Peng et al. have outlined several characteristics common to all COVID-19 patients using lung ultrasound and the 12 zone method. Zotzmann et al. in a follow-up letter raised the question on whether these areas of subpleural consolidation are actually indicative of segmental pulmonary embolus.

We would like to propose the use of contrast enhanced ultrasound (CEUS) to answer their question.

In order to assess the lungs for the presence of a thrombotic process, we used CEUS to evaluate the subpleural “consolidations” and they recognised as being typical to this disease.

CEUS is a technique that involves the intravenous introduction of microbubbles consisting of a phospholipid shell surrounding a perflourocarbon gas (sulphur hexaflouride) the approximate size of red blood cells that can cross the capillary bed with transpulmonary stability.

The result is a truly intravascular contrast agent, which can be detected using contrast specific modes on ultrasound.

As a result, areas without contrast enhancement can be identified as being avascular.

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