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January 18, 2021 — Journal of Ultrasound in Medicine



To describe perfusion patterns of peripheral pulmonary lesions (PPLs) in COVID‐19 patients using contrast‐enhanced ultrasound (CEUS).

Patients and methods

From April 2020 until July 2020, 11 consecutive patients with RT‐PCR‐confirmed COVID‐19 and PPLs sized over 5 mm were investigated by B‐mode ultrasound (B‐US) and CEUS. The homogeneity of enhancement (homogeneous and inhomogeneous) was examined retrospectively using CEUS. An inhomogeneous enhancement was defined as a perfused lesion with coexisting non‐perfused areas (NPA).


On B‐US, all 11 patients showed an interstitial syndrome (B‐lines) with PPLs between 0.5 and 6 cm. On CEUS, all cases showed peripheral NPA during the complete CEUS examination. One patient underwent a partial lung resection with subsequent histopathological examination. The histological examination showed vasculitis, microthrombus in the alveolar capillary, and small obliterated vessels.


In our case series, PPLs in patients with RT‐PCR‐confirmed COVID‐19 infection presented a CEUS pattern with NPA during the complete CEUS examination. Our findings suggest a peripheral pulmonary perfusion disturbance in patients with COVID‐19 infection. In 1 case, the histopathological correlation with the perfusion disturbance in the PPL was proven.

Authors: Ehsan Safai Zadeh MD 1; Björn Beutel MD 2; Christoph Frank Dietrich MD 3; Corinna Ulrike Keber MD 2; Katharina Paulina Huber MD 1; Christian Görg MD 1; Corinna Trenker MD 2

1 University Hospital Giessen and Marburg, Germany; 2 University Hospital Giessen and Marburg, Philipps University Marburg, Germany; 3 Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Bern, Switzerland

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