Chest Ultrasonography Research Articles

Bilateral chylothorax following papillary thyroid carcinoma with cervical lymph node dissection: Case report and comprehensive review of the literature.

This case analysis and literature review aim to identify the causes of bilateral chylothorax following thyroid cancer surgery, a rare yet serious complication. We report 2 East Asian women who developed bilateral chylothorax after undergoing total thyroidectomy with neck lymph node dissection. Both patients presented with dyspnea and significant pleural effusion postoperatively. Both patients were diagnosed with bilateral chylothorax based on clinical examination and imaging studies, including chest ultrasonography and X-rays. In both cases, conservative management was initially implemented, involving chest tube drainage, total parenteral nutrition, and octreotide therapy. Surgical intervention was considered if conservative measures failed to control the chylous output. Both patients showed gradual improvement with conservative treatment, ultimately resulting in successful resolution of pleural effusion and discharge from the hospital without complications. For patients with bilateral chylothorax, conservative treatment should be the initial approach for small effusions. For moderate to large effusions, placement of a chest drainage tube is recommended, and surgical intervention should be considered if chyle volume exceeds 10 mL/(kg/d) for 48 to 72 hours or persists for more than 11 days following conservative treatment.

Point-of-care lung ultrasound in the diagnosis of childhood pneumonia.

Lung ultrasound is emerging as a rapid, simple and safe alternative for diagnosing pneumonia since it has a higher sensitivity than X-rays and lower radiation exposure than computerized tomography. This is a prospective observational study done at a tertiary care centre in Chennai to study the diagnostic utility of lung ultrasound in pneumonia. Children aged 1 month to 12 years who were admitted to the hospital with complaints of cough, fever and/or breathing difficulty and on examination had tachypnea and/or chest indrawing were included in the study. All children underwent chest X-rays which was a standard hospital protocol. At admission, an independent investigator who was blinded to the clinical and radiological features of the child performed lung ultrasound. In all children, the final diagnosis of pneumonia was made by another independent expert paediatrician on the basis of the clinical features and chest X-ray. The test characteristics of ultrasound and chest X-ray were compared against this gold standard of physician-diagnosed pneumonia. Out of the 252 children studied, 225 (89.3%) had pneumonia while the rest 27 (10.7%) had other diagnoses. Among the 225 children with pneumonia, 223 (99.1%) were detected by ultrasound while 157 (69.8%) were detected by chest X-ray. All the test characteristics such as sensitivity, specificity, positive and negative predictive values of ultrasound were higher than those of chest X-ray. The sensitivity and specificity of ultrasound to diagnose pneumonia were 99.11% and 81.48%, respectively, while the sensitivity and specificity of X-ray for the same were 69.77% and 74.07%, respectively. Overall diagnostic accuracy for chest ultrasonography was 97.22% (94.36% to 98.88%), whereas for chest radiography, it was found to be 70.24% (64.18% to 75.81%).While both modalities were able to diagnose pneumonia significantly, ultrasound had better strength of association (Cramer's V value = 0.849) than X-ray to the final diagnosis. Lung ultrasound can be employed as a point-of-care investigation to diagnose pneumonia in suspected cases and can even replace chest X-ray in such circumstances.

Prediction of Mortality and Outcome of Various Trauma Scores in Polytrauma Patients.

Background In developing nations, the primary cause of death is trauma, and the prevalence of trauma is increasing as more vehicles are driven. Numerous trauma scoring systems have been created in order to predict the mortality rate and patients with trauma's prognosis. The purpose of the current study was to assess the prognostic ability of various trauma scoring systems for patients' mortality and morbidity in cases involving chest and abdominal injuries, as they are common in the surgery department. Methodology At Ranchi, Jharkhand's Rajendra Institute of Medical Sciences, a prospective observational study was conducted from June 2021 to September 2022. All patients who met the requirements for inclusion were older than 18 and reported chest and abdominal trauma totaling 204. Before any essential therapies, primary care and resuscitation, including airway maintenance, breathing, circulation, and hemorrhage control, were established. A comprehensive clinical evaluation was done based on each patient's needs. Radiological evaluation included chest X-ray and ultrasonography (USG) for chest trauma, whereas USG (FAST) and CT scans were for abdominal trauma. Trauma scores, such as the Revised Trauma Score (RTS), the Trauma Revised Injury Severity Score (TRISS), the New Injury Severity Score (NISS), and the Injury Severity Score (ISS), were computed and examined using IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp. Results Of the 204 patients, 14.7% were female and 85.3% were male. The age range of 21-30 years old accounted for the largest percentage of cases (28%). 50 percent of injuries were caused by automobile accidents, while 25% were the result of assaults. At 83.8% versus 16.2%, blunt injuries were substantially more common than penetrating ones. In comparison to the chest, the abdomen was more frequently involved. The study's findings demonstrated that, while every trauma scoring was statistically significant in predicting mortality, the New Injury Severity Score (NISS), as well as the Trauma Revised Injury Severity Score (TRISS), became the most effective in predicting mortality (p < 0.0001). Conclusion According to the results, the most precise trauma grading method for chest and abdominal injuries is the Trauma Revised Injury Severity Score (TRISS), even though all other trauma scoring systems are useful in predicting patient outcomes. Surgeons using these metrics to predict outcomes and make well-informed treatment decisions can benefit greatly.

