This post shows the lung ultrasound progression of an emergency medicine physician from Spain, Dr. Yale Tung Chen who was diagnosed with COVID-19 (Coronavirus) as he documented his illness day-by-day on twitter. You can follow him on twitter here: @yaletung
The first day he documented it was March 9th, 2020 with normal ultrasound and it progressed to interstitial edema (B-lines), pleural thickening, and pleural effusions in a matter of days. He is still documenting residual findings of interstitial edema (B-lines) 2 weeks after, just showing how long the COVID-19 can affect the lungs.
I think this is a great case to follow and understand what may be going on in the lungs of patients being discharged from the emergency department or urgent care. After reviewing this case I was surprised how quick the onset is and how long it takes for COVID-19 to resolve.
I compiled Dr. Yale Tung Chen’s daily ultrasound tweets so you can see the progression and also put a summary of the lung ultrasound findings on the left side.
Daily Lung Ultrasound Tweets from Dr. Yale Tung Chen:
DAY 1 of COVID-19
- Normal Findings
- A-profile
- No Pleural Effusions
Day 1 after #COVID diagnosis. Sore throat, headache (strong!), Dry cough but not shortness of breath. No lung US abnormalities. Will keep a #POCUS track of my lungs. #coronavirus @TomasVillen @ButterflyNetInc pic.twitter.com/wLtSc70pxQ
— Yale Tung Chen (@yaletung) March 9, 2020
DAY 2 of COVID-19
- B-lines in Dependent Lung Fields (costodiaphragmatic angles)
- Small Bilateral Pleural Effusions
- Thickened (echogenic) Pleural Line
Day 2 after #COVID diagnosis. Less sore throat, cough & headache (thank God!), still no shortness of breath or pleuritic chest pain. #POCUS update: small bilateral pleural effusion, thickened pleural line & basal b-lines (plaps). #coronavirus @TomasVillen @ButterflyNetInc pic.twitter.com/tpKkeFdhac
— Yale Tung Chen (@yaletung) March 10, 2020
DAY 3 of COVID-19
- Similar to Day 2
- B-lines in Dependent Lung Fields (costodiaphragmatic angles)
- Small bilateral pleural effusions
- Thickened (echogenic) Pleural Line
Day 3 after #COVID diagnosis. No sore throat/headache. Yesterday was cough day, still no shortness of breath/chest pain. Diarrhea started, lucky cough got better. #POCUS update: similar effusion, seems less thickened pleural line + no b-lines (PLAPS). #mycoviddiary @TomasVillen pic.twitter.com/ycJfQNtLL8
— Yale Tung Chen (@yaletung) March 11, 2020
DAY 4 of COVID-19
- B-lines in Dependent Lung Fields (costodiaphragmatic angles)
- Small bilateral pleural effusions
- Thickened (echogenic) Pleural Line
- Subpleural Consolidations
Day 4 after #COVID diagnosis. More cough & tiredness (very badly), still no dyspnea/chest pain. #POCUS update: Right side on resolution, Left side a more thickened pleural line + 2 subpleural consolidations. #mycoviddiary @TomasVillen pic.twitter.com/KBUf084mkC
— Yale Tung Chen (@yaletung) March 12, 2020
[et_bloom_inline optin_id=”optin_5″]
DAY 5 of COVID-19
- Increasing B-lines that look confluent
- Pleural Effusions Resolve
- Thickened (echogenic) Pleural Line
- Increase in Subpleural Consolidations
Day 5 after #COVID diagnosis. Less cough & tired, still no dyspnea/chest pain. #POCUS update: Effusion resolved, as subpleural consolidations spread bilaterally on both posterior lower lobes. Started on HCQ yesterday. #mycoviddiary @TomasVillen @acam_acam pic.twitter.com/fjtq2SEM1d
