Chest Ultrasonography Research Articles

Operative Use of Thoracic Ultrasound in Respiratory Medicine: A Clinical Study.

For over 15 years, thoracic ultrasound has been applied in the evaluation of numerous lung diseases, demonstrating a variable diagnostic predictive power compared to traditional imaging techniques such as chest radiography and CT. However, in unselected pulmonary patients, there are no rigorous scientific demonstrations of the complementarity of thoracic ultrasound with traditional and standardized imaging techniques that use radiation. In this study 101 unselected pulmonary patients were evaluated blindly with ultrasound chest examinations during their hospital stay. Other instrumental examinations, carried out during hospitalization, were standard chest radiography, computed tomography (CT), and, when needed, radioisotopic investigation and cardiac catheterization. The operator who performed the ultrasound examinations was unaware of the anamnestic and clinical data of the patients. Diffuse fibrosing disease was detected with a sensitivity, specificity and diagnostic accuracy of 100%, 95% and 97%, respectively. In pleural effusions, ultrasound showed a sensitivity, specificity and diagnostic accuracy of 100%. In consolidations, the sensitivity, specificity and diagnostic accuracy were 83%, 98% and 93%, respectively. Low values of sensitivity were recorded for surface nodulations of less than one centimeter. Isolated subpleural ground glass densities were identified as White Lung with a sensitivity of 72% and a specificity of 86%. Only the associations Diffuse ultrasound findings/Definitive fibrosing disease, Ultrasound Consolidation/Definitive consolidation and non-diffuse ultrasound artefactual features/Definitive vascular pathology (pulmonary hypertension, embolism) were statistically significant with adjusted residuals of 7.9, 7 and 4.1, respectively. The obtained results show how chest ultrasound is an effective complementary diagnostic tool for the pulmonologist. When performed, as a complement to the patient’s physical examination, it can restrict the diagnostic hypothesis in the case of pleural effusion, consolidation and diffuse fibrosing disease of the lung.

Could chest ultrasonography replace chest radiography in outpatient chest clinic?

Objective Plain chest radiography is the commonest ordered investigation in chest outpatient clinic; however, it is time consuming and may be expensive in some settings. With the availability of chest ultrasonography (CUS) at bedside, CUS might be used instead of plain chest radiography in outpatient settings. Still there is controversy regarding CUS as the primary investigation in outpatient chest clinics. Patients and methods Consecutive patients referred to the outpatient chest clinic of Assiut University between March 2018 till June 2020 who were proposed to have computed tomography (CT) chest after plain chest radiography were asked to participate in the study. The included patients had CUS with a pulmonologist who was blind to the chest radiography and chest CT results. CUS was done using a convex probe of ultrasonography in all chest anatomical planes for any finding that may help in the diagnosis. The plain chest radiography results also were recorded. Both results were compared with chest CT results as the gold standard investigation. Result A total of 101 patients were included in the study. There were 18% female patients, with mean age of 49.4±17.9 years. The final diagnosis was lung malignancy, pneumonia, bronchiectasis, chronic obstructive lung diseases, pulmonary embolism, pleural effusion, interstitial lung disease, and other miscellaneous causes. CUS were normal in 14 cases, with a sensitivity of 89.5% and a specificity of 80%, whereas chest radiography was normal in 20 cases, with a positive finding in 81 cases, with a sensitivity of 83.3% and a specificity of 80%, in comparison with chest CT. Conclusion CUS may be the primary investigation in chest outpatient clinic with good accuracy and rapid patient diagnosis.