Lung ultrasonography underdiagnoses clinically significant pneumothorax

BackgroundUltrasonography for trauma is an integral part of the Advanced Trauma Life Support algorithm and supported extensively in the literature. The reliability of chest ultrasonography as a screening examination for pneumothorax during initial trauma evaluation is unclear. We performed a prospective study where we hypothesized that chest ultrasonography would have low sensitivity for detecting clinically significant pneumothorax. MethodsA prospective observational analysis of patients with blunt chest trauma at a level 1 trauma center was performed. Patients included had supine chest radiography and chest ultrasonography performed prior to intervention as well as confirmatory computed tomographic imaging. All chest ultrasonography was performed in the trauma bay by a registered sonographer. All imaging was evaluated by an attending trauma surgeon and radiologist in real time. ResultsOf 2,185 patients screened with a diagnosis of blunt thoracic trauma, 1,489 patients had chest radiography, chest ultrasonography, and confirmatory computed tomography and were included for analysis. Patients were 71% male, with median age of 42 years, and mean Injury Severity Score of 6. The sensitivity of chest ultrasonography to detect pneumothorax was low. Chest ultrasonography had a false negative rate of 72% (n = 58), with 22% (n = 13) undergoing tube thoracostomy. Patients with false negative examinations had lower initial O2 saturation and systolic blood pressure and were more likely to have rib fractures compared with true negative chest ultrasonography examinations. ConclusionChest ultrasonography performed on initial trauma evaluation has low sensitivity with a high rate of false negative examinations. Because many of these false negative results are clinically significant requiring thoracostomy, using chest ultrasonography alone to screen for pneumothorax should be done with caution.

The Efficacy of Bedside Chest Ultrasound in the Detection of Traumatic Pneumothorax

Background Chest X-rays have long been used to diagnose pneumothorax. In trauma patients, chest ultrasonography combined with chest CT may be a safer, faster, and more accurate approach. This could lead to better and quicker management of traumatic pneumothorax, as well as enhanced patient safety and clinical results. Aim The purpose of this study was to assess the efficacy and utility of bedside US chest in identifying traumatic pneumothorax and also its capacity to estimate the extent of the lesion in comparison to the gold standard modality chest computed tomography. Methods This was an observational cross-sectional study of 160 patients with traumatic pneumothorax. This sample was collected from all chest trauma patients admitted to Al-Kindy Teaching Hospital in Baghdad-Iraq between November 2021 and September 2022. Such patients were to have a bedside chest US and chest CT scan performed by a skilled radiologist to detect lung point signs and lung sliding, which would be used to determine the patient's pneumothorax status. Results According to the study's findings, about 77.5% of the patients evaluated were men. Furthermore, 40.6% of patients experienced blunt trauma. Chest ultrasound revealed positive pneumothorax in 50 cases (31.2%), while positive pneumothorax was confirmed by computed tomography in 53 cases (33.1%) with no significance in the detection of pneumothorax between the two imaging modalities p-value(0.719). Comparably, there was no significant difference in estimating the size of a pneumothorax between the two modalities (p-value = 0.547). Chest ultrasound diagnostic accuracy showed a sensitivity of approximately 92.45%, specificity of 99.07%, and diagnostic accuracy of 96.88%. Conclusion Our findings indicated that chest ultrasound might be a valuable rapid diagnostic tool for traumatic pneumothorax in the emergency department in addition to diagnosis. It eliminates the need to transport patients for a CT chest scan.

