Lung Ultrasound Notes

US is not transmitted through aerated tissue

Normal parenchyma is not visible
Interface between pleura and lung reflects US
Intercostal space -> acoustic window

Re-aeration  (Loss of aeration is reverse of the following order)

Black (Normal) > Black and white (Interstitial edema) > White (Alveolar edema) > Grey
(Consolidation)

Use Convex probe

Scanning Scheme Right and Left, Above and below nipple, Anterior, lateral and posterior. R1, R2 etc
till R8 (R7 and R8 posterior part usually difficult if patient bedbound). L1, L2 etc till L8

LUS score in points 0 to 3.

0 point: Normal aeration. Horizontal A-lines (or no more than two B-lines)
1 point: Moderate loss of aeration. Multiple B-lines covering <50% of the screen.
2 points: Severe loss of aeration. Multiple B-lines covering >50% of the screen
3 points: Complete loss of aeration.

Beware of Z-lines- artifacts looking like B lines. Inconsistent, changes with respiration cycle, not
directly from pleural line.

B-lines directly from pleural line and consistent with respiration cycle.

Subpleural alterations: Irregular pleural line with gap of hypodense area.

** The probe cannot replace your brain, your medical knowledge or clinical judgement/ experience.

Always consider the distance from symptoms onset

Always integrate LUS with the overall picture and other tests

LUS changes are earlier than clinical deterioration

Clinical integration:

1) Role in diagnosis
- more sensitive than CXR
- probably useful for home monitoring
2) Role in risk stratification of short term prognosis
- High negative predictive value
- LUS changes are earlier than clinical deterioration
3) Role in monitoring and titrating treatment
- Response to drugs
- Monitoring respiratory support
- Choosing patient position
- Time of weaning
References
 COVID-19: how to use and interpret lung ultrasound- https://www.youtube.com/watch?
v=VamGcXmixsQ&list=WL&index=3

Lung Ultrasound in COVID-19 – English- https://www.youtube.com/watch?v=dce8he450bE

Webinar on Lung Ultrasound in COVID19 patients- https://www.youtube.com/watch?

v=6n_xtzHkaDc

www.openlus.com