Abstract
When using lung ultrasound to determine the cause of acute respiratory failure, the BLUE protocol is often used. In a 65-year old patient, an A/B-profile was found, suggesting pneumonia, following the flowchart of this protocol. In this case, however, pulmonary hemorrhage confirmed by bronchoscopy was the final diagnosis. This case report outlines the importance of understanding the limitations of the BLUE protocol and that lung ultrasound findings should always be used in the context of the patient’s history and physical exam. In addition, pulmonary hemorrhage should be considered in patients with no clinical signs of pneumonia and/or presence of risk factors for lung bleeding as a rare cause of lung ultrasound A/B-profile.
Highlights
Over the last few years, lung ultrasound has found routine use in critical care, even outperforming chest X-ray in detecting lung pathology[1,2]
In the following article we present a case of pulmonary hemorrhage as a rare cause of lung ultrasound A/B-profile
The BLUE-protocol relies on simplification of reality by categorizing the etiology of dyspnea into five groups. This is demonstrated by our case report, in which A/B profile was not caused by pneumonia but pulmonary hemorrhage
Summary
Over the last few years, lung ultrasound has found routine use in critical care, even outperforming chest X-ray in detecting lung pathology[1,2]. The BLUE protocol, developed by Lichtenstein et al, is often used to rapidly identify the cause of acute respiratory failure, with a claimed accuracy of 90.5%1 It uses interpretation of artifacts visible in the presence of pleural and/or pulmonary pathology on three distinct places. The presence of more than two B-lines indicates interstitial syndrome Combining these artifacts on every point and following the schema, the physician is led to five distinct diagnoses, which are cardiogenic pulmonary edema, pulmonary embolism, pneumothorax, obstructive disease or pneumonia. Admission the patient developed atrial fibrillation, which was only temporarily relieved by cardiac resynchronization and amiodarone (300 mg intravenous loading dose in addition to 1200 mg/24 h intravenous for 1 day) This caused a further decline in cardiopulmonary function. Due to the lack of additional therapeutic options, palliative care was started in line with the patient’s wishes, after which he passed away
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