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      Comparison Between Lung Ultrasound and Computed Tomographic Findings in Patients With COVID‐19 Pneumonia

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          Abstract

          Objectives

          The aim of this study was to describe findings from lung ultrasound (LUS) and computed tomography (CT) in health professionals with coronavirus disease 2019 pneumonia and to evaluate the associations of the findings of both tests.

          Methods

          This cross‐sectional observational study evaluated 45 health professionals who were initially seen in screening tents and had a diagnosis of coronavirus disease 2019 as confirmed by a reverse transcription polymerase chain reaction and lung involvement diagnosed by LUS. Subsequently, these individuals were admitted to the hospital, where chest CT was performed. Aeration scores were obtained for the LUS examinations based on the following findings: more than 2 B‐lines, coalescent B‐lines, and subpleural consolidations. A subjective assessment of the extent of lung disease on CT was performed on the basis of the percentage of lung parenchyma involvement as follows: 25% or less, 25% to 50%, and greater than 50%.

          Results

          Regarding LUS signs, more than 2 B‐lines, coalescent B‐lines, and subpleural consolidations were present in 73.3%, 68.2%, and 24.4% of cases, respectively. The main findings on CT were ground glass opacities, a crazy‐paving pattern, and consolidations (66.7%, 20%, and 20% of cases); 17.8% of cases had examinations without abnormalities. Patients with more than 2 B‐lines on LUS had more ground glass opacity areas on CT ( P = .0007), whereas patients with subpleural consolidations on LUS had more consolidations on CT ( P < .0001). In addition, patients with higher LUS aeration scores had more extensive disease on CT ( P < .0001).

          Conclusions

          Lung ultrasound can detect lung injury even in the presence of normal CT results. There are associations between the abnormalities detected by both methods, and a relationship also exists between LUS aeration scores and the disease extent on CT.

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          Most cited references30

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          The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak

          Coronavirus disease (COVID-19) is caused by SARS-COV2 and represents the causative agent of a potentially fatal disease that is of great global public health concern. Based on the large number of infected people that were exposed to the wet animal market in Wuhan City, China, it is suggested that this is likely the zoonotic origin of COVID-19. Person-to-person transmission of COVID-19 infection led to the isolation of patients that were subsequently administered a variety of treatments. Extensive measures to reduce person-to-person transmission of COVID-19 have been implemented to control the current outbreak. Special attention and efforts to protect or reduce transmission should be applied in susceptible populations including children, health care providers, and elderly people. In this review, we highlights the symptoms, epidemiology, transmission, pathogenesis, phylogenetic analysis and future directions to control the spread of this fatal disease.
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            Time Course of Lung Changes On Chest CT During Recovery From 2019 Novel Coronavirus (COVID-19) Pneumonia

            Background Chest CT is used to assess the severity of lung involvement in COVID-19 pneumonia. Purpose To determine the change in chest CT findings associated with COVID-19 pneumonia from initial diagnosis until patient recovery. Materials and Methods This retrospective review included patients with RT-PCR confirmed COVID-19 infection presenting between 12 January 2020 to 6 February 2020. Patients with severe respiratory distress and/ or oxygen requirement at any time during the disease course were excluded. Repeat Chest CT was obtained at approximately 4 day intervals. The total CT score was the sum of lung involvement (5 lobes, score 1-5 for each lobe, range, 0 none, 25 maximum) was determined. Results Twenty one patients (6 males and 15 females, age 25-63 years) with confirmed COVID-19 pneumonia were evaluated. These patients under went a total of 82 pulmonary CT scans with a mean interval of 4±1 days (range: 1-8 days). All patients were discharged after a mean hospitalized period of 17±4 days (range: 11-26 days). Maximum lung involved peaked at approximately 10 days (with the calculated total CT score of 6) from the onset of initial symptoms (R2=0.25), p<0.001). Based on quartiles of patients from day 0 to day 26 involvement, 4 stages of lung CT were defined: Stage 1 (0-4 days): ground glass opacities (GGO) in 18/24 (75%) patients with the total CT score of 2±2; (2)Stage-2 (5-8d days): increased crazy-paving pattern 9/17 patients (53%) with a increase in total CT score (6±4, p=0.002); (3) Stage-3 (9-13days): consolidation 19/21 (91%) patients with the peak of total CT score (7±4); (4) Stage-4 (≥14 days): gradual resolution of consolidation 15/20 (75%) patients with a decreased total CT score (6±4) without crazy-paving pattern. Conclusion In patients recovering from COVID-19 pneumonia (without severe respiratory distress during the disease course), lung abnormalities on chest CT showed greatest severity approximately 10 days after initial onset of symptoms.
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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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                Author and article information

                Contributors
                agnaldolopes.uerj@gmail.com
                Journal
                J Ultrasound Med
                J Ultrasound Med
                10.1002/(ISSN)1550-9613
                JUM
                Journal of Ultrasound in Medicine
                John Wiley & Sons, Inc. (Hoboken, USA )
                0278-4297
                1550-9613
                30 September 2020
                : 10.1002/jum.15521
                Affiliations
                [ 1 ] Postgraduation Program in Medical Sciences School of Medical Sciences, State University of Rio de Janeiro Rio de Janeiro Brazil
                [ 2 ] Rehabilitation Sciences Postgraduation Program Augusto Motta University Center Rio de Janeiro Brazil
                [ 3 ] Department of Pulmonology Piquet Carneiro Policlinic, State University of Rio de Janeiro Rio de Janeiro Brazil
                [ 4 ] Department of Radiology Pedro Ernesto University Hospital, State University of Rio de Janeiro Rio de Janeiro Brazil
                Author notes
                [*] [* ] Address correspondence to Agnaldo José Lopes, MD, PhD, Postgraduation Program in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro, Avenida Prof Manuel de Abreu 444, 2° Andar, Vila Isabel, 20550‐170 Rio de Janeiro–RJ, Brazil. E‐mail: agnaldolopes.uerj@ 123456gmail.com

                Author information
                https://orcid.org/0000-0001-8598-4878
                https://orcid.org/0000-0002-6193-4822
                https://orcid.org/0000-0001-6785-0753
                Article
                JUM15521
                10.1002/jum.15521
                7537266
                32996607
                81be32b2-0453-4d00-96cb-1e27216236c1
                © 2020 American Institute of Ultrasound in Medicine

                This article is being made freely available through PubMed Central as part of the COVID-19 public health emergency response. It can be used for unrestricted research re-use and analysis in any form or by any means with acknowledgement of the original source, for the duration of the public health emergency.

                History
                : 25 June 2020
                : 22 August 2020
                : 11 September 2020
                Page count
                Figures: 3, Tables: 1, Pages: 9, Words: 5712
                Funding
                Funded by: Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro , open-funder-registry 10.13039/501100004586;
                Award ID: #E‐26/010.002124/2019
                Award ID: #E‐26/202.679/2018
                Funded by: Conselho Nacional de Desenvolvimento Científico e Tecnológico , open-funder-registry 10.13039/501100003593;
                Award ID: 302215/2019‐0
                Categories
                Original Research
                Original Research
                Custom metadata
                2.0
                corrected-proof
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.9.2 mode:remove_FC converted:06.10.2020

                computed tomography,coronavirus disease 2019,covid‐19,lung ultrasound,pneumonia,severe acute respiratory syndrome coronavirus 2

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