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Background Transthoracic ultrasound (TUS) can potentially give important complementary information in particular conditions like bedside rapid diagnostic evaluation of dyspneic patients who commonly present to emergency (ER) units. Objective Assessing the significance and diagnostic utility of B-lines and pleural line abnormalities detected on TUS among patients presented to the ER unit for the assessment of dyspnea against high-resolution computed tomography findings. Patients and methods A prospective observational study including 240 consecutive patients was conducted. TUS was done for patients presenting to the ER for the assessment of dyspnea. B-lines and the pleural line were evaluated by a linear and convex transducers. Sonographic findings were reported against high-resolution computed tomography findings, which was considered the gold standard. Results Slightly rough, fringed, irregular, interrupted, wavy, coexistence of more than one abnormal type of pleural line were detected in 30.8%, 35.4%, 19.2%, 17.9%, and 30% of cases, respectively. Warrick score classified patients with interstitial lung disease to mild (44.6%), moderate (36.3%), and severe (19.2%). Diffusing capacity for carbon monoxide (DLCO% predicted) and total lung capacity (TLC% predicted) predicted showed negative correlation with Warrick score (r=−0.66, r=−0.48 respectively, P≤0.001 for both) and positive correlation with distance between B lines (r=0.31 and 0.30 respectively, P≤0.001 for both). Warrick score at a cutoff more than 7 showed 96.3% sensitivity and 64.3% specificity. Distance between B lines at cutoff more than 3 mm had 100% sensitivity and 40.4% specificity. Cutoff more than 3 for B lines number/scan showed 92.6% sensitivity and 31% specificity. Pleural thickness at cutoff more than 2 mm showed 100% sensitivity and 34% specificity. Abolished lung sliding showed 96.3% sensitivity and 50% specificity. Conclusion TUS is an important tool for the diagnosis and assessment of pulmonary disorders. B-lines number and distance, pleural line abnormalities, lung sliding, and pleural thickness added diagnostic value for the ER assessment of dyspneic patients.

OBJECTIVES: Discrete B-lines have clear definitions, but confluent B-lines, consolidations, and pleural line abnormalities are less well defined. We proposed definitions for these and determined their reproducibility using COVID-19 patient images obtained with phased array probes. METHODS: Two raters collaborated to refine definitions, analyzing disagreements on 107 derivation scans from 10 patients. Refined definitions were used by those raters and an independent rater on 1260 validation scans from 105 patients. Reliability was evaluated using intraclass correlation coefficients (ICC) or Cohen's kappa. RESULTS: The agreement was excellent between collaborating raters for B-line abnormalities, ICC = 0.97 (95% confidence interval [CI] 0.97-0.98) and pleural line to consolidation abnormalities, ICC = 0.90 (95% CI 0.87-0.92). The independent rater's agreement for B-line abnormalities was excellent, ICC = 0.97 (95% CI 0.96-0.97) and for pleural line to consolidation was good, ICC = 0.88 (95% CI 0.84-0.91). Agreement just on pleural line abnormalities was weak (collaborators, kappa = 0.54, 95% CI 0.48-0.60;independent, kappa = 0.54, 95% CI 0.49-0.59). CONCLUSION: With proposed definitions or via collaboration, overall agreement on confluent B-lines and pleural line to consolidation abnormalities was robust. Pleural line abnormality agreement itself was persistently weak and caution should be used interpreting pleural line abnormalities with only a phased array probe.

It is of vital importance to identify the pleural line when performing lung ultrasound, as the pleural line not only indicates the interface between the chest wall and lung, but offers additional diagnostic information. In the current clinical practice, the pleural line is visually detected and evaluated by clinicians, which requires experiences and skills with challenges for the novice. In this study, we developed a computer-aided technique for automated pleural line detection using ultrasound. The method first utilized the Radon transform to detect line objects in the ultrasound images. The relation of the body mass index and chest wall thickness was then applied to estimate the range of the pleural thickness, based on which the pleural line was detected together with the consideration of the ultrasonic properties of the pleural line. The proposed method was validated by testing 83 ultrasound data sets collected from 21 pneumothorax patients. The pleural lines were successfully identified in 76 data sets by the automated method (successful detection rate 91.6%). In those successful cases, the depths of the pleural lines measured by the automated method agreed with those manually measured as confirmed with the Bland-Altman test. The measurement errors were below 5% in terms of the pleural line depth. As a conclusion, the proposed method could detect the pleural line in an automated manner in the defined data set. In addition, the method may potentially act as an alternative to visual inspection after further tests on more diverse data sets are performed in future studies.

