Sensitivity Of Lung Ultrasound Research Articles

Chest X-rays and Lung Ultrasound Are Not Interchangeable in Intensive Care Practice.

Data comparing lung ultrasound (LUS) and chest X-rays (CXRs) have increased over the past years. However, there still is a lack of knowledge as to how these modalities compare with one another in the critical care setting, and several factors, including artificial study conditions, limit the generalizability of most published studies. Our study aimed to analyze the performance of LUS in comparison with CXRs in real-world critical care practice. This study presents new data from the prospective FASP-ICU trial. A total of 209 corresponding datasets of LUS and CXR results from 111 consecutive surgical ICU patients were subanalyzed, and categorial findings were compared. Statistical analysis was performed on the rates of agreement between the different imaging modalities. A total of 1162 lung abnormalities were detected by LUS in ICU patients compared with 1228 detected by CXR, a non-significant difference (p = 0.276; 95% CI -0.886 to 0.254). However, the agreement rates varied between the observed abnormalities: the rate of agreement for the presence of interstitial syndrome ranged from 0 to 15%, consolidation from 0 to 56%, basal atelectasis from 33.9 to 49.34%, pleural effusion from 40.65 to 50%, and compression atelectasis from 14.29 to 19.3%. The rate of agreement was 0% for pneumothorax and 20.95% for hypervolemia. LUS does not detect more lung abnormalities in real-world critical care practice than CXRs, although a higher sensitivity of LUS has been reported in previous studies. Overall, low agreement rates between LUS and CXRs suggest that these diagnostic techniques are not equivalent but instead are complementary and should be used alongside each other.

Diagnostic efficacy of lung ultrasound in cardiogenic pulmonary edema: a systematic review and meta-analysis.

This meta-analysis was performed to evaluate the diagnostic efficacy of lung ultrasound (LUS) in cardiogenic pulmonary edema. An electronic search of databases, including MEDLINE, Embase, PubMed, and Web of Science, was performed to collect clinical studies on ultrasound diagnosis of cardiogenic pulmonary edema from inception to 23 March 2023. The number of patients with true-positive, true-negative, false-positive, and false-negative cardiogenic pulmonary edema diagnosed by LUS was collected, and the R package was used to analyze the diagnostic efficacy of LUS. Nine pieces of literature were finally included with 2,097 participants, including 1,047 patients with cardiogenic heart failure. Across the nine included papers, the pooled sensitivity of LUS in the included studies was 0.92 (95% CI: 0.84, 0.97) with a maximum sensitivity of 0.99 (95% CI: 0.96 to 1.00) and a minimum of 0.59 (95% CI: 0.50, 0.68). The pooled specificity of the included studies was 0.87 (95% CI: 0. 82, 0.91) with a maximum specificity of 0.93 (95% CI: 0.90-0.95) and a minimum of 0.80 (95% CI: 0.67, 0.89). The pooled AUC was 0.93 (95% CI: 0.84 to 0.97), suggesting a high diagnostic value of LUS in cardiogenic pulmonary edema. Lung ultrasound offers a good diagnostic efficacy for cardiogenic pulmonary edema. Further standardization of the examination method is required to provide a reference for the clinical use of LUS.

Evaluation of the diagnostic performance of physician lung ultrasound versus chest radiography for pneumonia diagnosis in a peri-urban South African cohort.

Lung ultrasound (US), which is radiation-free and cheaper than chest radiography (CXR), may be a useful modality for the diagnosis of pediatric pneumonia, but there are limited data from low- and middle-income countries. The aim of this study was to evaluate the diagnostic performance of non-radiologist, physician-performed lung US compared to CXR for pneumonia in children in a resource-constrained, African setting. Children under 5years of age enrolled in a South African birth cohort study, the Drakenstein Child Health Study, who presented with clinically defined pneumonia and had a CXR performed also had a lung US performed by a study doctor. Each modality was reported by two readers, using standardized methodology. Agreement between modalities, accuracy (sensitivity and specificity) of lungUS and inter-rater agreement were assessed. Either consolidation or any abnormality (consolidation or interstitial picture) was considered as endpoints. In the 98 included cases (median age: 7.2months; 53% male; 69% hospitalized), prevalence was 37% vs. 39% for consolidation and 52% vs. 76% for any abnormality on lung US and CXR, respectively. Agreement between modalities was poor for consolidation (observed agreement=61%, Kappa=0.18, 95% confidence interval [95% CI]: - 0.02 to 0.37) and for any abnormality (observed agreement=56%, Kappa=0.10, 95% CI: - 0.07 to 0.28). Using CXR as thereference standard, sensitivity of lung US was low for consolidation (47%, 95% CI: 31-64%) or any abnormality (5%, 95% CI: 43-67%), while specificity was moderate for consolidation (70%, 95% CI: 57-81%), but lower for any abnormality (58%, 95% CI: 37-78%). Overall inter-observer agreement of CXR was poor (Kappa=0.25, 95% CI: 0.11-0.37) and was significantly lower than the substantial agreement of lung US (Kappa=0.61, 95% CI: 0.50-0.75). LungUS demonstrated better agreement than CXR for all categories of findings, showing a significant difference for consolidation (Kappa=0.72, 95% CI: 0.58-0.86 vs. 0.32, 95% CI: 0.13-0.51). LungUS identified consolidation with similar frequency to CXR, but there was poor agreement between modalities. The significantly higher inter-observer agreement of LUS compared to CXR supports the utilization of lungUS by clinicians in a low-resource setting.

