Abstract
Simple SummaryThe high usefulness of thorax ultrasound examination in diagnosing lower respiratory tract diseases is well-evidenced in both human and veterinary medicine. However, the type of transducer (microconvex, linear, and phased array) which is most effective in the examination of dogs and cats remains unknown. In this study we examined dogs and cats using the three types of transducers and we assessed how consistent they were in detecting and quantifying B-lines. Moreover, we developed a method that allowed to quantitatively evaluate the occurrence of B-lines in cardiogenic pulmonary edema (CPE), pneumonia and lung neoplasm, referred to as the lung ultrasound score (LUSscore). Our results indicate that microconvex and linear transducers can be used interchangeably. LUSscore may help distinguish between lung neoplasms (lower values) and CPE or pneumonia (higher values) in dogs, and between CPE (higher values) and pneumonia or lung neoplasms (lower values) in cats.Transthoracic heart and lung ultrasound (LUS) was performed in 200 dogs and cats with dyspnea to evaluate the agreement between the results obtained using three types of transducers (microconvex, linear, and phased array) and to determine the accuracy of LUS in discriminating between three conditions commonly causing dyspnea in companion animals: cardiogenic pulmonary edema (CPE), pneumonia, and lung neoplasm. The agreement beyond chance was assessed using the weighted Cohen’s kappa coefficient (κw). The highest values of κw (>0.9) were observed for the pair of microconvex and linear transducers. To quantify B-lines the lung ultrasound score (LUSscore) was developed as a sum of points describing the occurrence of B-lines for each of 8 standardized thoracic locations. The accuracy of LUSscore was determined using the area under ROC curve (AUROC). In dogs AUROC of LUSscore was 75.9% (CI 95%: 65.0% to 86.8%) for distinguishing between lung neoplasms and the two other causes of dyspnea. In cats AUROC of LUSscore was 83.6% (CI 95%: 75.2% to 92.0%) for distinguishing between CPE and the two other causes of dyspnea. The study shows that results obtained with microconvex and linear transducers are highly consistent and these two transducers can be used interchangeably. Moreover, the LUSscore may help identify dogs with lung neoplasms and cats with CPE, however its diagnostic accuracy is only fair to moderate.
Highlights
Lung ultrasound (LUS) examination is an easy and useful diagnostic tool for lower respiratory tract pathology. It is recommended in the suspect of: cardiogenic pulmonary edema (CPE), consolidation, atelectasis, embolism, neoplasia, pneumonia, pneumothorax, interstitial lung diseases especially with fibrosis, as well as in any other lower respiratory tract signs like dyspnea, pleural pain or fluid and acute cough [1]
Several special rapid examination protocols have been developed for animals in emergency situations: Veterinary Bedside lung ultrasound exam (Vet BLUE) and Thoracic Focused Assessment with Sonography for Trauma (TFAST) [2,3]
In our study we introduced the concept of a numerical score which would allow to express the results of LUS in a quantitative manner
Summary
Lung ultrasound (LUS) examination is an easy and useful diagnostic tool for lower respiratory tract pathology. It is recommended in the suspect of: cardiogenic pulmonary edema (CPE), consolidation, atelectasis, embolism, neoplasia, pneumonia, pneumothorax, interstitial lung diseases especially with fibrosis, as well as in any other lower respiratory tract signs like dyspnea, pleural pain or fluid and acute cough [1] This technique is relatively inexpensive, non-ionizing, portable, and available. Several special rapid examination protocols have been developed for animals in emergency situations: Veterinary Bedside lung ultrasound exam (Vet BLUE) and Thoracic Focused Assessment with Sonography for Trauma (TFAST) [2,3] They allow to establish a tentative or even definitive diagnosis very quickly, usually within less than 3 min. This complementary examination should be interpreted with reference to the patient’s medical history and clinical manifestation
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