Role of thoracic ultrasonography in diagnosis of different chest diseases

Background Thoracic ultrasonography (TUS) is a low-cost, noninvasive, practical, and rapid method for visualization of different respiratory disorders. Previous reports showed a high sensitivity, specificity, and diagnostic accuracy (96.8%) of TUS in the diagnosis of different chest diseases. Objective The aims were to assess the diagnostic accuracy of chest ultrasound (US) in the diagnosis of different chest diseases and to compare its accuracy with currently available imaging techniques. Patients and methods A prospective study was conducted on 213 patients. The patients were categorized according to their respiratory disorders into five groups (parenchymal, pleural, vascular, airway disease, and diaphragmatic dysfunctions). Chest radiography, computed tomography, and TUS were done for each group and were compared together. US chest examination was done using gray-scale (B-mode) or time-motion mode (M-mode). Results In patients with pneumonia, the sensitivity of US and radiography was 97.5 and 90.6%, respectively. In interstitial group patients, the sensitivity of US and radiography was 95.7 and 100%, respectively. In patients with lung mass, the sensitivity of US and radiography was 88.2 and 94.1%, respectively. In patients with cavitary lesion, the sensitivity of US and radiography was 100 and 87.5%, respectively. The sensitivity of US in detecting pleural effusion was 100% with accuracy of 100%. However, chest radiography showed 93.1% sensitivity and accuracy in detecting pleural effusion. The sensitivity and accuracy of both US and chest radiography in detecting vascular diseases were the same. Conclusion TUS is a useful tool in the diagnosis of different respiratory disorders especially in the diagnosis of pleural and diaphragmatic disorders. In addition, US offers a number of advantages of being easily performed by clinicians at the point of care, inexpensive, and avoiding exposure to radiation.

Overview of Lung Ultrasound in Pediatric Cardiology.

Lung ultrasound (LUS) is increasing in its popularity for the diagnosis of pulmonary complications in acute pediatric care settings. Despite the high incidence of pulmonary complications for patients with pediatric cardiovascular and congenital heart disease, especially in children undergoing cardiac surgery, the use of LUS remains quite limited in these patients. The aim of this review is to provide a comprehensive overview and list of current potential applications for LUS in children with congenital heart disease, post-surgery. We herein describe protocols for LUS examinations in children, discuss diagnostic criteria, and introduce methods for the diagnosis and classification of pulmonary disease commonly encountered in pediatric cardiology (e.g., pleural effusion, atelectasis, interstitial edema, pneumothorax, pneumonia, and diaphragmatic motion analysis). Furthermore, applications of chest ultrasounds for the evaluation of the retrosternal area, and in particular, systematic search criteria for retrosternal clots, are illustrated. We also discussed the potential applications of LUS, including the guidance of interventional procedures, namely lung recruitment and drainage insertion. Lastly, we analyzed current gaps in knowledge, including the difficulty of the quantification of pleural effusion and atelectasis, and the need to differentiate different etiologies of B-lines. We concluded with future applications of LUS, including strain analysis and advanced analysis of diaphragmatic mechanics. In summary, US is an easy, accurate, fast, cheap, and radiation-free tool for the diagnosis and follow-up of major pulmonary complications in pediatric cardiac surgery, and we strongly encourage its use in routine practice.

Radiological features of round pneumonia in children: 10 years of experience

Aim: Round pneumonia (RP) is a type of pneumonia that appears round on imaging studies and usually occurs in children. Although round pneumonia is a well-known clinical condition, few publications available in the literature describing the imaging findings and features of round pneumonia. The purpose of the review was to evaluate the chest radiographs, chest ultrasonography and CT findings associated findings of round pneumonia as compared to the published literature.
 Material and Method: 65 children who were diagnosed with round pneumonia in our hospital between December 2010 and July 2020 were included in our study. Initial chest radiographs and CT scans were evaluated for lesion parameters: number, margin, opacity, size, location, and hilar LAP and air bronchogram accompaniment. Follow-up chest radiographs were evaluated for temporal variation (resolution or progression to lobar pneumonia). The findings of the patients who underwent chest ultrasonography were recorded.
 Results: The mean age of the 65 children with round pneumonia included was 6.2 years and their ages ranged from 9 months to 16 years. Evaluation of chest radiographs showed one lesion in each of 63 children (96%, 63/65) and two lesions in two children (4%, 2/65). Lesion margins were sharp in 84% (55/65) and the mean diameter of lesions was 2,5 cm with a range of 1.5–9.5 cm. On the radiograph, the opacity of round pneumonia was low (60%, 39/65) and hilar lymphadenopathy was detected in 1 out of 5 patients (20%, 13/65). The location of the lesion tended to be posterior (51%, 33/65) and upper lobe (54%, 35/65). On chest ultrasonography, consalidation was seen in 8 patients, consalidation and pleural effusion were seen in 3 patients. CT images were available in 11 (17%) children. Pleural thickening or satellite lesions were not observed in any of the patients on tomography. Follow-up radiographs tended to show resolution in 95% (62/65) and progression to lobar pneumonia in 4.6% (3/65). 1 patient progressed to lobar pneumonia and died. 2 patients developed cavitary pneumonia.
 Conclusion: Round pneumonia is a benign type of pneumonia that is mostly seen in children due to its physiopathology. Most patients with RP recover clinically and radiologically after antibiotic therapy. Although there are many diseases in the differential diagnosis, knowing the radiological features facilitates the diagnosis and prevents unnecessary diagnostic and imaging studies.