This paper proposes a quantitative analysis method for lung ultrasound (LUS) images to evaluate the severity of COVID-19 pneumonia. Specifically, biomarkers related to the pleural line, including the thickness of pleural line (TPL) and the roughness of pleural line (RPL), and biomarkers related to the B-lines, including the accumulated width of B-lines (AWBL) and the acoustic coefficient of B-lines (ACBL), are extracted from LUS images to characterize the image patterns associated with the disease severity. 27 patients of COVID-19 pneumonia are enrolled in this study, including 13 moderate cases, 7 severe cases, and 7 critical cases. Patients of moderate cases are regarded as non-severe patients, and patients of severe and critical cases are regarded as non-severe patients. Biomarkers among different cases are compared, and the performances in the binary diagnosis of severe and non-severe patients are assessed using a support vector machine (SVM) classifier with all the biomarkers as the input. The classification performance is optimal using the SVM classifier (area under the receiver operating characteristics curve = 0.93, sensitivity = 0.93, specificity = 0.85). The proposed method may be a promising tool for the automatic grading and follow-up of patients with COVID-19 pneumonia.

Background and objective Lung ultrasound is an inherently user‐dependent modality that could benefit from quantitative image analysis. In this pilot study we evaluate the use of computer‐based pleural line (p‐line) ultrasound features in comparison to traditional lung texture (TLT) features to test the hypothesis that p‐line thickening and irregularity are highly suggestive of coronavirus disease 2019 (COVID‐19) and can be used to improve the disease diagnosis on lung ultrasound. Methods Twenty lung ultrasound images, including normal and COVID‐19 cases, were used for quantitative analysis. P‐lines were detected by a semiautomated segmentation method. Seven quantitative features describing thickness, margin morphology, and echo intensity were extracted. TLT lines were outlined, and texture features based on run‐length and gray‐level co‐occurrence matrix were extracted. The diagnostic performance of the 2 feature sets was measured and compared using receiver operating characteristics curve analysis. Observer agreements were evaluated by measuring interclass correlation coefficients (ICC) for each feature. Results Six of 7 p‐line features showed a significant difference between normal and COVID‐19 cases. Thickness of p‐lines was larger in COVID‐19 cases (6.27 ± 1.45 mm) compared to normal (1.00 ± 0.19 mm), P

BACKGROUND There is no research on quantitative pleural line movement. In this study, we assume that tissue Doppler and its quantitative technology can quantify the pleural line movement and can be used to diagnose pneumothorax. AIM To evaluate the quantitative assessment of pleural line movement measured by tissue Doppler imaging (TDI) for pneumothorax diagnosis. METHODS Adult patients (n = 45) diagnosed with unilateral pneumothorax were included in this study. Each patient underwent TDI of both lungs. The pneumothorax side and contralateral normal lung side were compared using several indices obtained from TDI: peak pleural line velocity (PVmax), peak chest wall tissue velocity (CVmax), peak pleural line strain value (PSmax), peak chest wall tissue strain value (CSmax), PVmax/CVmax and PSmax/CSmax. The receiver operating characteristic analysis was used to evaluate the performance of these quantitative assessments for pneumothorax diagnosis. RESULTS Various quantitative variables of the pneumothorax side were all lower than that of the non-pneumothorax side and included the PVmax (0.36 cm/s vs 0.59 cm/s, P < 0.001), PSmax (1.14% vs 1.90%, P = 0.001), PVmax/CVmax (1.06 vs 4.93, P < 0.001), and PSmax/CSmax (0.76 vs 1.74, P < 0.001). For the discrimination of pneumothorax, the cut-off values of the PVmax, PSmax, PVmax/CVmax, and PSmax/CSmax were calculated as 0.50 cm/s, 0.94%, 1.96, and 1.12, respectively. Similarly, the sensitivities and specificities of PVmax, PSmax, PVmax/CVmax, and PSmax/CSmax were 96% and 62%, 47% and 91%, 93% and 96%, and 82% and 93%, respectively. The area under the receiver operating characteristic curve were 0.84, 0.72, 0.99, and 0.91, respectively, for PVmax, PSmax, PVmax/CVmax, and PSmax/CSmax. CONCLUSION Quantification analysis of pleural line movement using TDI is a useful tool for the diagnosis of pneumothorax.

