1 , João Pedro S Munhoz  1 , Gabriela C Cardoso  2 , Guilherme F Picheth  1   2
Affiliations
Review

COVID-19 pathophysiology and ultrasound imaging: A multiorgan review

Giovana N W Ito et al. J Clin Ultrasound. 2022 Mar.

Abstract

COVID-19 is a dynamic disease and may affect different tissues and organs as it progresses. Therefore, the impact generated by the disease in all its stages and organs requires a functional and versatile imaging technique able to detect particularities or artifacts dynamically. Ultrasonography fulfills all these requirements and exhibit several advantages relative to other imaging modalities, including portability, lower cost and biosafety. Throughout the COVID-19 pandemic, ultrasonography displayed a crucial role in the triage, monitoring, indicating organ damages and enabling individualized therapeutical decisions in COVID-19 patients. This review is dedicated to highlight the main pathological effects correlated with ultrasound changes caused by COVID-19 in the lungs, heart and liver.

Keywords: COVID-19; SARS-CoV-2; echocardiography; multiorgan tropism; ultrasound.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

FIGURE 1
FIGURE 1
Representation of the airway and alveolar's biochemistry during classic acute respiratory distress syndrome (ARDS) and in COVID‐19‐induced ARDS. In both syndromes, the alveolar‐interstitial‐capillary structure is similarly affected. There is an increase in pro‐inflammatory biomarkers, endothelial and capillary permeability, in addition to an increase in inflammatory cells (neutrophils, monocytes and macrophages) in vessels and alveoli. However, the increased biomarkers in the two syndromes are distinct. Image adapted from
FIGURE 2
FIGURE 2
Longitudinal section of chest B‐mode ultrasound imaging. The association of ribs and pleural line generate a solid landmark called the “bat sign” (A). The A lines (blue arrow), ribs (orange arrows) and their respective acoustic shadows (asterisks) are represented in image B. The B lines (asterisks) eliminate the A lines (yellow arrow) when they cross (x) (C). Adapted from
FIGURE 3
FIGURE 3
PUS and CT images of the lungs of individuals affected by COVID‐19 at different stages, from normal aeration (A), progressive deaeration states (B and C) small and peripheral consolidation (D) and large consolidation (E). Adapted from
FIGURE 4
FIGURE 4
Detailing of the lung zones for the recommended PUS scan in patients with COVID‐19. Adapted from
FIGURE 5
FIGURE 5
Echocardiography images of a patient with COVID‐19. The images display the thickening of the left ventricular wall (A), widening of the right ventricle and thickening of the left ventricular wall (B), pericardial effusion (indicated by the white arrow) (C), M‐mode graph of the left ventricular base with marked dyskinesia (D), Color Doppler mode showing tricuspid valve regurgitation (E) and continuous Doppler mode of the tricuspid regurgitation indicating pulmonary hypertension (E). Image adapted from
FIGURE 6
FIGURE 6
Echocardiography of a patient infected with SARS‐CoV‐2 indicating right ventricular dilatation with minor secondary left ventricular compression due to mechanical ventilation (A). Image adapted from. Echocardiography images highlighting moderate aortic regurgitation (B), right ventricle and tricuspid valve regurgitation (C) and wall thickening with moderate impairment of systolic function and movement abnormality of the anterior basal wall (D). Adapted from
See this image and copyright information in PMC

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