Late presentation of congenital type IV esophageal hiatus hernia in a 9-year-old boy: a case report

BackgroundCongenital diaphragmatic hernia affects 1 in every 2000–5000 live births. The mediastinum shifts to the opposite side, the lungs are hypoplastic, and the arterioles are abnormal, resulting in pulmonary hypertension. Respiratory and cardiovascular functions are severely impaired at birth, resulting in significant mortality and morbidity as a result of the associated malformations.Case presentationA 9-year-old persian boy was referred with complaint of intermittent abdominal pain in the left lower quadrant and an episode of vomiting. The patient was tachypneic, and the abdomen was nontender on examination. Lung sounds on the left side were considerably decreased, whereas heart sounds on the right side were louder. There was no history of underlying disease in the patient. Initial laboratory blood tests, chest x-ray, spiral computed tomography scan, and chest sonography were requested. Blood tests were normal, and chest x-ray revealed a round-shaped lesion with relatively clear boundaries containing air–fluid level and shift of the heart and mediastinum to the right. A spiral computed tomography scan of the lungs demonstrated the shift of the heart and mediastinum to the right side was due to dilated stomach and colon pressure, and chest sonography revealed that half of the stomach was inside the thorax. Laparotomy surgery was performed. The patient had no complications following surgery.ConclusionsHerniation of abdominal contents through the diaphragmatic hiatus should be suspected in patients with tachypnea and mediastinal shift to the right side. Rapid diagnosis and early surgical treatment are necessary to avert any potentially life-threatening complications.

Diaphragmatic Function Assessment Using Chest Ultrasonography as a Predictor for Weaning from Mechanical Ventilation

Diaphragmatic Function Assessment Using Chest Ultrasonography as a Predictor for Weaning from Mechanical Ventilation

Persistent secondary spontaneous pneumothorax as a complication of tuberculosis infection: a case report

Introduction: A pneumothorax is a collection of air outside the lung contained within the pleural cavity. Primary spontaneous pneumothorax (PSP) and secondary spontaneous pneumothorax (SSP) are two types of spontaneous pneumothorax that differ due to the underlying illness. If the patient has a history of pulmonary disease, including tuberculosis infection, SSP may be present. Chest X-rays, chest ultrasonography, and CT scans are imaging tests that can be used to diagnose pneumothorax. We report a case of a 20-year-old man with persistent secondary spontaneous pneumothorax as a complication of tuberculosis infection.Case description: A 20-year-old man complained of shortness of breath two weeks before being admitted to the hospital. He had a story of a TB infection. A chest X-ray and a CT scan were used to assess the patient. The pneumothorax is seen with the sign of reactive old tuberculosis. The surgeon inserted a chest tube drainage to empty the pneumothorax. However, following the assessment, the pneumothorax grew even larger than before.Conclusion: Clinical evaluation should probably be the key determinant of the care strategy and assist with the initial diagnosis. Imaging modalities can help confirm a pneumothorax diagnosis and provide information about the extent of the pneumothorax.

Role of ultrasonography in the diagnosis of dengue fever

The purpose of this article is to review the literature and outlining the role of abdominal and chest ultrasonography in the diagnosis and as a predictor of severity of dengue fever. Methods: Standard medical electronic databases were searched and relevant articles were used to present the conclusive outcomes. Results: Eighteen studies on 2601 patients undergoing chest and abdominal ultrasonography fulfilled the inclusion criteria. The incidence of plasma leakage triad such as pleural effusion, ascites and gallbladder wall thickening was 44.98 %, 39.44 % and 61.89 % respectively. Other ultrasonic findings included Hepatomegaly, splenomegaly and pericardial effusion. Conclusion: In patients with suspected dengue fever and dengue haemorrhagic fever, the abdominal and chest ultrasonography, although nonspecific, may be a relevant ancillary tool for the early diagnosis of microvasculature hyper-permeability in addition to a tool used for the prediction of disease severity identifying mild and severe cases of DF. Furthermore, ultrasonography may also be used for the differential diagnosis of other febrile conditions affecting both pediatric and adult population.

