Fighting COVID-19 together.

Lung ultrasound is used to identify pulmonary complications in suspected and/or confirmed COVID-19 patients and helps risk stratify those for admission and closer observation. It is not diagnostic of COVID-19.  The definitive diagnosis is made by real-time RT-polymerase chain reaction (rRT-PCR) detection of the SARS-CoV-2 virus (the virus that causes COVID-19) in respiratory specimens.

Lung ultrasound is a portable, bedside, radiation-free, inexpensive imaging modality that can readily detect many features of COVID-19 associated lung disease. The cost, portability, accuracy and ability to use in an isolated environment lead to significant potential benefit over chest radiography or computed tomography (CT) imaging. Imaging findings can accelerate disposition decisions while awaiting culture results.

Clinicians are using lung ultrasound to assess and monitor COVID-19 patients with hypoxemia and to assess high risk infected patients to stratify disposition decisions. Lung ultrasound findings can change dynamically through the course of an illness, and monitoring for progression of B-lines and/or consolidation (or for resolution with return of a normal A-line pattern) could provide valuable information to the treatment team. While CT has confirmed value in the evaluation of COVID-19, many patients are too ill to transport or can extend the exposure risk to more health care providers. CT is also more expensive and studies suggest ultrasound may be equally as informative.

The following ultrasound features have been described in patients with COVID-19 infection:
· A fragmented, irregular pleural line
· B-lines (focal, scattered and/or confluent)
· Bilateral involvement
· Posterior and lateral segment involvement
· Lung consolidation (ranging from small to lobar, with or without air bronchograms)
· Rare pleural effusions
· See this study and this study for further details

Dr. Mike Stone, emergency room physician and Director of Education at Butterfly Network, has put together a proposed protocol based on expert input. Please note that this protocol is not validated by prospective trials.  Other clinicians have also shared their protocols with us. View them here:

Serial examinations with lung POCUS can reveal worsening B-lines and/or consolidations, indicating progression of disease. Additionally, return of a normal A-line pattern may indicate signs of recovery. Multiple approaches have been described (6-,8-,12-, 14+ zone protocols) for lung evaluation with POCUS. You may also consider imaging the heart as a baseline measure of ejection fraction. This may be specifically relevant to intensivists caring for severely ill patients with COVID-19.

Many users have reported positive results placing both iQ and mobile device in a standard probe sheath. CIVCO has created a unique landing page for sheaths that will work with the iQ. You may also use standard sheaths available from ProTek, Medline, Sheathes and other retailers. For more details, view our COVID-19 cleaning and disinfection page.

We are actively seeking to connect with the medical community, and add to the data available for research, teaching and understanding of COVID-19. Qualified professionals are encouraged to contribute to our library of de-identified positive cases, as well as share care delivery protocols. Contact us at covid@butterflynetwork.com for more details.

The images and clips in our COVID-19 gallery originate from clinicians across the world and have been useful to accelerate learning and collaboration throughout our community. Please reach out to us via email at covid@butterflynetwork.com, and we will be happy to provide further instructions. We appreciate your contributions to this evolving resource center.