Clinico-Radiological Evaluation of COVID-19 Pneumonia and Its Correlation with USG Chest: Single Centre Study at SMS Hospital, Jaipur

Abstract

Purpose: The present study was undertaken to investigate imaging features of emerging COVID-19 pneumonia by chest ultrasound (POCUS) and digital radiographs (Chest X-Ray) and their correlation with clinical and lab parameters. The study also aims to recognize the role, technique and limitation of Point of Care USG Lung (POCUS) in COVID-19 patients.

Materials and Methods: The present ongoing single-centre study assessed patients admitted from 15th March to 14th April 2020 with laboratory-confirmed COVID-19 pneumonia at SMS Medical college & Hospital, Jaipur, Rajasthan. The clinical features, laboratory investigations, Chest x ray and lung USG (POCUS) findings were evaluated and compared.

Results: Eighteen patients (fourteen male and four female) with manifestation of COVID-19 pneumonia were assessed. Male patients constituted 78% of total sample patients population. It was observed that 78% of sample population of age more than 50 years were affected. All pneumonitis patients of sample population were symptomatic and presented with chief complaints of Fever (89%), Cough (83%), Dyspnoea (56%), Headache (28%), Vomiting (11%), Drowsiness (11%), Haemoptysis (6%), Chest pain (6%) and Arthralgia (6%). Nine patients had underlying comorbid conditions of which 22% of sample population had pre-existing hypertension, 17% had diabetes mellitus, 11% had old k-chest and other 11% was suffering from chronic obstructive pulmonary disease (COPD). The digital radiograph-chest findings of 56% patients exhibited Classic COVID-19 pneumonia findings of bilateral, multiple, peripheral and lower lobe predominant areas of ground glass opacities (GGO) whereas 39% of patients had indeterminate and remaining 6% had non-COVID chest x-ray findings. The ultrasonography (USG) chest findings documented pleural and lungs changes in 94% of patients with COVID19 positive pneumonia. It was observed that as compared to digital chest X-ray findings (56% of classic findings), the USG Chest, with 94% chances of diagnosing COVID-19 positive pneumonia, seems to be a better chest imaging technique for such patients. Three patients out of eighteen (17% patients) exhibited pleural effusion associated with thickened and irregular pleura. The POCUS scan documented basal involvement in 88% of sample COVID-19 pneumonia patients, out of which 93% typically had posterior basal lung involvement. In the present study follow-up USG of seven patients was also done in which six patients (86%) showed clinical and radiological improvement in USG chest while 1 patient deteriorated clinically as well as radiologically. Moreover, three patients with pleural effusion in previous USG chest also resolved clinically and in follow-up USG. The percent laboratory profile of COVID-19 positive patients having concomitant pneumonia documented interesting trend with 22% having haemoglobin levels of more than 15 gm/dl, with a seeming inflammatory overdrive as observed in 44% of patients exhibiting leucocyte profile of lymphocytopenia, antecedent relative neutrophilia with total leucocyte range being in normal range (a signature of viral disease), 61% documenting a state of heightened acute phase reactants with raised serum positive C-reactive proteins and procalcitonin (PCT) (11% patient), 67% patients exhibiting raised Lactate Dehydrogenase (LDH) exemplifying state of cell and tissue damage and 37% patient population documenting hypercoagulable states as illustrated through positive fibrinogen degradation product (FDP), D-Dimer. In addition, 44% patient had deranged liver functions with 11% of patient population exhibiting dysfunctional renal profile (raised renal function test) and 6% had deranged electrolytes levels.

Conclusion: The spectrum of COVID-19 pneumonia has a predilection for advancing age and male gender. Fever, cough and dyspnoea are predominant presenting features and seems to be more prevalent in patient population with antecedent comorbid condition. It can be concluded that ultrasonographic chest imaging has a higher sensitivity of detecting COVID-19 pneumonia of the order of 94% as compared to that of Classic chest X-ray findings. COVID-19 pneumonia primarily and predominantly involves posterior-basal zone of lungs, detectable with a high level of sensitivity by USG chest that could be used to prognosticate and serially corroborate with clinical pattern. USG chest also useful to see minimal pleural effusion and early recovery in clinically improving patients. POCUS is a quick bedside imaging modality with higher sensitivity of diagnosis for COVID-19 pneumonia and also for detection of severity and prognosis of patients.

Funding Statement: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not for profit sectors.

Declaration of Interests: All authors report no potential conflicts.

Ethics Approval Statement: The present study was approved by the institutional review board.