Value Comparison of Iterative Reconstruction Algorithm-Based Chest CT and Ultrasound in the Diagnosis of Community-Acquired Pneumonia in Children

This study aimed to explore the diagnostic value of chest computed tomography (CT) based on adaptive statistical iterative reconstruction (ASiR) in the optimal weight range for children with community-acquired pneumonia (CAP) and find the differences between chest CT and ultrasound in the diagnosis of CAP. 106 children who were diagnosed as CAP were selected as the research objects. All objects underwent CT and ultrasound scans to measure the noise of CT images after iterative reconstruction and the contrast-to-noise ratio (CNR) of the thoracic aorta and the back muscles. The correlation between ASiR weight, noise, and CNR was analyzed and compared further. In addition, the differences in imaging manifestations of lung consolidation, abnormal pleural line, alveolar interstitial syndrome, and pleural effusion were observed under the ultrasound and CT scans of the patients. The sensitivity, specificity, positive predicted value (PV), and negative PV of the CT scan and ultrasound were analyzed further for the diagnosis of CAP in children. The results showed that ASiR weight and image noise were extremely and negatively correlated ( P < 0.001 ) and that CNR and ASiR weight were extremely and positively correlated ( P < 0.001 ). 40–60% of ASiR image noise was in the middle position, and the muscle space and subcutaneous fat in CT images were clearer when ASiR was at 40% and 60%. 60.38% of children were diagnosed as CAP. The proportions of children with lung consolidation, interstitial changes, pleural effusion, and atelectasis after ultrasound and CT examination were not greatly different ( P > 0.05 ). After ASiR, the sensitivity of CT in detecting the abnormal pleural line + B-line/consolidation feature was the highest, 93.75%. The results of ultrasound diagnosis were consistent with those of chest CT diagnosis ( P < 0.01 ). This indicated that the sensitivity, specificity, positive PV, and negative PV of ASiR-based chest CT in the diagnosis of CAP were close to those of ultrasound.

OUTCOMES OF NEONATAL CHYLOUS EFFUSIONS: A 20-YEAR WEST-AUSTRALIAN TERTIARY CENTER EXPERIENCE

Neonatal chylous effusions are rare entity with limited evidence-based management. We conducted a retrospective review of neonates admitted to King Edward Memorial and Princess Margaret/Perth Children's Hospital over 20 years with laboratory-confirmed chylous effusions. A total of 51 infants with chylous effusion were identified. Median gestational age and birth weight were 35.5 weeks and 2620 grams respectively. Congenital [27/ 51] and acquired [24/51] cases were included. Antenatal interventions were performed in 17/22 with antenatal hydrops and 50/51 needed postnatal drains. Effusions were monitored with serial (≥2) chest ultrasounds in 29/51 infants and multiple (≥5) x-rays in 45/51 infants. Median duration of mechanical ventilation, oxygen requirement, and hospital stay was 294.5 hours, 400 hours, and 49 days respectively. 39/51 received medium chain triglyceride (MCT) diet while 8/51 received octreotide. Six infants died during hospital stay. 12/19 had normal developmental assessment at one-year. The acquired group had higher number of xrays done, need for MCT diet and inotropes, and hospital stay vs congenital group. Duration of drains, radiological investigations and immunoglobulin administration were higher in neonates who received octreotide. Syndromic association, duration of ventilation and oxygenation were risk factors for mortality. In our setting, neonatal chylous effusions are associated with significant morbidity and mortality.

FACE-HF: Focused Assessment by Chest Sonography and Echocardiography in Acute Heart Failure Patients

Background: Acute heart failure (AHF) is a life-threatening condition that necessitates urgent evaluation and treatment with an urgent need for hospital admission. Among the available imaging modalities, echocardiography is the method of choice due to its feasibility and cost-effectiveness. Lung ultrasonography in emergency department, critical and cardiac care units is becoming popular. The present study aimed to assess the value of the focused echocardiography and lung ultrasound protocol for guiding treatment and its effect on the hospitalization period in AHF patients admitted to the CCU, 6 months re-hospitalization and mortality. Methods: This study included 40 consecutive patients admitted to the Cardiology and Angiology department after disposition from the emergency department at Alexandria main university hospital in Egypt with the diagnosis of (AHF). Patients were divided into 2 groups, 20 patients received the standard treatment while the other group received a modification of medication doses according to daily imaging changes. All patients were followed up for 6 months to assess the 6 months HF rehospitalization and death rates. Results: Group II patients had a significantly shorter duration of hospitalization; 6.45 ± 2.01 days compared to 9.10 ± 3.82 days among group I patients (P = 0.02). There was no significant difference between the two groups regarding the 6 months rehospitalization and death rates. Conclusion: The focused echocardiography and lung ultrasound-guided therapy for AHF patients resulted in a shorter duration of hospitalization without increased adverse events.

