Role of lung ultrasound in identifying COVID-19 pneumonia in  patients  with  negative  swab  during  the  outbreak

Internal Medicine - Azienda Ospedaliera Santi Antonio e Biagio e Cesare Arrigo. Alessandria - Italy – EU.

US imaging A - B: Bilateral thickening of the parietal pleura, thickening, and roughness of the pleural line with interruptions due to the presence of small subpleural infiltrates and B lines.

US imaging - A: Parietal pleura thickening with a thin film of pleural fluid, thickening, and irregularity of the pleural line with B lines at the right posterior basal field. - B: Bilateral subpleural infiltrates. - C: Bilateral posteroinferior thickening and roughness of the pleural line, confluent B lines (waterfall sign) and subpleural infiltrate.

US imaging - A-B-C: Thickening of the parietal pleura, subpleural infiltrates of various sizes and B lines in bilateral pulmonary posteroinferior fields (crazy paving pattern). The US findings were suspected of COVID-19 pulmonary lesions, and then a TC scan was performed.

US imaging - A: Hepatization of the right middle lung lobe with distension of the right pulmonary artery, evidence of perivascular air bronchogram and pleural effusion. - B: Pleural effusion with atelectasis of right inferior lung lobe. No characteristic signs of COVID-19 pneumonia were detected.

US imaging - A: Bilateral postero-inferior thickening and roughness of the pleural line with bundled B lines (waterfall sign) and subpleural infiltrates. B: Bilateral postero-lateral hypoechoic thickening of the parietal pleura, subpleural infiltrates and thickening of the pleural line. C: Subpleural consolidation area with the presence of air bronchogram at the right postero-inferior pulmonary field. The pleural line is not detected.

US imaging A - B: Bilateral posterior hypoechoic thickening of the parietal pleura. Subpleural infiltrates with disruption of the pleural line. Bundled B lines (white lung).

US imaging - A: Basal anterolateral scan upwards —> Hepatization of the right lower lobe with the lobar delimitation, internal hypo-isoechoic areas, and peripheral pleural effusion. Wet lung to the right middle lobe with bundled B lines starting from the fissure (waterfall sign). B-C: Lower right lobe hepatized with a large hypo-isoechoic roundish area containing dense and corpuscular fluid material with fine movements, synchronous with the heartbeats, which, at color doppler, produce the "flash artifact" effect. D: Lung abscess in the pneumonia of the inferior right lobe with pleural effusion. Normal findings at left lung, no characteristic signs of COVID-19 pneumonia.

US imaging A - B: Small subpleural infiltrates that determine pleural line irregularity and interruption. The pleural line often appears thickened. B-lines departing from subpleural infiltrates. C: hypoechoic thickening of the parietal pleural line. Small subpleural infiltrate (3 mm) with air bronchogram.

US imaging A - B: bilateral pleural effusion prevalent on the right. After drainage of the right hemithorax appears extensive pneumonia in the lower lobe with a static air bronchogram. C: On the left side, small subpleural nodules from which B lines are generated, thickened pleural line with a rough surface.

US imaging – A - B: Hypoechoic thickening of the parietal pleura with adjacent small pleural effusion film. Thickened pleural line with the irregular and interrupted surface due to the presence of small hypoechoic subpleural nodular infiltrates. C: B lines and inhomogeneous hypoechoic subpleural consolidation with small echogenic spots (air bronchogram).

US imaging – A: On the right inferior posterior-lateral side, thickening and coarseness of the pleural line interrupted by small subpleural infiltrates with numerous B lines. B: On the left posterolateral supradiaphragmatic area, there is pneumonia with a gross consolidation area with an air bronchogram and parapneumonic pleural effusion. A sample of pleural effusion was collected under ultrasound guidance.