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   2020| October  | Volume 30 | Issue 6  
    Online since October 27, 2020

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Lung semiotics ultrasound in COVID-19 infection
Agatella Barchitta, Mauro Pepi, Ines Paola Monte, Giuseppe Trocino, Andrea Barbieri, Quirino Ciampi, Alberto Cresti, Sofia Miceli, Licia Petrella, Frank Benedetto, Maio Daniele, Francesco Antonini-Canterin
October 2020, 30(6):1-5
This paper aims to highlight the usefulness of “bedside” lung ultrasound in the context of the COVID-19 pandemic. The evaluation of lung artifacts allows to detect at the subpleural level the presence of an altered “tissue/air” ratio both in case of consolidative or not consolidative lung lesions. Furthermore, lung ultrasound allows acquiring topographical images of the lesions, establishing their extension on the lung surface as well as their evolution or regression over time, without radiation exposure. Since ultrasound semiotics is already widely known and described in other similar diseases (acute respiratory distress syndrome, interstitial flu virus, and pneumonia), thoracic ultrasound is a useful diagnostic tool in different scenarios in the COVID-19 pandemic: in the first triage of symptomatic patients, both in the prehospital setting or in the emergency department, in the prognostic stratification and monitoring of patients with pneumonia, and in the management of patients in the intensive care unit. Moreover, “bedside” lung ultrasound can reduce the number of health-care workers exposed to the virus during patient assessment and treatment.
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The role of imaging in COVID-19 pneumonia diagnosis and management: Main positions of the experts, key imaging features and open answers
Nicholas Landini, Martina Orlandi, Michele Fusaro, Pierluigi Ciet, Cosimo Nardi, Silvia Bertolo, Vito Catalanotti, Marco Matucci-Cerinic, Stefano Colagrande, Giovanni Morana
October 2020, 30(6):25-30
Lung imaging is widely involved in facing the coronavirus disease (COVID-19) pandemic. In fact, the COVID-19 infection may lead to a rapidly evolving and potentially fatal pneumonia. Moreover, computed tomography (CT) can be more sensitive than the COVID-19 reverse transcriptase-polymerase chain reaction test, especially at the beginning of the disease. Only patients with mild features consistent with COVID-19 infection, negative COVID-19 test, or positive COVID-19 test but at low risk for disease progression should avoid imaging. However, imaging becomes mandatory if respiratory symptoms worsen. A CT pattern classification has been designed to help both radiologists and clinicians. The typical pattern of COVID-19 is depicted by multifocal, bilateral, and peripheral ground-glass opacities (with or without consolidations or crazy paving) or findings of organizing pneumonia. Moreover, CT has demonstrated a prognostic role in patients with a diagnosis of COVID-19 pneumonia. Lung ultrasounds (LUS) are an emergent tool in the diagnosis of the disease. The adoption of LUS combined to chest X-rays in COVID-19 in pneumonia diagnosis is an interesting prospect that needs to be confirmed.
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Lung ultrasound in the COVID-19 pandemic
Vito Cianci, Mirko Zanatta
October 2020, 30(6):6-10
Lung ultrasound (LUS) is one of the most important and innovative applications in emergency and critical care medicine for the management of critically ill patients. Ultrasound has been widely used in the COVID-19 pandemic as an extremely reliable technique and has proved to have a key role in the diagnosis and monitoring of patients with acute respiratory failure. The diagnostic accuracy of LUS is higher than chest X-ray and similar to computed tomography, which is considered the gold standard. COVID-19 pneumonia has some distinctive ultrasonographic signs but not pathognomonic, and LUS significantly improves the management of COVID-19 patients speeding up the diagnostic path. The examination is bedside; reduces the risk of contamination, avoiding mobilization of the patients; cuts down the amount of radioactive exposure; and gives real-time answers to many diagnostic and therapeutic doubts. Finally, the instruments are small and the scanner and the probes can be protected from contamination easily.
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Lung ultrasound in COVID-19 critically ill patients with acute respiratory distress syndrome
Enrico Storti, Adriana Nailescu, Pier Giorgio Villani
October 2020, 30(6):11-17
The “gold” standard radiological method for the diagnosis of the lung findings in COVID-19 patients is known to be the chest high-resolution computed tomography. However, in a mass casualty scenario, as in times of COVID-19 epidemics, in which emergency departments, intensive care units, and whole hospitals are massive overcrowded and continue to change their original configuration, a more rapid, flexible, and performant diagnostic approach is required. Moreover, the high contagiousness of these patients and the risk of transporting critical patients make chest computed tomography (CT) a limited option for them. Lung ultrasonography, a rapid, reliable, bedside, nonradiating and repeatable examination, with its sensitivity closed to chest CT and much higher than the chest X-ray for COVID patients, has proved to be in COVID-19 pandemic as crucial diagnostic and monitoring tool of patients with acute respiratory failure. It could be performed in the prehospital setting, in the emergency department (as part of the diagnostic approach), up to the normal wards and the intensive care unit. The aim of this article is to describe the central role of LUS in the management of COVID-19 critically ill patients with acute respiratory distress syndrome, as valid diagnostic and monitoring point-of-care technique.
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Echocardiography and Multimodality Cardiac Imaging in COVID-19 Patients
Alberto Cresti, Agata Barchitta, Andrea Barbieri, Ines Paola Monte, Giuseppe Trocino, Quirino Ciampi, Sofia Miceli, Licia Petrella, Emilija Jaric, Marco Solari, Cristina Basso, Mauro Pepi, Francesco Antonini-Canterin
October 2020, 30(6):18-24
The pandemic caused by the new SARS-CoV-2, named coronavirus disease 2019 (COVID-19) disease, has challenged the health-care systems and raised new diagnostic pathways and safety issues for cardiac imagers. Myocardial injury may complicate COVID-19 infection in more than a quarter of patients and due to the wide a range of possible insults, cardiac imaging plays a crucial diagnostic and prognostic role. There is still little evidence regarding the best-imaging pathway and the echocardiographic findings. Most of the data derive from the single centers experiences and case-reports; therefore, our review reflects the recommendations mainly based on expert opinion. Moreover, knowledge is constantly evolving. The health-care system and physicians are called to reorganize the diagnostic pathways to minimize the possibility of spreading the infection. Thus a rapid, bedside, ultrasound assessment of the heart, chest, and leg veins by point-of-care ultrasound seems to be the first-line tool of the fight against the SARS-CoV-2. A second Level of cardiac imaging is appropriate when the result may guide decision-making or may be life-saving. Dedicated scanners should be used and special pathways should be reserved for these patients. The current knowledge on cardiac imaging COVID-19 patients is reviewed.
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