Use of lung ultrasound to differentiate COVID-19 pneumonia from community-acquired pneumonia

Tan, Guoliang; Lian, Xihua; Zhu, Zhixing; Wang, Zhenhua; Huang, Fang; Zhang, Ying; Zhao, Yanping; He, Shaozheng; Wang, Xiali; Shen, Haolin; Lyu, Guorong

To investigate the feasibility of lung ultrasound in evaluating coronavirus disease 2019 (COVID-19) and distinguish the sonographic features between COVID-19 and community-acquired pneumonia (CAP), a total of 12 COVID-19 patients and 20 CAP patients were selected and underwent the lung ultrasound. Modified Buda scoring system for interstitial lung disease (ILD) was used to evaluate the severity and treatment effect of COVID-19 on ultrasonography. The differences between modified lung ultrasound (MLUS) score and high-resolution computed tomography (HRCT) Warrick score were analyzed to evaluate their correlation. COVID-19 showed the following sonographic features: thickening (12/12), blurred (9/12), discontinuous (6/12) pleural line; rocket sign (4/12), partially diffused B-line (12/12), completely diffused B-line (10/12), waterfall sign (4/12); C-line sign (5/12); pleural effusion (1/12), and pulmonary balloon (Am line, 1/12). The last two features were rarely seen. Differences of ultrasonic features, including lesion range, lung signs and pneumonia-related complications, between COVID-19 and CAP were statistically significant (P<0.05 or 0.001). MLUS scores (P=0.006) and HRCT Warrick scores (P=0.015) increased as the severity of COVID-19 increased. The differences between moderate [29.00(25.75-37.50)] and severe [43.00(38.75-47.25)] (P=0.022) or between moderate and critical [47.50(44.25-50.00)] (P=0.002) type COVID-19 were statistically significant, compared with those between severe and critical types. Correlation between MLUS scores and HRCT Warrick scores was positive (r=0.54, P=0.048). MLUS scores (Z=2.61, P=0.009) and HRCT Warrick scores (Z=2.63, P=0.009) of five severe or critical COVID-19 patients significantly decreased as their conditions improved after treatment. The differences of sonographic features between COVID-19 and CAP patients were notable. The MLUS scoring system could be used to evaluate the severity and treatment effect of COVID-19.