Editor:

As reported by Dr Pan and colleagues in an article published online in Radiology in February 2020 (1), chest CT has a pivotal role for the diagnosis and assessment of lung involvement in coronavirus disease 2019 (COVID-19) pneumonia. Nowadays CT protocols are used to estimate the pulmonary damage (1–3). Unfortunately, CT scan 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 (nine men and three women; mean age ± standard deviation, 63 years ± 13) with flulike symptoms in the last 4–10 days and COVID-19 infection underwent bedside lung US and CT scan. Two patients had emphysema but without need of oxygen therapy at home. None of the patients had severe respiratory distress (PaO 2 /FiO 2 ratio, 257–376 mm Hg).

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 present to the emergency department with flulike symptoms in the era of novel COVID-19.

Acknowledgments The authors would like to thank all the emergency doctors and nurses of their hospital for the help and energy to face such a difficult public health crisis.

References 1. Pan F , Ye T , Sun P et al . Time Course of Lung Changes at Chest CT during Recovery from 2019 Novel Coronavirus (COVID-19) Pneumonia . Radiology 2020 Feb 13 :200370 [Epub ahead of print] Link Google Scholar :200370 [Epub ahead of print] https://doi.org/10.1148/radiol.2020200370

2. Chung M , Bernheim A , Mei X et al . CT Imaging Features of 2019 Novel Coronavirus (2019-nCoV) . Radiology 2020 ;295(1):202–207. Google Scholar ;295(1):202–207. Link

3. Ai T , Yang Z , Hou H et al . Correlation of Chest CT and RT-PCR Testing in Coronavirus Disease 2019 (COVID-19) in China: A Report of 1014 Cases . Radiology 2020 ; Feb 26:200642 [Epub ahead of print]. Google Scholar ; Feb 26:200642 [Epub ahead of print]. Link

4. Mongodi S , Pozzi M , Orlando A et al . Lung ultrasound for daily monitoring of ARDS patients on extracorporeal membrane oxygenation: preliminary experience . Intensive Care Med 2018 ;44(1):123–124. Medline Google Scholar ;44(1):123–124. Crossref

5. Laursen CB , Sloth E , Lassen AT , Christensen Rd , Lambrechtsen J , Madsen PH , Henriksen DP , Davidsen JR , Rasmussen F . Point-of-care ultrasonography in patients admitted with respiratory symptoms: a single-blind, randomised controlled trial . Lancet Respir Med 2014 ;2(8):638–646. Medline Google Scholar ;2(8):638–646. Crossref

6. Zhou B , Bartholmai BJ , Kalra S , Osborn TG , Zhang X . Lung US Surface Wave Elastography in Interstitial Lung Disease Staging . Radiology 2019 ;291(2):479–484. Google Scholar ;291(2):479–484. Link

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