We used the lung ultrasound score (LUSS) to analyze the ultrasound images and assess the lesions and aeration loss in 12 lung regions of 11 COVID-19 neonates born to mother with COVID-19 and 11 age- and gender-matched controls. In the COVID-19 group, 132 regions were reviewed and 83 regions (62.8%) detected abnormalities. Compared with controls, COVID-19 neonates showed more increased B-lines (83 regions), abnormal A-lines (83 regions), abnormal pleural line (29 regions) and subpleural consolidation (5 regions). among which 49 regions (37%) were normal, 73 regions (55%) scored 1, and 10 regions (8%) scored 2. The LUSS was significantly higher in COVID-19 group. All the lesions were bilateral, multiple regions involved, and mainly located in bilateral lower lobes and right middle lobe. The intra-observer and inter-observer reproducibility of LUSS were excellent. Lung ultrasound is a noninvasive and convenient method for the assessment of neonatal COVID-19 pneumonia and presents typical signs. LUSS provides valuable semi-quantitative information about the lesion distribution and severity.

Background: The work wants to see if the Lung Sonography (LUS) can be helpful in the evaluation of a new device before and after a respiratory treatment. Aim: Simeox is a new device for airway clearway. The patient activates it using a button during the expiration phase that creates a negative vibratory suction of small volumes of air.The action is directed to the mucus rheology, improves the drainage from the periphery of the lung. Methods: 8 patients (4 female and 4 male), were examined by comparing LUS with traditional parameters such as SpO2 , FC, scales before and after a week’s use of the Simeox device and gym exercises. The ecography machine was set in B-mode with a convex probe oriented horizontally to have a greater view of the pleural line in the four Volpicelli’s zones. We took note on a map of number of the vertical artifacts B lines starting from the pleural line with a score from 0 to 4. Results: Lus and all parameters have improved but some patients, little compliant, were unable to tell if the amount of secretions had changed. The usual exams give the state of health but not the specific state of the lung such as LUS that represents a third eye, inner, in addition to the clinic exam. Conclusion: Our study suggests that LUS is a patient bedside exam modality, safe, reliable, fast to evaluate the alveolar drainage. Further studies are needed to understand the interaction of LUS with the respiratory treatments.

Introduction: Diagnosis and monitoring of interstitial lung disease (ILD) in children are mainly based on chest computed tomography (CT), resulting in significant exposure to x-rays. In adult patients, studies have shown a good sensitivity of the lung ultrasound (LUS) for detecting interstitial lesions, with a high correlation between LUS and CT images. The aim of this pilot study was to assess in children with ILD: (i) the feasibility of lung ultrasound and (ii) the comparability of LUS and CT images. Methods: LUS was performed in 5 children followed in the RespiRare® centre for an ILD of various aetiologies. Images visualized by LUS were described and compared to those seen at the latest chest CT. Results: The 5 children were 1.5, 2.5, 7, 11 and 16 years old respectively. Interstitial lesions were visualized by LUS in 4 of the 5 children, characterized by the presence of more than 3 confluent or spaced B lines per field, associated with an irregularity of the pleural line. Two children presented sub-pleural consolidations that were also seen on their CT. Bilateral pleural effusion was observed by LUS in one child. Only one child had a normal LUS while his CT showed some scattered micro-nodular lesions. Conclusion: This pilot study demonstrated a good correlation between LUS and CT images. As in adult patients, LUS could be an interesting tool for screening and monitoring children with ILD, reducing their exposure to x-rays in comparison to CT.

Objective Evidence for the use of lung ultrasound scan (LUS) examinations in coronavirus 2019 pneumonia is rapidly growing. The safe and non-ionizing nature of LUS drew attention, particularly for pregnant women. This study aimed to contribute to the interpretation of LUS findings in pregnant women for the obstetricians. Materials and methods LUS was performed to pregnant women suspected of or diagnosed as having Severe Acute Respiratory syndrome coronavirus-2 (SARS-CoV-2) in the first 24 hours of admission. Fourteen areas (3 posterior, 2 lateral, and 2 anterior) were scanned per patient for at least 10 seconds along the indicated anatomical landmarks. The scan was performed in supine, right-sided and left-sided positions, respectively. Each area was given a score between 0 and 3 according to the specific pattern. Results In this study, 21 still images and 21 videoclips that enabled dynamic and real-time evaluation were provided. Pleural line assessment, physiologic A-lines, pathologic B-lines, light beam pattern, white lung pattern, and specific patterns for quick recognition and evaluation are described. Conclusion The potential advantages and limitations of LUS and its areas of use for obstetricians are discussed. LUS is a promising supplementary imaging tool during the SARS-CoV-2 pandemic. It is easy to perform and may be feasible in the hands of obstetricians after a brief didactic course. It may be a firstline imaging modality for pregnant women.

