COVID-19

• Indicator up towards the head
• Place over a rib, identify pleural line

• Image each of the 6 zones with a LF AND HF transducer
• Left and then Right side
• Label side, Zone, Transducer (i.e. R2 LF)
• Image Zones the same way each time (Left Zone 1,2,3,4,5,6 and Right Zone 1,2,3,4,5,6)
• If patient being proned a)Anterior and Side (L 1,2,3,4 then R 1,2,3,4) and then b)Posterior (L 5,6 then R 5,6) when patient flipped
• Completely image ALL of each zone
• If pathology save 3-5 second clip of area if interest
• If no pathology still save clip

• Best seen with a low frequency probe
• Focal B-lines early (Progressive to confluence, Multi-lobar distribution, and Bilateral distribution)
• Pleural effusions are rare
• A-lines during recovery

• Best visualized with a high frequency probe
• Identify the pleural line and then rotate the probe horizontally (thickened, irregular pleural line, sub pleural consolidations, and localized pleural effusion adjacent to consolidations)

Tips

• Always save a clip of each zone
• Curvilinear allows seeing more rib spaces
• B lines in a variety of patterns including focal, multifocal, and confluent
• Consolidations in a variety of patterns including multifocal small, non-translobar, and translobar with occasional mobile air bronchograms
• Appearance of A lines during recovery phase
• Pleural effusions are uncommon

Figure 1 - Lung Windows

Figure 2 - B-lines in COVID-19 Pneumonia

Figure 3 - Pleural Findings in COVID-19 Pneumonia (High Frequency)

Figure 4 - Pleural Findings in COVID-19 Pneumonia (Curvilinear)

Clip 1 - Conflucence of B-lines

Clip 2 - Subpleural Abscess (High Frequency)

Clip 3 - Subpleural Abscess (Curvilinear)

Lung Ultrasound for Pulmonary COVID-19

Peng, Qian-Yi, et al. “Findings of lung ultrasonography of novel corona virus pneumonia during the 2019–2020 epidemic.” Intensive Care Medicine (2020): 1.

Lichtenstein, Daniel A. “Lung ultrasound in the critically ill.” Annals of intensive care 4.1 (2014): 1.