Pulmonary sonography-avaluable supplement to basic diagnostics for timely outpatient clarification of cough and dyspnea

Abstract

Cough and dyspnea are among the most common symptoms in primary medical care and potentially threatening diseases must be excluded in atimely manner, especially acute heart failure and its causes, pneumonia, pleural effusion, pulmonary embolism and pneumothorax. Anamnesis, inspection, physical examination and technical basic diagnostics are usually sufficient for an initial risk stratification. Areliable suspected diagnosis can often be made in this way; however, it is not uncommon for the findings to be ambiguous. Chest X‑ray diagnostics and laboratory diagnostics are established as the standard approach for these situations; however, amajor limitation of these diagnostic techniques is the lack of immediate availability in the general practitioner's office and laboratory results are not available until the next day or the day after. Furthermore, the sensitivity and specificity of these diagnostic procedures are limited but often overestimated, especially in the case of mild to moderately pronounced alterations and in early stages of adisease. Thoracic sonography can be used in these situations as adirect extension of the physical examination. Its diagnostic value is undisputed. The most important pathological findings, such as pleural effusion and subpleural consolidations can be immediately visualized with sufficient certainty using miniaturized handheld ultrasound devices. The concept of the ultrasound stethoscope, which has been under discussion for more than 15years, can also be implemented as point-of-care ultrasound (POCUS). The POCUS will become established as routine diagnostics in the future, for example in emergency outpatient diagnostics. It is time for pulmonary ultrasound to be added to the repertoire of primary care diagnostics.