Adversarial Neural Network Classifiers for COVID-19 Diagnosis in Ultrasound Images

The novel Coronavirus disease 2019 (COVID-19) pandemic has begun in China and is still affecting thousands of patient lives worldwide daily. Although Chest X-ray and Computed Tomography are the gold standard medical imaging modalities for diagnosing potentially infected COVID-19 cases, applying Ultrasound (US) imaging technique to accomplish this crucial diagnosing task has attracted many physicians recently. In this article, we propose two modified deep learning classifiers to identify COVID-19 and pneumonia diseases in US images, based on generative adversarial neural networks (GANs). The proposed image classifiers are a semi-supervised GAN and a modified GAN with auxiliary classifier. Each one includes a modified discriminator to identify the class of the US image using semi-supervised learning technique, keeping its main function of defining the “realness” of tested images. Extensive tests have been successfully conducted on public dataset of US images acquired with a convex US probe. This study demonstrated the feasibility of using chest US images with two GAN classifiers as a new radiological tool for clinical check of COVID-19 patients. The results of our proposed GAN models showed that high accuracy values above 91.0% were obtained under different sizes of limited training data, outperforming other deep learning-based methods, such as transfer learning models in the recent studies. Consequently, the clinical implementation of our computer-aided diagnosis of US-COVID-19 is the future work of this study.

Evaluation of double lung point sign as a marker for transient tachypnoea of the newborn in preterm.

PurposeThe study was conducted to diagnose transient tachypnoea of the newborn (TTN) in the early stage using ultrasonography and to estimate the sensitivity and specificity of double lung point (DLP) sign in diagnosing TTN.Material and methodsThe study population included premature neonates with respiratory distress, admitted in the neonatal intensive care unit from December 2017 to June 2019, who fulfilled the inclusion criteria. A total of 100 patients were included in the study, and they underwent lung ultrasonography within 6 hours of birth. Inclusion criteria were as follows: preterm babies born < 37 weeks of gestation presenting with respiratory distress within 6 hours, clinically diagnosed with TTN and other causes like respiratory distress syndrome and pneumonia. Term neonates and neonates with congenital malformations and trauma were excluded from the study. Preterms with respiratory distress were enrolled in the study. Based on the clinical findings and laboratory investigations, clinical diagnosis was made by the paediatrician. After obtaining informed consent, ultrasonography of bilateral chest was performed using a Philips HD7 XE and a Sonoscape S2 portable ultrasound machine with a linear transducer (6-12 MHz) within 6 hours of birth.ResultsThe mean gestational age was 33.0 ± 1.9 weeks. Double lung point sign was present in 55 preterm neonates in our study. It was most common in bilateral posterior lung fields. The sensitivity and specificity of DLP in diagnosing TTN was 85% and 100%, respectively.ConclusionsIt was found in our study that double lung point sign is the primary ultrasonographic characteristic of TTN, and ultrasonography can almost accurately diagnose TTN in early stages.

Loculations and Associated Risk Factors of Childhood Pleural Tuberculosis.

Background: Pleural loculation in childhood pleural tuberculosis (TB) remains a problem in practice, it is usually associated with failure drainage. Therefore, to improve the management of childhood pleural TB, a retrospective study was conducted to identify the risk factors associated with loculated effusion in childhood pleural TB.Methods: Between January 2006 and December 2019, consecutive children (≤15 years old) with tuberculous pleural effusion (definite and possible) were included for further analysis. The demographic, clinical, laboratory, and radiographic features were collected from the medical records. Univariate and multivariate logistic regressions were used to explore the factors associated with the presence of pleural loculation in children with pleural TB.Results: A total of 154 children with pleural TB (definite, 123 cases; possible, 31 cases) were included in our study and then were classified as loculated effusion (n = 27) and non-loculated effusion (n = 127) groups by chest X-ray or ultrasonography. Multivariate analysis revealed that male gender (age-adjusted OR = 3.903, 95% CI: 1.201, 12.683), empyema (age-adjusted OR = 4.499, 95% CI: 1.597, 12.673), peripheral monocytes ≤0.46 × 109/L (age-adjusted OR = 4.122, 95% CI: 1.518, 11.193) were associated with the presence of loculated effusion in children with pleural TB.Conclusion: In conclusion, several characteristics, such as male gender, empyema, and peripheral monocyte count have been identified as risk factors for pleural loculation in children with pleural TB. Our findings may be helpful to improve the management of pleural loculation in childhood pleural TB.