The Role of Chest Ultrasound in the Diagnosis of Thoracic Tuberculosis

Abstract Introduction There is limited data on the role of chest ultrasound (CUS) in thoracic tuberculosis (TTB). If the diagnostic accuracy of CUS for pulmonary TB (PTB) is similar to that for CUS in diagnosis of pneumonia, CUS could play an important role in diagnosis of PTB in areas without ready access to chest x-ray. Aim of the work This study aimed to describe the diagnostic features and utility of CUS in TTB. Comparing CUS findings in PTB versus community acquired pneumonia (CAP). Patients and methods Consecutive patients presenting with TTB and CAP to Abbasia Chest hospital between May 2019 to April 2020 were enrolled in this cohort study. CT of the chest, CUS, mediastinal ultrasound (US) and abdominal US to detect pericardial effusion were performed. CUS lesion pattern in thoracic TB, pulmonary TB and CAP cases were recorded. Results Sub-pleural nodules (97 patients, 95%), air-bronchograms (79 patients, 77,45%) and sub-pleural consolidations (SPC) (77 patients, 75.49%) were the most frequent features recorded by CUS in TB patients, CUS was able to report; pleural gap (28 patients, 27%), fragmented pleura (35 patients,34%), sub-pleural fluid collection (3 patients, 2.9%), and sub-pleural nodules (97patients, 95%) not detected by CT with P value &amp;lt; 0.05 for all. CUS was not only equal to CT in visualizing air-bronchogram (24 patients, 96%) and pleural effusion (4 patients,100%) in CAP, but also could detect fragmented pleura (12 patients, 48%) and SPC (8 patients, 32%) not detected by CT with P value &amp;lt; 0.05 for all. Conclusion CUS was more accurate than CT chest in diagnosis of TTB and CAP, it can report new patterns (pleural gap, fragmented pleura, sub-pleural fluid collection, SPN and SPC) not detected by CT.

#201 Bedside lung ultrasound and bioimpedance spectroscopy for assessment of volume status in chronic kidney disease patients on hemodialysis

Abstract Background and Aims Fluid balance is important in patients with chronic kidney disease undergoing hemodialysis (HD). Majority of HD treatment incorporate a prescription for fluid removal targeted to patient's dry weight. Overestimation of dry weight causes hypertension, left ventricular hypertrophy and heart failure, while underestimation is responsible for chronic dehydration leading to the risk of hypotension. Both complications have a significant impact on the overall morbidity and mortality. Dry weight of the patient is usually assessed by using clinical parameters (edema, BP, JVP etc.), Biochemical parameters (BNP, ANP), Bioimpedance Spectroscopy (BIS) or IVC diameter and collapsibility on ultrasound (VCI index). The use of chest ultrasound to detect lung water has recently received growing attention in clinical research. Ultrasonographic lung comets (counting B-lines artifact) evaluate extravascular lung water and hence is considered as a useful tool to evaluate the hydration status of hemodialysis patients. This study aims to compare the efficacy of body fluid volume status and lung water assessment by clinical methods, Ultrasound chest and Bioimpedance Spectroscopy in chronic kidney disease patients on hemodialysis. Method A cross-sectional study was conducted over a period of 6 months. Dry weight of the patient was assessed by the attending nephrologist based on clinical criteria such as: weight, blood pressure, presence of edema or vascular congestion. A Longitudinal Ultrasound scan of the chest was performed using MicroMaxx Ultrasound System with patient in supine position from second to fourth intercostal space of left hemi-thorax and second to fifth intercostal space of right hemi-thorax along parasternal, midclavicular, anterior axillary and midaxillary lines of each side in a total of 28 sectors. B-lines were defined as hyperechogenic linear artifact emerging from the pleural line, up to the bottom of the screen. Pre and Post dialysis comet score was determined by calculating the total B-lines in each sector. Bioimpedance spectroscopy using Bodystat QuadScan 4000 was performed. Pre and post dialysis total body water (TBW), intracellular water (ICW), extracellular water (ECW) and residual fluid overload (ECW pre HD- ECW post HD) were recorded. Results We conducted 100 assessments on 34 patients presenting to the hospital for maintenance hemodialysis. The mean age of the study population was 54.3 + 11 years with a sex ratio (M/F) of 6:1. Mean systolic blood pressure was 141.1 + 19 mmHg and diastolic blood pressure was 83 + 9.3 mmHg with 3 episodes of intradialytic hypotension. The mean dry weight was 59.8 + 10 Kg and weight gain by clinical assessment was 2.1 + 1.5 Kg. Comet score assessed by ultrasound chest had a mean of 4.54 + 2.53 before dialysis and 1.73 ± 1.36 after dialysis. Residual fluid overload on Bio impedance spectroscopy was 1.11 ± 0.85 litre. The residual fluid overload on Bio impedance spectroscopy and lung ultrasound comet score after dialysis had a significant correlation (p value &amp;lt;0.0001). Of the 100 assessments, 40% had fluid overload after dialysis on Bio impedance and 35% had lung congestion on ultrasound chest even after achieving euvolemia according to the dry weight assessed clinically. Conclusion Lung comets on ultrasound chest and residual volume on bio impedance spectroscopy may precede the development of clinical sign and symptoms in a patient. Therefore, these methods are superior to clinical volume status assessment in chronic kidney disease patients on hemodialysis.