Objective To explore the reliability and accuracy of lung ultrasound for diagnosing neonatal pneumothorax. Methods This study was divided into two phases. (1) In the first phase, from January 2013 to June 2015, 40 patients with confirmed pneumothorax had lung ultrasound examinations performed to identify the sonographic characteristics of neonatal pneumothorax. (2) In the second phase, from July 2015 to August 2016, lung ultrasound was undertaken on 50 newborn infants with severe lung disease who were suspected of having pneumothorax, to evaluate the sonographic accuracy and reliability to diagnose pneumothorax. Results (1) The main ultrasonic manifestations of pneumothorax are as follows: ① lung sliding disappearance, which was observed in all patients (100%); ② the existence of the pleural line and the A-line, which was also observed in all patients (100%); ③ the lung point, which was found in 75% of the infants with mild-moderate pneumothorax but not found to exist in 25% of the severe pneumothorax patients; ④ the absence of B-lines in the area of the pneumothorax (100% of the pneumothorax patients); and ⑤ no lung consolidation existed in the area of the pneumothorax (100% of the pneumothorax patients). (2) The accuracy and reliability of the lung sonographic signs of lung sliding disappearance as well as the existence of the pleural line and the A-line in diagnosing pneumothorax were as follows: 100% sensitivity, 100% specificity, 100% positive predictive value, and 100% negative predictive value. When the lung point exists, the diagnosis is mild-moderate pneumothorax, whereas if no lung point exists, the diagnosis is severe pneumothorax. Conclusion Lung ultrasound is accurate and reliable in diagnosing and ruling out neonatal pneumothorax and, in our study, was found to be as accurate as chest X-ray.

Objectives Detection of B-line in dyspneic patients is often accompanied by abnormal changes of pleural line on transthoracic ultrasonography (TUS). The aim of the study was to evaluate the relevance and diagnostic performance of pleural line abnormalities and B-lines detected on high-resolution TUS against the computed tomography (CT) findings. Methods Transthoracic ultrasonography was performed in patients admitted to the emergency department with dyspnea. The pleural line and accompanying B-line were assessed using a linear transducer. The TUS findings were assessed against the corresponding high-resolution CT findings in the same location, which were considered to be the gold standard. Results Out of a total of 116 patients, 68.1% had changes of the pleural line on TUS. The characteristic changes of the pleural line were classified into four types: slightly rough pleural line with confluent B-lines on TUS corresponded with CT findings of ground-glass opacity; irregular and interrupted pleural line with confluent B-lines corresponded with parenchymal infiltration; fringed pleural line with confluent B-lines corresponded with superimposed ground-glass and irregular reticular opacities; and fringed pleural line with scattered B-lines corresponded with irregularly thickened interlobular septa. Wavy pleural line indicated subpleural emphysema. The coexistence of more than one abnormal pleural line was also found in 31 cases (26.7%). Conclusions High-resolution TUS may help in the initial assessment of lung pathology by its ability to identify pleural line abnormalities and B-lines that are shown to be associated with CT, which could add diagnostic value in the emergency evaluation of dyspneic patients.

The aim of the study was to assess the significance and diagnostic concert of pleural line aberrations and B-lines detected by high-resolution transthoracic sonography (TS) in contradiction of the high resolution computed tomography (HRCT) findings. The pleural lines and accompanying B-line were assessed using a linear transducer. The TS findings were assessed against the corresponding HRCT findings in the same location, which were considered to be the gold standard. Among 320 patients, pleural line changes were detected in 240 patients (75%) on TS. The characteristic variations of the pleural line were categorized into four types: slightly rough pleural line with confluent B-lines on TS corresponded with HRCT findings of ground-glass opacity; irregular and interrupted pleural line with confluent B-lines corresponded with parenchymal infiltration; fringed pleural line with confluent B-lines corresponded with superimposed ground-glass and irregular reticular opacities; and fringed pleural line with scattered B-lines corresponded with irregularly thickened interlobular septa. Wavy pleural line indicated subpleural emphysema. The coexistence of more than one abnormal pleural line was also found in in 96 cases (30%). In conclusion, High-frequency TS may help in the early assessment of lung pathology by its ability to recognize pleural line anomalies and B-lines that are shown to be associated with CT changes, which could add diagnostic value in the emergency assessment of dyspneic patients.