The Role of Ultrasonography in the Diagnosis and Decision Algorithm for the Management of Pneumothorax after Transbronchial Lung Cryobiopsy

Background: Pneumothorax is one of the main complications of transbronchial lung cryobiopsy (TBLC). Chest ultrasound (CUS) is a radiation-free alternative method for pneumothorax detection. Objective: We tested CUS diagnostic accuracy for pneumothorax and assessed its role in the decision algorithm for pneumothorax management. Secondary objectives were to evaluate the post-procedure pneumothorax occurrence and risk factors. Methods: Eligible patients underwent TBLC, followed by chest X-ray (CXR) evaluation 2 h after the procedure, as our standard protocol. Bedside CUS was performed within 30 min and 2 h after TBLC. Pneumothorax by CUS was defined by the absence of lung sliding and comet-tail artefacts and confirmed with the stratosphere sign on M-mode. Pneumothorax size was determined through lung point projection on CUS and interpleural distance on CXR and properly managed according to clinical status. Results: Sixty-seven patients were included. Nineteen pneumothoraces were detected at 2 h after the procedure, of which 8 (42.1%) were already present at the first CUS evaluation. All CXR-detected pneumothoraces had a positive CUS detection. There were 3 discordant cases (κ = 0.88, 95% CI: 0.76–1.00, p < 0.001), which were detected by CUS but not by inspiration CXR. We calculated a specificity of 97.5% (95% CI: 86.8–99.9) and a sensitivity of 100% (95% CI: 87.2–100) for CUS. Pneumothorax rate was higher when biopsies were taken in 2 lobes and if histology had pleural representation. Final diagnosis was achieved in 79.1% of patients, with the most frequent diagnosis being hypersensitivity pneumonitis. Regarding patients with large-volume pneumothorax needing drainage, the rate of detection was similar between CUS and CRX. Conclusion: CUS can replace CXR in detecting the presence of pneumothorax after TBLC, and the lung point site can reliably indicate its size. This useful method optimizes time spent at the bronchology unit and allows immediate response in symptomatic patients, helping to choose optimal treatment strategies, while preventing ionizing radiation exposure.

The Adding Role and Accuracy of Chest Ultrasound and Doppler in Peripheral Lung Lesions

Abstract Background: Chest ultrasound (US) and color Doppler sonography play important roles in the diagnosis and charac-terization of different pathologies of peripheral lung lesions, especially in the emergency setting. Aim of Study: The aim of this study is to assess the role of chest US and Doppler examination in the assessment of peripheral lung lesions in comparison with chest CT, which is the gold standard for chest diagnosis. Subjects and Methods: This cross-sectional study involved 120 patients who underwent chest CT examination, full chest US, and Doppler. Results were assessed blindly and compared with CT. Results: The main lung lesions assessed by US and Doppler were lung collapse, consolidation, interstitial lung changes, and peripheral pulmonary nodules, with the estimated sensi-tivity, specificity, positive predictive value, negative predictive value, and accuracy of detection ranging from 63.9%-76.9%, 94%-95%, 79.2%-95%, 85.9%-91.5%, and 85%-93.3% re-spectively. There was a significant correlation between US and Doppler in comparison with CT. Conclusion: Chest US proved its value as a complementary tool for the diagnosis of peripheral lung lesions, with high specificity and accuracy. This finding was enforced by Doppler, history, and clinical suspicion, although the use of CT to obtain the final diagnosis would be more applicable.

