Ultrasound of the Week #016


A 64 year old male with a PMH of asthma, hypertension and Type 2 Diabetes presented with gradual onset central chest tightness worse on exertion, associated shortness of breath and feeling hot for 8 days.  He had no other symptoms of note.

Examination revealed scattered bibasal crackles on auscultation but no other abnormalities.

SpO2 93% RA, 80% on exertion.  HR96, T37.5, RR20, BP 136/78.

He had a lung ultrasound and bedside echo:

Lung US:

Left lung


Right lung


[expand title=”Echo:” tag=”h2″]

[/expand] [expand title=”Interpretation:” tag=”h2″]

The echo is essentially normal, with no signs of right heart strain nor LV dysfunction. The focus here is on the lung ultrasound.

There are diffuse B-lines that in many places are coalescing, pleural irregularity and areas of sub-pleural consolidation.  Remember, B-lines represent ‘alveolar-interstitial syndromes’ (pulmonary oedema, inflammation).  We see these most commonly in pulmonary oedema.  However, given a normal bedside Echo and especially the pleural thickening and sub-pleural consolidation, this is highly suggestive of a diffuse inflammatory process which in this case is most likely COVID-19 pneumonia.

This patient was admitted under the medical team.  As he had a normal lymphocyte count, low CRP, was tachycardic and had pleuritic chest pain he had a CTPA which was reported as:

“No pulmonary embolism identified.  Bilateral new peripheral ground-glass opacification is highly suspicious of COVID-19 pneumonia. Correlation with RT-PCR is recommended”

[expand title=”Lung Ultrasound in COVID-19:” tag=”h2″]

Lung ultrasound has been put to great use in the COVID-19 pandemic in many countries, from streaming patients to tracking progression of disease in ICU and titrating therapy according to findings[1], and more evidence continues to be published on it’s utility.  The sensitivity of Lung Ultrasound for signs of viral pneumonia is considerably higher than chest XR[2] and approaches that of CT.

The classic findings in viral pneumonia are[3]:

  • B-lines, focal and confluent
  • Irregular or thickened pleural line
  • Sub-pleural consolidation
  • Small or no pleural effusions (large effusions are uncommon in COVID-19)
  • Dense consolidation with air bronchograms in more severe disease

Lung ultrasound can identify features strongly supporting a diagnosis, map progression of disease and most importantly assess for alternative diagnoses[4] (e.g. pneumothorax, pleural effusions).



  1. Moore S, Gardiner E. Point of care and intensive care lung ultrasound: A reference guide for practitioners during COVID-19. Radiography (Lond). 2020 Nov;26(4):e297-e302. doi: 10.1016/j.radi.2020.04.005. Epub 2020 Apr 17. PMID: 32327383; PMCID: PMC7164867.
  2. Shumilov E, Hosseini ASA, Petzold G, Treiber H, Lotz J, Ellenrieder V, Kunsch S, Neesse Comparison of Chest Ultrasound and Standard X-Ray Imaging in COVID-19 Patients. Ultrasound Int Open. 2020 Sep;6(2):E36-E40. doi: 10.1055/a-1217-1603. Epub 2020 Sep 2. PMID: 32905446; PMCID: PMC7467801.
  3. Peng QY, Wang XT, Zhang LN; Chinese Critical Care Ultrasound Study Group (CCUSG). Findings of lung ultrasonography of novel corona virus pneumonia during the 2019-2020 epidemic. Intensive Care Med. 2020

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