— Yale Tung Chen (@yaletung) March 13, 2020
DAY 6 of COVID-19
- Continued Significant Amount of B-lines
- Thickened (echogenic) Pleural Line
- Subpleural Consolidations Resolving
Day 6 after #COVID diagnosis. Less cough, bit tired, still no dyspnea. No fever. Oxygen saturation 98%. #POCUS update: thick pleural line, b-lines and subpleural consolidations tend to resolve. Significant lung improve from yesterday. #mycoviddiary @TomasVillen @acam_acam pic.twitter.com/StQnbPPFUE
— Yale Tung Chen (@yaletung) March 14, 2020
DAY 7 of COVID-19
- Decrease in Amount of B-lines
- Thickened (echogenic) Pleural Line
- Subpleural Consolidations Resolved
Day 7 after #COVID diagnosis. Cough & weakness got worse (again), still no dyspnea. No fever. SpO2 96%. #POCUS update: similar to yesterday – thick pleural line, b-lines & consolidations tend to resolve. On paracetamol + HCQ. Stopped NSAIDs. #mycoviddiary @TomasVillen
— Yale Tung Chen (@yaletung) March 15, 2020
@acam_acam pic.twitter.com/SPmEV7t7JK
DAY 8 of COVID-19
- Right Lung Improvement/Resolution
- New B-lines in Left Lateral Side
Day 8 after #COVID diagnosis. Less Cough & similar weakness, still no dyspnea or red flag symptoms. No fever. SpO2 96%. #POCUS update: Right resolved. Left lower lobe much better. Left lateral appeared new focal B-lines. On paracetamol + HCQ. #mycoviddiary @TomasVillen @acam_acam pic.twitter.com/8vqMwJPiOb
— Yale Tung Chen (@yaletung) March 16, 2020
DAY 9 of COVID-19
- Focal B-lines On Left Lower and Lateral Side
Day 9 after #COVID diagnosis. Feeling slightly better. More cough. No dyspnea or red flag symptoms. No fever. SpO2 97%. #POCUS update: similar to yesterday. Left lower & lateral with thick pleural line & focal B-lines. On paracetamol + HCQ. #mycoviddiary @TomasVillen
— Yale Tung Chen (@yaletung) March 17, 2020
@acam_acam pic.twitter.com/51K6z5tgU3
DAY 10 of COVID-19
- Continued focal B-lines in the Left Lung
- Now also with Right Lung Involvement Showing B-lines
Day 10 after #COVID diagnosis. Less tired, but more cough, ageusia & anosmia. No dyspnea or red flag symptoms. No fever. SpO2 97%. #POCUS update: Right, Left lower & lateral with thick pleural line & focal B-lines. On paracetamol + HCQ. #mycoviddiary @TomasVillen @acam_acam pic.twitter.com/N93wZlc4NE
— Yale Tung Chen (@yaletung) March 18, 2020
DAY 11 of COVID-19
- Continued Focal B-lines in both lungs
- Bilateral subpleural consolidations
- Thickened Pleura
Day 11 after #COVID diagnosis. Less tired & cough, unable to endure small efforts. No dyspnea or red flag symptoms. No fever. SpO2 98%. #POCUS update: Bilateral subpleural consolidations, thick pleura & focal B-lines. On paracetamol + HCQ. #mycoviddiary @TomasVillen
— Yale Tung Chen (@yaletung) March 19, 2020
@acam_acam pic.twitter.com/DZN9bP8X2y
DAY 12 of COVID-19
- Subpleural consolidations resolving
- Thickened Pleura
- Continued Focal B-lines
Day 12 after #COVID diagnosis. Better, main symptoms cough, nausea & diarrhea. No dyspnea or red flag sympts. No fever. SpO2 98%. #POCUS update: Subpleural consolidations resolving, thick pleura & B-lines, small effusion. On azithromycin+HCQ. #mycoviddiary @TomasVillen @acam_acam pic.twitter.com/WUjhB9Ksey
— Yale Tung Chen (@yaletung) March 20, 2020
DAY 13 of COVID-19
- Subpleural consolidations resolving
- Thickened Pleura
- Continued scattered B-lines