Diagnostic Value of Sonography in Detecting Hemothorax and Determining its Size in Blunt Trauma Patients

Background: Hemothorax is among the most prevalent complications after thoracic trauma. Extended focused assessment with sonography for trauma (e-FAST) is one of the diagnostic methods for hemothorax assessment. However, there are still limited data about its diagnostic value, especially in determining the size of the hemothorax. Objective: This study aimed to assess the diagnostic value of e-FAST in detecting hemothorax and determining its size among patients with blunt thoracic trauma. Methods: This cross-sectional diagnostic assessment study was conducted on 400 adult patients with blunt trauma who needed chest CT-scan. Chest X-ray (CXR), sonography and chest CT-scan were performed and hemothorax size was assessed with sonography and CT-scan. Sensitivity, specificity, and positive and negative predictive values of sonography and CXR were calculated. Hemothorax size on sonography was compared with the results of CT-scan as gold standard. Findings: Mean age of participants was 43.67±22.03. Based on CT-scan findings, 176 participants (44%) had a hemothorax. The sensitivity, specificity, positive and negative predictive values, and correct classification rate of sonography were 79%, 99.1%, 98.6%, 85.7%, and 90.2%, respectively. Sonography detected accurately 97.1% of small hemothoraxes, 46.9% of medium hemothoraxes and 33.3% of large hemothoraxes. Conclusion: Sonography is a sensitive diagnostic modality for the detection of hemothorax in multiple trauma patients, but tends to underestimate moderate to large sized hemothoraxes. Chest sonography can be an acceptable imaging modality, if CT-scan is not available or desired.

English

BACKGROUND Around 4 million people are affected by peptic ulcer diseases worldwide annually. The incidence of around 1.5 % to 3 % has been estimated. Peptic ulcer perforation presents with an overall mortality of 10 %. The management is also associated with significant post-operative morbidity and mortality regardless of whether laparoscopic or open repair is performed. In this study, we wanted to find out the incidence of peptic ulcer perforation and its management. METHODS Our study was a prospective observational study conducted in post graduate Department of Surgery, Government Medical College Srinagar, from October 2018 to November 2020. All patients were evaluated properly with all baseline investigations followed by X-ray chest and abdomen and ultrasonography (USG). RESULTS In our study, 136 patients were diagnosed as cases of peptic ulcer perforation. The maximum number of patients were in age group of 41 - 50 years (27.20 %). The male : female ratio was 14.1 : 1. Abdominal pain was present in all patients as presenting symptom followed by abdominal distension. In this study, 124 patients (91.2 %) had perforation in first part of duodenum, 9 patients (6.6 %) had perforation in prepyloric region and 3 (2.2 %) patients had perforation in body of stomach. Graham’s Patch repair was done in 133 patients, 1 patient underwent primary closure, and 2 patients underwent distal gastrectomy with gastrojejunostomy. CONCLUSIONS Our study shows that young people with perforated peptic ulcer have fewer coexisting medical illness, a lower complication rate and a more favorable outcome as compared to elderly patients with perforated peptic ulcer. A majority of such perforations are in 1st part of duodenum with male preponderance. A plain chest radiograph is sufficient to make diagnosis in the classic case of sudden onset epigastric pain. KEYWORDS Perforation Peritonitis, Management of Peptic Ulcer Perforation, Graham’s Repair, Clinical Presentation of Peptic Ulcer Perforation

Chestultrasonography versus computed tomography in the diagnosis of pleural effusion (Menoufia experience)

Background Pleural effusion is a common clinical problem and can arise from many diseases. Several imaging methods such as chest radiograph, ultrasonography (US), and computed tomography (CT) scan are being used to diagnose and detect the etiology of pleural effusion. Objective The aim of this work was to compare imaging findings of chest US and CT and the role of chest US in diagnosis of pleural effusion. Patients and methods This observational prospective cohort study was done on 70 patients with pleural effusion of determined etiology admitted to the Chest Department, Menoufia University Hospital, in the period between August 2018 and June 2019. We compared between chest US and CT in different types of pleural effusion. Results This study showed that pleural septations were detected by US more than CT, and the difference was statistically significant (P&lt;0.05). There was a significant statistical difference in detection of pleural thickening by US over CT (P&lt;0.005). It showed a highly significant statistical difference in the detection of the site of pleural thickening and nodules by US, especially on diaphragmatic pleura (P&lt;0.001). There was also a highly significant statistical difference in the detection of pleural nodules by US over CT (P&lt;0.001). There was a significant difference in the detection of parenchymal lesions by US and CT, where US could see collapse more than CT (P&lt;0.05), but CT detected consolidation patches more than US. Conclusion Chest US finding has higher diagnostic accuracy than chest CT finding in the diagnosis of pleural effusion and more sensitive in detection of pleural septations, diaphragmatic pleural nodules, and thickening.