To explore the clinical value of bedside lung ultrasound in emergency-plus (BLUE-plus) for assessing pulmonary lesions of patients with coronavirus disease 2019 (COVID-19) based on chest CT imaging.

Total of 22 patients with COVID-19 admitted to Xi’an Chest Hospital (COVID-19 designated hospital in Xi’an) from January to February 2020 were dynamically examined by BLUE-plus, and compared with chest CT examination, the consistency and diagnostic accuracy were analyzed by Kappa test and ROC curve, respectively.

Among the 22 confirmed cases with COVID-19 according to BLUE-plus, the lesions were mostly distributed in the intersection of the posterior and lower blue dots and the ipsilateral posterior axillary line, which were named as posterolateral alveolar and/or pleural syndrome (PLAPS) point, and the consistent Kappa value between BLUE-plus and chest CT was 0.73 (95%CI: 0.442-1.018, P < 0.001). The sensitivity, specificity and accuracy of BLUE-plus on lung lesions were 94.7%, 83.3% and 93.2%. During the progressive period, the ultrasound image characteristics of patients with COVID-19 gradually changed from B ray to small patchy pulmonary consolidation, gradually aggravated to large sheet consolidation, and the bronchial inflation sign in the consolidation lesion was gradually reduced. The features of ultrasound image in recovery period of COVID-19 were opposite to the progressive period.

BLUE-plus could be used to evaluate lung lesions and dynamic changes of patients with COVID-19. The application of ultrasound in these patients could provide dynamic imaging evidence in the evaluation of disease courses and therapeutic efficacy.