Speckled Tracking of Pleura—A Novel Tool for Lung Ultrasound; Distinguishing COVID-19 from Acute Heart Failure

Batsheva Tzadok, Yair Blumberg, Moti Shubert, Majdi Halabi, Eran Tal-Or, Noa Bachner-Hinenzon, Shemy Carasso

Research output: Contribution to journalArticlepeer-review


For the acutely dyspneic patient, discerning bedside between acute decompensated heart failure (ADHF) and COVID-19 is crucial. A lung ultrasound (LUS) is sensitive for detecting these conditions, but not in distinguishing between them; both have bilateral B-lines. The Blue protocol uses pleural sliding to differentiate decreased pneumonia; however, this is not the case in ADHF. Nonetheless, this pleural sliding has never been quantified. Speckled tracking is a technology utilized in the echocardiography field that quantifies the motion of tissues by examining the movement of ultrasound speckles. We conducted a retrospective study of LUS performed in emergency room patients during the COVID-19 pandemic. Speckled tracking of the pleura by applying software to the B-mode of pleura was compared between COVID-19 patients, ADHF patients, and patients with no respiratory complaints. A significant difference was found between the patient groups on speckled tracking both in respect of displacement and velocity. ADHF had the highest displacement, followed by COVID-19, and then non-respiratory patients: 1.63 ± 1.89, 0.59 ± 0.71, and 0.24 ± 0.45, respectively (p < 0.01). A similar trend was seen in velocity with ADHF having the highest velocity 0.34 ± 0.37, followed by COVID-19 0.14 ± 0.71, and non-respiratory patients 0.02 ± 0.09 (p <0.01). Speckled tracking of the pleura is a potential tool for discerning between different causes of dyspnea.

Original languageEnglish
Article number4846
JournalJournal of Clinical Medicine
Issue number16
StatePublished - Aug 2022

Bibliographical note

Publisher Copyright:
© 2022 by the authors.


  • B protocol
  • COVID-19
  • COVID-19 pneumonia
  • congestive heart failure
  • emergency medicine COVID-19
  • lung ultrasound
  • point-of-care ultrasound
  • speckled tracking
  • viral pneumonia


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