A comparative study between bedside pleuropulmonary ultrasonography and chest X-ray in patients with dyspnea

Abstract

Objective To evaluate the ability of high resolution pleuropulmonary ultrasonography and bedside chest X-ray in identifying different pathologic abnormalities in patients with dyspnea, using thoracic computed tomography (CT) as a gold standard. Methods Bedside pleuropulmonary ultrasonography was performed in 350 dyspneic patients in the emergency department and ICU, 111 patients were enrolled in the study with pleuropulmonary ultrasonography, chest X-ray and chest CT examination performed within 24 hours.Pathologic entities were evaluated: pleural effusion, consolidation, atelectasis, pneumothorax, pulmonary interstitial fibrosis, and pulmonary edema. The sensitivity, specificity, negative and positive prediction value of pleuropulmonary ultrasonography and chest X-ray were compared with the corresponding CT scan results. Results Pleuropulmonary ultrasonography was highly concordant with chest X-ray. Overall ultrasonography exhibited higher sensitivity than chest X-ray and CT for pleural effusion.For atelectasis and pulmonary edema, the sensitivity of ultrasonography was up to 100%. In the diagnosis of pulmonary interstitial fibrosis, the sensitivity of pleuropulmonary ultrasonography was higher than that of chest X-ray, but the specificity was slightly lower. The sensitivity of pleuropulmonary ultrasonography was slightly higher than that of chest X-ray in pneumothorax, and the specificity was coincident with chest X-ray. Although the sensitivity of ultrasonography was slightly lower for consolidation, it was still higher than chest X-ray. The ability of chest X-ray for differentiating pleural effusion from atelectasis or consolidation was worse than that of ultrasonography. Conclusions Our study demonstrates a high concordance between ultrasonography with radiography. The diagnostic performance of bedside pleuropulmonary ultrasonography is better than that of chest X-ray. Key words: Ultrasonography; Dyspnea; Lung diseases; Pleural diseases; Chest X-ray; CT