Comparison between chest ultrasound (CUS) and chest radiography (CXR) in pneumothorax diagnosis: a literature review

Thoracic injuries include 25% of mortalities in traumatic cases and are associated with a 40% mortality rate. Early diagnosis of pneumothorax in thoracic traumas can decrease the mortality rate and the resultant burden significantly. Diagnosis accuracy is crucial for the management and treatment of pneumothorax since that carries significant morbidity and mortality rates. More than 90% of injury deaths occur in low- and middle-income countries, where the World Health Organization recognizes injuries as a neglected epidemic with the least prepared healthcare systems to handle the trauma burden. Over the past decades, computed tomography (CT) scans have been the gold standard for pneumothorax diagnosis. Even though this diagnostic tool is highly accurate in the detection of intrathoracic injuries, patients undergoing CT scan examination receive a high radiation dose. This study aims to review and comprehend the comparison between chest ultrasound (CUS) and chest radiography (CXR) as a diagnostic tool for pneumothorax. CUS is non-invasive, affordable, and does not pose an ionizing radiation risk. It offers dynamic procedures that can be done at the patient's bedside and can also be used to guide procedures. Previous systematic reviews and meta-analyses showed the diagnostic accuracy of CUS was higher than supine CXR for pneumothorax detection. Patients in some health care centers undergo percutaneous transthoracic needle interventions for ongoing care, including a follow-up chest X-ray (CXR) to detect pneumothorax. In spite of the adjustment for possible sources of heterogeneity, CUS is more sensitive and specific than CXR as the detection modality of pneumothorax. Some important factors, including operator experience, patient demographics, frequency, signs, and ultrasound probes, could be associated with the accuracy of CUS in identifying and diagnosing pneumothorax.

Comparative Evaluation of Chest Ultrasonography and Computed Tomography as Predictors of Malignant Pleural Effusion: A Prospective Study.

Malignant pleural effusion (MPE) is a manifestation of advanced cancer that requires a prompt and accurate diagnosis. Ultrasonography (US) and computed tomography (CT) are valuable imaging techniques for evaluating pleural effusions; however, their relative predictive ability for a malignant origin remains debatable. This prospective study aimed to compare chest US with CT findings as predictors of malignancy in patients with undiagnosed exudative pleural effusion. Fifty-four adults with undiagnosed exudative pleural effusions underwent comprehensive clinical evaluation including chest US, CT, and histopathologic biopsy. Blinded radiologists evaluated the US and CT images for features suggestive of malignancy, based on predefined criteria. Diagnostic performance measures were calculated using histopathology as a reference standard. Of the 54 patients, 33 (61.1%) had MPEs confirmed on biopsy. No significant differences between US and CT were found in detecting parietal pleural abnormalities, lung lesions, chest wall invasion, or liver metastasis. US outperformed CT in identifying diaphragmatic pleural thickening ≥10 mm (33.3% vs. 6.1%, p < 0.001) and nodularity (45.5% vs. 3%, p < 0.001), whereas CT was superior for mediastinal thickening (48.5% vs. 15.2%, p = 0.002). For diagnosing MPE, diaphragmatic nodularity detected by US had 45.5% sensitivity and 100% specificity, whereas CT mediastinal thickening had 48.5% sensitivity and 90.5% specificity. Both US and CT demonstrate reasonable diagnostic performance for detecting MPE, with particular imaging findings favoring a malignant origin. US may be advantageous for evaluating diaphragmatic pleural involvement, whereas CT is more sensitive to mediastinal abnormalities.