Day 13 after #COVID diagnosis. Lesser cough, weakness, nausea & diarrhea. No dyspnea or red flag symptoms. No fever. SpO2 97%. #POCUS update: 2 subpleural consolidations (resolving), thick pleura & Bil scattered B-lines. On azithromycin+HCQ. #mycoviddiary @TomasVillen @acam_acam pic.twitter.com/U7p3iWvXrN
— Yale Tung Chen (@yaletung) March 21, 2020
DAY 14 of COVID-19
- Decreased Thickening Pleura
- Continued scattered B-lines
Day 14 after #COVID diagnosis. Less symptoms – cough, weakness, nausea, light headache. Regain apetite/smell. No fever/dyspnea. SpO2 98%. #POCUS update: Improving – thick pleura & Bilateral scattered B-lines, no effusion. On azithromycin+HCQ. #mycoviddiary @TomasVillen @acam_acam pic.twitter.com/IZ0wmyL0l5
— Yale Tung Chen (@yaletung) March 22, 2020
DAY 15 of COVID-19
- Similar to Day 14
- Decreased Thickening Pleura
- Continued scattered B-lines
Day 15 after #COVID diagnosis. Similar cough, less weakness. Diarrhea due azithromycin. No fever or shortness of breath. SpO2 97%. #POCUS update: Similar to yesterday, thick pleura & bilateral scattered B-lines. On azithromycin(5d)+HCQ(11d). #mycoviddiary @TomasVillen @acam_acam pic.twitter.com/y2O3eRcRUX
— Yale Tung Chen (@yaletung) March 23, 2020
DAY 16 of COVID-19
- Decreased Thickening Pleura
- Improving B-lines Bilaterally
Day 16 after #COVID diagnosis. Similar dry cough, but with good energy & high spririt. No fever or dyspnea. SpO2 97%. #POCUS update: Improved, less thickened pleura & less bilateral B-lines. On HCQ (D12). Waiting the re-test on friday. #mycoviddiary @TomasVillen @acam_acam pic.twitter.com/qdgon08j6L
— Yale Tung Chen (@yaletung) March 24, 2020
DAY 17 of COVID-19
- Resolving B-lines
- Improved pleural thickness
Day 17 after #COVID diagnosis. Less cough, nausea & more apetite, energy. No fever or dyspnea. SpO2 97%. #POCUS update: right side resolved, left lateral & lower less thickened pleura & B-lines. On HCQ (D13). Waiting the re-test on friday. #mycoviddiary @TomasVillen
— Yale Tung Chen (@yaletung) March 25, 2020
@acam_acam pic.twitter.com/fQWqRS9d4V
DAY 18 of COVID-19
Day 18 after #COVID diagnosis. Similar cough. No fever or dyspnea. SpO2 97%. #POCUS update: slight worsening. Bilateral thickened pleura & B-lines, subpleural consolidation reappeared. On HCQ (D14). Waiting to re-test on friday. #mycoviddiary @TomasVillen @acam_acam pic.twitter.com/br3CE254Rm
— Yale Tung Chen (@yaletung) March 26, 2020
DAY 19 of COVID-19
Day 19 after #COVID diagnosis. More cough & weakness. No fever or dyspnea. SpO2 97%. #POCUS update: Subpleural consolidation got bigger on left lower lobe. Yesterday started levofloxacin (bacterial sobreinfection?). #mycoviddiary @TomasVillen @acam_acam pic.twitter.com/uvUvh5rOpa
— Yale Tung Chen (@yaletung) March 27, 2020
DAY 20 of COVID-19
Day 20 after #COVID diagnosis. Almost recovered. SpO2 96%. #POCUS update: Significant improvement, remains thick pleura & B-lines. Yesterday tested NEGATIVE. I will try update a lung scan every week. FINALLY, I am returning to the TRENCHES?. #mycoviddiary @TomasVillen @acam_acam pic.twitter.com/EeGjaykSaR
— Yale Tung Chen (@yaletung) March 28, 2020
Awesome!
Thanks Dr. Ko!
[…] Chen YT. Lung ultrasound progression of COVID-19 coronavirus. 2020. Available at: https://www.pocus101.com/lung-ultrasound-progression-of-COVID-19-coronavirus/. Accessed August 17, […]
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