Ultrasound in diagnosis of COVID-19 in Pregnant Women
Moro et al 34devised pathological ultrasound patterns in pregnant females when
compared to those expected in a normal lung, with particular emphasis on
those more indicative of COVID-19 infection. The normal lung ultrasound
will show A-Lines which are hyperechoic, repetitive reverberations, at
regular intervals of the pleural line. The authors discuss 4 different
presentations:
- B-Lines: These occur when the lung loses normal aeration, but is not
completely consolidated, it creates vertical artifacts of varying
lengths and shapes, referred to as the B-Lines. These can occur in the
setting of interstitial lung disease, pulmonary fibrosis etc. and have
to be clinically correlated. With early stages of COVID-19, the
pleural line is usually irregular, thickened, and have a
characteristic distribution (multifocal, monofocal, patchy etc.)
surrounded by normal lung field and no gravitational distribution.
- White Lung: When the density of the peripheral lung parenchyma is
increased as in the settings of SARS-CoV-2 acute respiratory distress
syndrome (ARDS), ultrasound examination shows a white area which has
no visible A or B lines.
- Consolidation: This presentation occurs in the setting of pneumonia or
atelectasis, when the lung is almost completely collapsed. In
pathology such as COVID-19 pneumonia, advanced ARDS, or bronchiolitis,
the lung may present only small subpleural, hypoechoic consolidations.
- Pleural Effusion: In general, pleural effusion can be simple and
uniformly anechoic or complicated by the presence of hyperechoic spots
due to blood, pus, fibrin and/or septa.