Comparative study of lung ultrasound and chest computed tomography scan in the assessment of severity of confirmed COVID-19 pneumonia

Intensive Care Med. 2020 Sep;46(9):1707-1713. doi: 10.1007/s00134-020-06186-0. Epub 2020 Jul 29.


Purpose: The relationship between lung ultrasound (LUS) and chest computed tomography (CT) scans in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia is not clearly defined. The primary objective of our study was to assess the performance of LUS in determining severity of SARS-CoV-2 pneumonia compared with chest CT scan. Secondary objectives were to test the association between LUS score and location of the patient, use of mechanical ventilation, and the pulse oximetry (SpO2)/fractional inspired oxygen (FiO2) ratio.

Methods: A multicentre observational study was performed between 15 March and 20 April 2020. Patients in the Emergency Department (ED) or Intensive Care Unit (ICU) with acute dyspnoea who were PCR positive for SARS-CoV-2, and who had LUS and chest CT performed within a 24-h period, were included.

Results: One hundred patients were included. LUS score was significantly associated with pneumonia severity assessed by chest CT and clinical features. The AUC of the ROC curve of the relationship of LUS versus chest CT for the assessment of severe SARS-CoV-2 pneumonia was 0.78 (CI 95% 0.68-0.87; p < 0.0001). A high LUS score was associated with the use of mechanical ventilation, and with a SpO2/FiO2 ratio below 357.

Conclusion: In known SARS-CoV-2 pneumonia patients, the LUS score was predictive of pneumonia severity as assessed by a chest CT scan and clinical features. Within the limitations inherent to our study design, LUS can be used to assess SARS-CoV-2 pneumonia severity.

Keywords: Chest computed tomography; Diagnostic accuracy; Lung ultrasound; SARS-CoV-2.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Aged
  • Betacoronavirus
  • COVID-19
  • Comorbidity
  • Coronavirus Infections / diagnostic imaging*
  • Emergency Service, Hospital
  • Female
  • Hospitals, University
  • Humans
  • Intensive Care Units
  • Lung / diagnostic imaging*
  • Male
  • Middle Aged
  • Oximetry
  • Pandemics
  • Pneumonia, Viral / diagnostic imaging*
  • SARS-CoV-2
  • Severity of Illness Index
  • Tomography, X-Ray Computed
  • Ultrasonography