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      Can Lung US Help Critical Care Clinicians in the Early Diagnosis of Novel Coronavirus (COVID-19) Pneumonia?

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          Abstract

          Dear Editor: As reported by Feng et al, chest CT has a pivotal role for the diagnosis and assessment of lung involvement in COVID-19 pneumonia (1). Nowadays CT protocols are used to estimate the pulmonary damage (1,2,3). Unfortunately, CT scanning is not available in all emergency departments. Lung US is a surface imaging technique greatly developed in the last decades and strongly recommended for acute respiratory failure (4). It is commonly used in the emergency department at the bedside for early diagnosis of pneumonia. It is a highly sensitive and specific technique considered as an alternative to chest radiography or CT scanning (5,6). We evaluated the role of lung US in patients who presented to our emergency department with COVID-19 pneumonia. Twelve patients (9 male and 3 female, mean age 63±13 years) with flu-like symptoms in the last 4–10 days and COVID-19 infection underwent bedside lung US and CT. Two patients had emphysema but without need of oxygen therapy at home. None of the patients had severe respiratory distress (PaO2/FiO2 257–376 mmHg). In all the patients, we found a diffuse B-pattern with spared areas. Only three patients had posterior subpleural consolidations. Chest CT scan was performed in all 12 patients and showed a strong correlation with US: bilateral lung involvement with ground-glass opacity; five of 12 patients had a crazy-paving pattern. Organizing pneumonia was confirmed in four patients as well as detected with lung US. We are aware that our data are preliminary and further studies are necessary to confirm the role of lung US in the diagnosis and management of COVID-19 pneumonia, but we strongly recommend the use of bedside US for the early diagnosis of COVID-19 pneumonia in all the patients who presented to the emergency department with flu-like symptoms in novel COVID-19 era.

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          Correlation of Chest CT and RT-PCR Testing in Coronavirus Disease 2019 (COVID-19) in China: A Report of 1014 Cases

          Background Chest CT is used for diagnosis of 2019 novel coronavirus disease (COVID-19), as an important complement to the reverse-transcription polymerase chain reaction (RT-PCR) tests. Purpose To investigate the diagnostic value and consistency of chest CT as compared with comparison to RT-PCR assay in COVID-19. Methods From January 6 to February 6, 2020, 1014 patients in Wuhan, China who underwent both chest CT and RT-PCR tests were included. With RT-PCR as reference standard, the performance of chest CT in diagnosing COVID-19 was assessed. Besides, for patients with multiple RT-PCR assays, the dynamic conversion of RT-PCR results (negative to positive, positive to negative, respectively) was analyzed as compared with serial chest CT scans for those with time-interval of 4 days or more. Results Of 1014 patients, 59% (601/1014) had positive RT-PCR results, and 88% (888/1014) had positive chest CT scans. The sensitivity of chest CT in suggesting COVID-19 was 97% (95%CI, 95-98%, 580/601 patients) based on positive RT-PCR results. In patients with negative RT-PCR results, 75% (308/413) had positive chest CT findings; of 308, 48% were considered as highly likely cases, with 33% as probable cases. By analysis of serial RT-PCR assays and CT scans, the mean interval time between the initial negative to positive RT-PCR results was 5.1 ± 1.5 days; the initial positive to subsequent negative RT-PCR result was 6.9 ± 2.3 days). 60% to 93% of cases had initial positive CT consistent with COVID-19 prior (or parallel) to the initial positive RT-PCR results. 42% (24/57) cases showed improvement in follow-up chest CT scans before the RT-PCR results turning negative. Conclusion Chest CT has a high sensitivity for diagnosis of COVID-19. Chest CT may be considered as a primary tool for the current COVID-19 detection in epidemic areas. A translation of this abstract in Farsi is available in the supplement. - ترجمه چکیده این مقاله به فارسی، در ضمیمه موجود است.
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            CT Imaging Features of 2019 Novel Coronavirus (2019-nCoV)

            In this retrospective case series, chest CT scans of 21 symptomatic patients from China infected with the 2019 novel coronavirus (2019-nCoV) were reviewed, with emphasis on identifying and characterizing the most common findings. Typical CT findings included bilateral pulmonary parenchymal ground-glass and consolidative pulmonary opacities, sometimes with a rounded morphology and a peripheral lung distribution. Notably, lung cavitation, discrete pulmonary nodules, pleural effusions, and lymphadenopathy were absent. Follow-up imaging in a subset of patients during the study time window often demonstrated mild or moderate progression of disease, as manifested by increasing extent and density of lung opacities. © RSNA, 2020
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              Point-of-care ultrasonography in patients admitted with respiratory symptoms: a single-blind, randomised controlled trial.

              When used with standard diagnostic testing, point-of-care ultrasonography might improve the proportion of patients admitted with respiratory symptoms who are correctly diagnosed 4 h after admission to the emergency department. We therefore assessed point-of-care ultrasonography of the heart, lungs, and deep veins in addition to the usual initial diagnostic testing in this patient population.
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                Author and article information

                Contributors
                Journal
                Radiology
                Radiology
                Radiology
                Radiology
                Radiological Society of North America
                0033-8419
                1527-1315
                13 March 2020
                : 200847
                Affiliations
                [1]Department of Emergency Medicine, Ospedale Guglielmo da Saliceto, via Taverna 49, Piacenza 29121, Italy.
                Author notes
                Address correspondence to E.P. (email: poggiali.erika@ 123456gmail.com , E.Poggiali@ 123456ausl.pc.it ).
                Author information
                https://orcid.org/0000-0003-0943-1256
                https://orcid.org/0000-0003-1091-3113
                https://orcid.org/0000-0001-7817-3014
                https://orcid.org/0000-0002-9406-1298
                https://orcid.org/0000-0002-6820-9412
                https://orcid.org/0000-0001-6026-9720
                https://orcid.org/0000-0003-1649-3279
                Article
                200847
                10.1148/radiol.2020200847
                7233381
                32167853
                4621d025-f4a6-477a-977c-9d31d25441ce
                2020 by the Radiological Society of North America, Inc.

                This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.

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