COVID 

Features of Covid begin bilaterally in the lower zones and progress superiorly and anteriorly. 

There is a natural progression to lung changes in Covid. The more features present and the greater area of lung involved, the more severe the disease and the increased morbidity and mortality (1,2,3).

Below is the stepwise progression of Covid lung changes (4). 

IRREGULAR PLEURAL LINE AND SCATTERED B LINES - score 1

Initially B lines are separated in space with areas of interspersed normal lung 

THICKENED PLEURAL LINE AND CONFLUENT B LINES - score 2

Pleura is thickened and irregular. The B lines become more confluent and look like a waterfall (waterfall sign (5))

SUBPLEURAL CONSOLIDATION - score 3

REFERENCES

1. Gil-Rodríguez J, Pérez de Rojas J, Aranda-Laserna P, Benavente-Fernández A, Martos-Ruiz M, Peregrina-Rivas JA, Guirao-Arrabal E. Ultrasound findings of lung ultrasonography in COVID-19: A systematic review. Eur J Radiol. 2022 Mar;148:

2. Kumar, A.; Weng, I.; Graglia, S.; Lew, T.; Gandhi, K.; Lalani, F.; Chia, D.; Duanmu, Y.; Jensen, T.; Lobo, V.; et al. Point-of-Care Ultrasound predicts clinical outcomes in patients with COVID-19. J. Ultrasound Med. 2021. ahead of print. 

3. Soldati G, Demi M. What Is COVID 19 Teaching Us about Pulmonary Ultrasound? Diagnostics (Basel). 2022 Mar 29;12(4):838

4. de Alencar JCG, Marchini JFM, Marino LO, da Costa Ribeiro SC, Bueno CG, da Cunha VP, Lazar Neto F, Brandão Neto RA, Souza HP; COVID U. S. P. Registry Team. Lung ultrasound score predicts outcomes in COVID-19 patients admitted to the emergency department. Ann Intensive Care. 2021 Jan 11;11(1):6.

5. Volpicelli G, Gargani L. Sonographic signs and patterns of COVID-19 pneumonia. Ultrasound J. 2020 Apr 21;12(1):22