Diagnosis of pneumonia in paediatric age group by comparing two modalities chest x-ray versus ultrasonography at tertiary care hospital

: Up to 20 million cases of pneumonia in children ages 0 to 5 years require hospitalization each year, from total 150 million cases of pneumonia. The most common cause of death in children worldwide is pneumonia. Due to the general non-specificity of the signs and symptoms, clinical history and physical examination cannot reliably distinguish between the causes of respiratory cases. As a result, accurate diagnosis frequently requires medical imaging, but two-thirds of the world's population lack access to diagnostic imaging, which lead to increasing the consequences of respiratory illnesses. : To know the characteristic of pneumonia in x-ray and ultrasonography. To compare X-ray chest and USG for early diagnosis. : A Prospective observational study was conducted among 100 paediatric patients diagnosed with pneumonia and admitted in paediatric ward, at New Civil Hospital, Surat. : Out of total, 52.7% and 47.3% patients were Males and Females, respectively. 87.2% cases were fully immunized, while remaining were partially immunized. Sensitivity and specificity of chest X-ray is 83.4 % and 86.8 % respectively. Sensitivity and specificity of USG thorax is 96.8 % and 90.5 % respectively. Young children are at least four times more susceptible to radiation damage than adults.: In comparison to chest radiography, lung ultrasound has the potential advantages of being more sensitive and specific, radiation-free, subject to less regulatory constraints, relatively less expensive so it can be used in diagnosis in patients with pneumonia.

Subclinical pleuro-pulmonary disease in patients with SLE: functional and radiological methods

Abstract Background Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease with highest prevalence of chest involvement; however, early detection of subclinical pleuropulmonary diseases may improve the quality of life and prognosis of patients. This study aimed to identify the subclinical pleuro-pulmonary involvement in SLE patients without respiratory symptoms. Methods A total of 228 patients diagnosed with SLE were recruited and subjected to high-resolution computed tomography (HRCT) chest, ultrasound (US) chest, and spirometry for further evaluation and finding of sub-clinical signs. Results Around 52.63% of patients had pulmonary involvement in HRCT, while in US, it was 73.68%. Ground glass opacity was observed in 31.58% of HRCT cases, and &gt; 1/3 of patients had pleural thickness in US. Spirometry showed that 26.32% of patients had small airway disease. SLE patients with subclinical lung involvement were significantly female and younger and had shorter disease duration, p &lt; 0.05 for all. SLE severity showed a significant negative correlation with lung function, and was positively correlated with pleural thickness and effusion, and pleural nodules in US finding. However, diaphragmatic excursion showed a negative correlation. Moreover, ground glass opacities, honey combing opacities, interlobular septal thickening, pleural thickness, and effusion in HRCT showed positive correlation with disease severity, p &lt; 0.001 for all, yet, the mosaic pattern showed a negative relationship. Conclusion The radiological assessments of SLE patients via HRCT and ultrasound unveiled prevalent findings such as ground glass opacities and pleural abnormalities. The severity of SLE correlated significantly with pulmonary function tests in a negative way, plus the positive correlation with lung opacities and pleural abnormalities.

Pleural effusion in a pediatric ward: clinical feature, etiology and outcome

Background: Pleural effusion is a common respiratory complication in children. We aimed to document clinical feature, etiology, biochemical parameters and outcome of the admitted children with pleural effusion. Methods: This cross-sectional study was conducted from January 2022 to June 2023 at pediatric ward of ICMH. All children from 6 months to 14 years presented with clinical features suggestive of pleural effusion and later supported by radiology and ultrasonography of chest either at presentation or owing to other systemic illness were enrolled. Children aged below 6 months, associated chronic illness and parental denial of giving consent were excluded. In indicated cases pleural fluid was tapped and sent to laboratory for physical, biochemical examination, staining, culture, GeneXpert, LDH and ADA assay. Results: Out of 43 children, 19 underwent pleural tap and rest were managed conservatively. Most of the children were in between 2 to 6 years. There were 22 male and 21 female. Unilateral effusion was found in 25 children and 18 children developed bilateral effusion. All the children had documented fever. Other symptoms were cough, respiratory distress, chest pain, weight loss, abdominal pain, jaundice and blood mixed sputum. Physical signs correlated classical effusion features. The etiologies included DF, TB, para-pneumonic effusion, empyema, nephrotic syndrome, malignancy, acute viral hepatitis, heart failure and acute pancreatitis. There was no mortality and long-term complication in non-malignant cases. Conclusions: DF outnumbered other causes of pleural effusion in recent times owing to recent Dengue outbreak. Tubercular effusion was leading cause among cases undergoing pleural tap.

