Lung ultrasound in the coronavirus disease 2019 pandemic: a practical guide for obstetricians and gynecologists








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The current coronavirus disease 2019 (COVID-19) pandemic is a challenge to every health system worldwide. Unfortunately, it is likely that this emergency will not disappear soon. No health system, with its present resources and work flow, is ready to deal with a full-blown wave of this pandemic. Rapid acquisition of specific new skills may be fundamental in delivering appropriate healthcare for our patients. COVID-19 is classically diagnosed by real-time reverse transcription polymerase chain reaction and radiological investigations (X-ray or high-resolution computerized tomography). These techniques are not without limitations. Ultrasonography has been suggested as a reliable and accurate tool for assessing the lungs in patients with suspected pneumonia. Obstetricians and gynecologists are usually familiar with the use of ultrasound. Lung ultrasound (LUS) findings can show specific signs of interstitial pneumonia, which is a characteristic of COVID-19. We believe that extensive and rapid training of healthcare providers on the application of ultrasound in the detection of characteristic pulmonary signs of COVID-19, in addition to proper care and handling of their ultrasound machines, is feasible and may be critical to provide appropriate management especially to the obstetrical patients in the coming period. We present a systematic approach to lung examination, simplified to encourage its adoption by obstetricians and gynecologists, in addition to an example of a recent pregnant woman with COVID-19, in which LUS was useful in its management.


Letter to the Editors


The current COVID-19 pandemic is a challenge to every healthcare system. Pregnant women and fetuses represent a high-risk population during pandemics. LUS is a reliable tool in the assessment of patients with suspected pneumonia. , We provide a guide to perform LUS and an example on its implementation in pregnancy.


Transducer


Linear, phased array, or convex probes can all be used for LUS.


Position


LUS is usually performed in the sitting, lateral, and supine positions.


Examined areas ( Figure 1 )




Figure 1


An illustration showing the 6 areas to be examined in each hemithorax

The anterior and posterior axillary lines are the hallmarks used to determine the 6 regions. Each region should be examined in the axial and sagittal views.

Youssef. Lung ultrasound in the coronavirus disease 2019 pandemic. Am J Obstet Gynecol 2020 .


Each hemithorax is divided into 6 regions by the aid of anterior and posterior axillary lines as follows: 2 anterior, 2 lateral, and 2 posterior regions. Each region is examined in sagittal and axial views.


Normal findings ( Table , Video )




  • Pleural line: Normally, only the pleural line is visualized, as hyperechoic sliding line, moving forward and backward with ventilation.



  • A-lines : Regularly spaced horizontal lines under the pleural line and are normal reverberation artifacts of the pleural line.



Table

Normal and abnormal findings on lung ultrasound examination

























Description Ultrasound image
Normal


  • pleural line visible and thin (solid arrow)



  • sliding pleural line during respiration



  • A-lines visible (dotted arrows)

Figures 3 and 4
Abnormal
Irregular pleural line Figure 5
Well-separated B-lines Figure 6
Coalescent B-lines (White lung) Figure 7
Consolidations (hypoechoic tissue-like lung) with bronchogram (hyperechoic punctiform images) Figure 8

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Aug 9, 2020 | Posted by in GYNECOLOGY | Comments Off on Lung ultrasound in the coronavirus disease 2019 pandemic: a practical guide for obstetricians and gynecologists
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