Accuracy of chest ultrasonography in the diagnosis of coronavirus disease 2019 pneumonia

Abstract

Background
Coronavirus disease 2019 (COVID-19) virus infection is an ongoing, catastrophic, worldwide pandemic with significant morbidity and mortality. Large numbers of people who are getting COVID-19 virus infection are at high risk of developing COVID-19 pneumonia; early diagnosis of COVID-19 pneumonia, patient care, and isolation using simple, less expensive images are required. High-resolution computed tomography chest (HRCT chest) is the reference standard method for the diagnosis of COVID-19 pneumonia; however, it is expensive with increasing the exposure risk; chest ultrasonography (CUS) may be an alternative method.


Patients and methods
CUS is performed on patients accepting to participate in the study at presentation of COVID-19 suspicious cases. HRCT chest to confirm COVID-19 pneumonia were done within 24 h of CUS examination. Two chest consultants who are experts in CUS at Assiut University Hospital performed CUS. The CUS is done using a convex probe of 3.5 MHz. The CUS was considered positive for pneumonia if the examiners find the presence of abnormal multiple vertical B lines with or without the presence of consolidation dots unilateral or bilateral with good cardiac function; HRCT chest results are recorded.


Results
In all, 197 patients were included in the study (102 males, mean age 48 ± 16.2 years). Regarding comorbidity: 10% had diabetes mellitus and 9% had hypertension. Ten (5%) patients needed hospitalization with a mean oxygen saturation of 95 ± 5%. One hundred fifty-two patients confirmed COVID-19 pneumonia with HRCT chest, while 45 patients had normal HRCT chest. CUS showed positive pneumonic finding in 128 patients and normal picture in 69 patients. There was good association (r=0.690, P<0.001) between both diagnostic modalities in COVID-19 pneumonia diagnosis. Sensitivity and specificity and accuracy of CUS in the diagnosis of COVID-19 pneumonia were 84.56, 95.83, and 87.31%, respectively, when compared with HRCT chest. One hundred and two patients were successfully followed; all of them showing clinical and ultrasonographic improvement.