A STUDY OF CLINCOETIOLOGICAL PROFILE OF PATIENTS WITH PLEURAL EFFUSION: A CROSS-SECTIONAL STUDY

Objectives: The objective of this study was to determine the clinical profile, etiology in patients presenting with plural effusion and correlation between etiology, clinical, and radiological findings. Methods: It was a cross-sectional study carried out at the GRMC JAH Department of Medicine, Gwalior, from to July 2013 to October 2014 after getting the permission from the Institutional Ethical Committee. Inclusion criteria were all 100 patients above 14 years of age with clinical and radiological evidence of plural effusion. Patients with history of trauma chest and thoracocentesis were excluded from the study. The demographic variables were gender, age in years, sex, and address. The research variables were breathlessness, fever, cough, chest pain, generalized edema, abdominal pain, hemoptysis, and cause of pleural effusion. Investigations such as complete blood count, retained blood syndrome, renal function test, serum albumin, chest X-ray, pleural fluid analysis, ultrasonography chest and abdomen, echocardiogram, upper gastrointestinal endoscopy, blood culture, fine-needle aspiration cytology, and computed tomography scan. There were eight age groups between below 21 years and above 81 years. Nominal data were analyzed for frequency and (%) and the numeric data were analyzed by Chi-square test p-value. Results: In the present study, maximum cases (66%) presented with exudative type of pleural effusion. Of these 43 cases (65.15%) had tuberculosis, 5 cases (7.5%) had malignancy and 4 cases (6.06%) had pneumonia. About 34% cases presented with transudative type of pleural effusion. Of these 10 cases (29.41%) had hepatic involvement, and 8 cases (23.52%) had congestive cardiac failure. Acute febrile illness 9 (9%), nephrotic syndrome 4 (16%), renal failure 5 (5%), hypoalbuminemea 5 (5%), pancreatitis (1%), and adult respiratory distress syndrome (1%) were other causes of pleural effusion in this study.

Clinical Utility of Chest Sonography in Chronic Obstructive Pulmonary Disease Patients Focusing on Diaphragmatic Measurements.

There are many methods of evaluating diaphragmatic function, including trans-diaphragmatic pressure measurements, which are considered the key rule of diagnosis. We studied the clinical usefulness of chest ultrasonography in evaluating stable chronic obstructive pulmonary disease (COPD) patients and those in exacerbation, focusing on diaphragmatic measurements and their correlation with spirometry and other clinical parameters. In a prospective case-control study, we enrolled 100 COPD patients divided into 40 stable COPD patients and 60 patients with exacerbation. The analysis included 20 age-matched controls. In addition to the clinical assessment of the study population, radiological evaluation included chest radiographs and chest computed tomography. Transthoracic ultrasonography (TUS) was performed for all included subjects. Multiple A lines (more than 3) were more frequent in COPD exacerbation than in stable patients, as was the case for B-lines. TUS significantly showed high specificity, negative predictive value, positive predictive value, and accuracy in detecting pleural effusion, consolidation, pneumothorax, and lung mass. Diaphragmatic measurements were significantly lower among stable COPD subjects than healthy controls. Diaphragmatic thickness and excursion displayed a significant negative correlation with body mass index and the dyspnea scale, and a positive correlation with spirometry measures. Patients in Global Initiative for Chronic Obstructive Lung Disease (GOLD) group D showed lower diaphragmatic measurements (thickness and excursion). The TUS of COPD patients both in stable and exacerbated conditions and the assessment of diaphragm excursion and thickness by TUS in COPD patients and their correlations to disease-related factors proved informative and paved the way for the better management of COPD patients.

