Lung ultrasound may help in the differential diagnosis of suspected oligosymptomatic COVID-19 patients on hemodialysis: A case report.
COVID-19
SARS-CoV-2
dialysis
lung ultrasound
Journal
Hemodialysis international. International Symposium on Home Hemodialysis
ISSN: 1542-4758
Titre abrégé: Hemodial Int
Pays: Canada
ID NLM: 101093910
Informations de publication
Date de publication:
10 2021
10 2021
Historique:
revised:
07
04
2021
received:
20
01
2021
accepted:
10
06
2021
pubmed:
25
6
2021
medline:
21
10
2021
entrez:
24
6
2021
Statut:
ppublish
Résumé
Considering that patients on dialysis showed a poor outcome during COVID-19 pandemic, and that COVID-19 symptoms in dialysis patients are often mild or absent, each dialysis unit should implement local strategies to early recognize patients affected by COVID-19. However, many available SARS-CoV-2 diagnostic tests demonstrated a moderate sensitivity, 70%-80% is probably a reasonable estimate. Consequently, having useful tools for differential diagnosis becomes essential. In this scenario, lung ultrasound (LUS) may have an important role in the evaluation of lung involvement in hemodialysis patients during COVID-19 pandemic. We present two cases of hemodialysis patients with COVID-19 pneumonia in whom LUS had a central role in the diagnostic process. Ultrasound images of COVID-19 pneumonia show a typical bilateral pattern characterized by multiple or confluent B-lines with spared areas, thickened and irregular pleural line, and rare subpleural consolidations. LUS showed high accuracy in diagnosing COVID-19 pneumonia. Despite both patients appeared clinically euvolemic and afebrile, they presented with acute diarrhea and oxygen saturation level of 92%-93%. Although clinical manifestations were mild and not specific in both patients, LUS raised suspicion on the possible COVID-19 diagnosis which was confirmed by a positive nasopharyngeal RT-PCR. There are many reasons for a patient on dialysis to present shortness of breath, fever, and multiple B-lines at LUS assessment (such as heart failure, fluid overload, vascular access infection, interstitial pneumonia) but the recognition of typical ultrasound patterns of the COVID-19 pneumonia is helpful for differential diagnosis. LUS may have an important role in the screening process of hemodialysis patients during the COVID-19 pandemic, especially in oligosymptomatic patients before the SARS-CoV-2 diagnostic tests, and in those with suspected symptoms and/or known exposure with unexpected negative SARS-CoV-2 diagnostic tests.
Identifiants
pubmed: 34164903
doi: 10.1111/hdi.12958
pmc: PMC8444644
doi:
Types de publication
Case Reports
Langues
eng
Sous-ensembles de citation
IM
Pagination
E48-E52Informations de copyright
© 2021 International Society for Hemodialysis.
Références
Hemodial Int. 2021 Oct;25(4):E48-E52
pubmed: 34164903
N Engl J Med. 2020 Aug 6;383(6):e38
pubmed: 32502334
Clin Exp Nephrol. 2020 Sep;24(9):850-852
pubmed: 32430767
J Nephrol. 2020 Jun;33(3):401-403
pubmed: 32323202
Ultrasound J. 2020 Jun 3;12(1):30
pubmed: 32488686
Pediatr Nephrol. 2016 Dec;31(12):2327-2335
pubmed: 27282380
Ultrasound Med Biol. 2020 Nov;46(11):2908-2917
pubmed: 32807570
Kidney Blood Press Res. 2021;46(1):126-134
pubmed: 33503627
Ann Emerg Med. 2021 Apr;77(4):385-394
pubmed: 33461884
J Am Soc Nephrol. 2020 Sep;31(9):1969-1975
pubmed: 32732391
Hemodial Int. 2020 Jul;24(3):423-427
pubmed: 32365278
Ultrasound J. 2020 Apr 21;12(1):22
pubmed: 32318891
Nephrol Dial Transplant. 2021 Dec 2;36(12):2182-2193
pubmed: 33184659