Lung, Heart, Vascular, and Diaphragm Ultrasound Examination of COVID-19 Patients: A Comprehensive Approach

Lung ultrasound (LU) has a multitude of features and capacities that make it a useful medical tool to assist physicians contending with the pandemic spread of novel coronavirus disease-2019 (COVID-19) caused by coronavirus SARS-CoV-2 Thus, a LU approach to patients with suspected COVID-19 is being implemented worldwide In non-critical COVID-19 patients, two new LU signs have been described and proposed: the �waterfall� and the �light beam� signs Both signs have been hypothesized to increase the diagnostic accuracy of LU for COVID-19 interstitial pneumonia In critically-ill patients, a distinct pattern of LU changes seems to follow the disease's progression, and this information can be used to guide decisions about when a patient needs to be ventilated, as occurs in other disease states similar to COVID-19 Furthermore, a new algorithm has been published, which enables the automatic detection of B-lines as well as quantification of the percentage of the pleural line associated with lung disease In COVID-19 patients, a direct involvement of cardiac function has been demonstrated, and ventilator-induced diaphragm dysfunction might be present due to the prolonged mechanical ventilation often involved, as reported for similar diseases For this reason, cardiac and diaphragm ultrasound evaluation is highly important Last but not least, due to the thrombotic tendency of COVID-19 patients, particular attention should also be paid to vascular ultrasound This review is primarily devoted to the study of LU in COVID-19 patients We explain the significance of its �light and shadows�, bearing in mind the context in which LU is being used: the emergency department and the intensive care setting The use of cardiac, vascular, and diaphragm ultrasound is also discussed, as a comprehensive approach to patient care