Assessment of atypical pneumonia by chest ultrasonography

BackgroundPatients with pneumonia exhibit similar clinical presentations despite having different causative organisms; thus, a rapid and easy test is needed to differentiate between the diseases. Here, we use lung ultrasound to discriminate between causative organisms in correlation with other diagnostic modalities.MethodsThis descriptive cross-sectional study was carried out on 67 patients diagnosed with atypical pneumonia admitted at Ain-Shams University hospitals in the period from July 2019 to June 2021. Study population was divided into three groups according to the causative agent based on the results of PCR: Group 1 included 23 patients (influenza A), group 2 included 30 patients (COVID-19), and group 3 included 14 patients (atypical organisms). Included patients underwent lung ultrasound scan via a 12-zone scanning protocol and CT scan with 24 h in between. The present study was approved by the ethical committee at our institution.ResultsThe mean age ranged from 39.93 ± 19.26 SD to 60.3 ± 13.02 SD years; 64.17% of them were males. There was also a highly statistically significant difference between the three groups as regard B-lines and thickened pleural line being higher among group 2; 100% of cases had B-lines in their chest ultrasound assessment, while thickened pleural line was found in 53.3% of cases. Dynamic air bronchogram was found with higher percentage in group 3 (71.4%) with a highly significant association. Higher mean Soldati score was associated with more severe disease among cases with viral pneumonia.ConclusionsLung ultrasound may be used as an aiding tool to estimate the etiology of atypical pneumonia. It can be useful during pandemics of acute respiratory diseases for rapid triage and stratification of patients as through calculation of modified Soldati score and detection of the most common finding. Also, modified Soldati score correlates with disease severity.

Diagnostic yield of combined ultrasound-guided fine needle aspiration and core needle biopsy versus either technique alone in peripheral lung and pleural lesions

IntroductionUltrasound (US) has become an integral tool for chest assessment as it provides crucial information on pleural pathologies and peripherally located lung lesions.AimTo assess the diagnostic yield of combined fine needle aspiration (FNAB) and core needle biopsy (CNB) versus each technique ultrasound-guided in peripheral lung and pleural lesions.MethodologyThe present study enrolled 30 patients presenting to Alexandria Main University Hospital, with CT scans showing undiagnosed peripheral lung or parietal pleural lesions with or without effusion. A full ultrasound chest assessment was done covering 12 regions. Assessment of the lesion of interest, vascularity was assessed via color Doppler, locating the safest entry site. Real-time US-guided FNAB was done using a spinal needle 22 gauge. Then real-time US-guided CNB using 18 gauge Trucut needle in the same setting. Duration and complications of each procedure were reported. In FNAB, three smears were prepared, fixed in alcohol, and stained with hematoxylin and eosin stain. The remaining sample was fixed in formalin and centrifuged to prepare cell blocks. On the other hand, Trucut needle biopsy specimens were fixed in formalin and processed as paraffin-embedded blocks. Immunohistochemical staining was done. The results were classified into four categories (inadequate, negative, suspicious, and positive for malignancy.ResultsThe diagnostic yield of combined techniques was 96.7% versus 63.3% using FNAB and 96.7% using CNB. The sensitivity of FNAB was 86% while CNB was 95%. The specificity and positive predictive value of both methods were 100%. The negative predictive value of FNAB was 57% versus 80% for CNB in peripheral lung lesions. Duration of US-guided CNB was statistically significantly longer than that of FNAB in both peripheral lung and pleural lesions. No major complications were reported using either technique.ConclusionCombined FNAB and CNB were not superior to CNB alone regarding diagnostic yield but were superior to FNAB. Ultrasound-guided CNB has a superior diagnostic yield over FNAB, with no statistically significant difference regarding associated complications, both techniques are safe. FNAB provided sufficient material for ancillary molecular testing.

Comparison of lung ultrasound technique versus clinical method to evaluate the accuracy of size and placement of left endobronchial double lumen tube in patients undergoing elective thoracic surgery: a prospective observational study.

Anthropometric measurements like height and gender have been frequently found to be inaccurate in prediction of size of double lumen tube (DLT). A tracheal ultrasonography (TUS) is a technique that can be used to predict the size of DLT and its correct placement for lung isolation. We aim to check the accuracy of ultrasound over clinical methods. This prospective study included 68 patients undergoing elective thoracic surgery requiring one-lung ventilation (OLV) with DLT. The groups were assessed for the size of DLT by either anthropometric measurement using height and gender (Group C) or ultrasound method (Group U). Further, the accuracy of placement of DLT was assessed through, either lung auscultation in group C or various ultrasonographic and ventilatory parameters such as lung isolation in the first attempt (lung sliding and lung pulse sign), oxygenation status and peak airway pressure, in group U. Surgeon satisfaction score was also compared in both the groups. The accuracy of predicted DLT size between Group C and Group U was statistically significant (p=0.044). In Group C, 56% of patients showed a mismatch between the predicted DLT size and the actual size required, while in Group U, the mismatch was only 32.4%. The accuracy of DLT placement through group C was 41% as compared to 79% in Group U. Surgeon satisfaction score was also significantly higher in Group U as compared to Group C (p=0.0028). Thus, our study suggests that tracheal and chest ultrasonography for DLT size selection and placement for lung isolation is superior to clinical methods.

Point-of-Care Ultrasound versus Chest X-Ray for Determining Lung Expansion Based on Rib Count in High-Frequency Oscillatory Ventilation

Introduction: Chest X-ray (CXR) is the most prevalent method for evaluating lung expansion in high-frequency oscillatory ventilation (HFOV). The purpose of this study was to compare the accuracy of chest radiography with point-of-care ultrasound (POCUS) in determining lung expansion. Methods: This prospective study included newborns who required HFOV and were monitored in a neonatal intensive care unit. A single neonatologist assessed lung expansion with CXR and POCUS to measure the costal level of the right hemidiaphragm and compared the results. Results: A neonatologist performed 55 measurements in 28 newborns with a gestational age of 32 (23.2–39.4) weeks, followed by HFOV. The rib counts obtained from anterior chest ultrasonography and posterior CXR showed a statistically high concordance (r = 0.913, p < 0.001). Conclusion: Lung ultrasonography is a reliable method for the evaluation of lung expansion based on rib count in patients with HFOV.

Clinical profile of febrile encephalopathy patients at a tertiary care hospital in India: A retrospective study

Objective: To investigate demography, etiology, and clinical profile and to analyze the outcomes of patients presenting with febrile encephalopathy at a tertiary care center in Eastern India. Methods: This retrospective, observational study included a total of 50 patients (&gt;18 years) who presented with fever and encephalopathy. All patients underwent blood analysis; culture test for blood, urine, sputum, cerebrospinal fluid, and other body fluids; chest and abdominal ultrasonography; neuroimaging; polymerase chain reaction test, and other relevant tests as and when applicable. Results: The mean age of all enrolled patients was (58.0±16.0) years with male to female ratio of 1.27:1. Viral encephalitis was diagnosed in 16 (32%) patients, sepsis-associated encephalitis in 14 (28%), bacterial meningoencephalitis in 8 (16%) and tuberculosis meningoencephalitis in 5 (10%). The mean hospital stay was 10 (4, 17) days. At 6-month follow-up, 10 (20%) patients died, 10 (20%)patients recovered with sequelae (cognitive impairment, critical careneuropathy, etc.), and 30 (60%) patients recovered without sequelae. A statistically significant association was noted between GlasgowComa Scale (&lt;8) and mortality rate (P=0.02). Conclusions: Primary central nervous system infection is the mostfrequent etiology of febrile encephalopathy and viral encephalitisis the most common etiological cause. Accurate, systematic, timelydiagnosis and management are prime factors to reduce mortality andmorbidity.

The role of chest ultrasound in the diagnosis of thoracic tuberculosis

Abstract Introduction Data regarding the role of chest ultrasound (CUS) in thoracic tuberculosis (TTB) are deficient. If the diagnostic accuracy of CUS for pulmonary tuberculosis (PTB) is similar to that for CUS in the diagnosis of pneumonia, CUS could play an important role in its diagnosis. Aim This study aimed to describe the diagnostic features and use of CUS in TTB and compare CUS findings in PTB versus community-acquired pneumonia (CAP). Patients and methods Consecutive patients presenting with TTB and CAP were enrolled in this study. Computed tomography (CT) chest, CUS, mediastinal US, and abdominal US were performed. CUS lesion pattern in TTB, PTB, and CAP cases were recorded. Results CUS in patients with PTB uniquely and significantly detected pleural gap (28 patients, 27%), fragmented pleura (35 patients, 34%), subpleural fluid collection (three patients, 2.9%), and subpleural nodules (SPN) (97 patients, 95%), which were not detected by CT (P&lt;0.05 for all). Moreover, CUS in patients with PTB uniquely and significantly detected absent sliding sign in a cavitary lesion, pleural gap, and SPNs, which were absent in CUS in CAP (P&lt;0.05 for all) and highly significant more subpleural consolidations when compared with CUS findings in CAP. However, more significant air bronchogram CUS patterns were encountered in patients with CAP than in those with PTB. Conclusion CUS is a complementary tool in assessing TTB. It can report new PTB patterns (pleural gap, fragmented pleura, subpleural fluid collection, SPN, and subpleural consolidation) not detected by CT. CUS detects different sonographic patterns in PTB than CAP.