Use of Lung Ultrasound versus Chest X-ray in Diagnosing Heart Failure in the Emergency Care Setting: A Systematic Review

Background: Acute heart failure (HF) is initially diagnosed and managed in the large part in the emergency care setting. Lung ultrasound (LUS) and chest X-ray (CXR) are the most common diagnostic and prognostic techniques for people with HF. It has been observed that lung ultrasonography has a higher sensitivity for diagnosing HF than CXR. In this review, we assess the comparison between the use of LUS and CXR in diagnosing HF. Methods: An extended search was done in the databases of PubMed, Medline, Wiley library, and Google Scholar between 2012 and 2022. Fifteen studies were included in this systematic review. Studies, in which the sensitivity of LUS and CXR was noted, were included. Results: Fifteen studies were included. The majority of the studies showed that LUS had high sensitivity and accuracy for detecting HF. Conclusion: The result of the present review shows that the sensitivity of the LUS was higher than those of the CXR in detecting HF. Ultrasound has certain advantages over CXR.

Lung ultrasound in ruling out COVID-19 pneumonia in the ED: a multicentre prospective sensitivity study

PurposeEarly diagnosis of COVID-19 has a crucial role in confining the spread among the population. Lung ultrasound (LUS) was included in the diagnostic pathway for its high sensitivity, low costs,...

Comparison of sensitivity of lung ultrasound and chest x-ray imaging for the diagnosis of community-acquired pneumonia in children

Purpose: Lung ultrasound (LUS) has only recently been considered to be a suitable tool for diagnosing community acquired pneumonia (CAP) in children. Little is known about the usefulness of LUS in different types of pneumonia. Therefore, we analyzed and compared the sensitivity of chest X-ray (CXR) and LUS in different etiological types of CAP in children.
 Methods: We performed a prospective study in 166 children with CAP, who were admitted to the hospital. The participants were stratified into bacterial (n=80), atypical bacterial (n=32) and viral (n=54) pneumonia subgroups, according to the laboratory and microbiological results. LUS and CXR were performed on all patients at admission.
 Results: Pneumonia was detected with LUS in 161 (97.0%) participants and with CXR in 137 (82.5%) participants (p<0.01). The sensitivity of LUS was calculated as 97.0% (95% CI, 93.1%–99.0%), and the sensitivity of CXR as 82.5% (95% CI, 75.9%– 88.0%), p<0.01. In patients with bacterial CAP, infiltrates were detected with LUS in 79 (98.7%) and with CXR in 67 (83.8%) of cases (p<0.01); in atypical bacterial CAP, with LUS in 30 (93.8%) and with CXR in 28 (87.5%) (p=0.69); and in patients with viral CAP with LUS in 52 (96.3%) and with CXR in 42 (77.8%) (p<0.01).
 Conclusion: We have determined that LUS is an excellent tool for diagnosing CAP in children. LUS is at least as sensitive as CXR in all types of CAP in children and will probably replace it as the investigation of choice in CAP.

A Comparative Study of Chest CT With Lung Ultrasound After SARS-CoV-2 Infection in the Assessment of Pulmonary Lesions in Rhesus Monkeys (Macaca Mulatta).

Lung ultrasound (LUS) is a fast and non-invasive modality for the diagnosis of several diseases. In humans, LUS is nowadays of additional value for bedside screening of hospitalized SARS-CoV-2 infected patients. However, the diagnostic value of LUS in SARS-CoV-2 infected rhesus monkeys, with mild-to-moderate disease, is unknown. The aim of this observational study was to explore correlations of the LUS appearance of abnormalities with COVID-19-related lesions detected on computed tomography (CT). There were 28 adult female rhesus monkeys infected with SARS-CoV-2 included in this study. Chest CT and LUS were obtained pre-infection and 2-, 7-, and 14-days post infection. Twenty-five animals were sub-genomic PCR positive in their nose/throat swab for at least 1 day. CT images were scored based on the degree of involvement for lung lobe. LUS was scored based on the aeration and abnormalities for each part of the lungs, blinded to CT findings. Most common lesions observed on CT were ground glass opacities (GGOs) and crazy paving patterns. With LUS, confluent or multiple B-lines with or without pleural abnormalities were observed which is corresponding with GGOs on CT. The agreement between the two modalities was similar over the examination days. Pleural line abnormalities were clearly observed with LUS, but could be easily missed on CT. Nevertheless, due to the air interface LUS was not able to examine the complete volume of the lung. The sensitivity of LUS was high though the diagnostic efficacy for mild-to-moderate disease, as seen in macaques, was relatively low. This leaves CT the imaging modality of choice for diagnosis, monitoring, and longitudinal assessment of a SARS-CoV-2 infection in macaques.

Lung Ultrasound Is More Sensitive for Hospitalized Consolidated Pneumonia Diagnosis Compared to CXR in Children.

Background: Pneumonia is the leading cause of death among children; thus, a correct early diagnosis would be ideal. The imagistic diagnosis still uses chest X-ray (CXR), but lung ultrasound (LUS) proves to be reliable for pneumonia diagnosis. The aim of our study was to evaluate the sensitivity and specificity of LUS compared to CXR in consolidated pneumonia. Methods: Children with clinical suspicion of bacterial pneumonia were screened by LUS for pneumonia, followed by CXR. The agreement relation between LUS and CXR regarding the detection of consolidation was evaluated by Cohen’s kappa test. Results: A total of 128 patients with clinical suspicion of pneumonia were evaluated; 74 of them were confirmed by imagery and biological inflammatory markers. The highest frequency of pneumonia was in the 0–3 years age group (37.83%). Statistical estimation of the agreement between LUS and CXR in detection of the consolidation found an almost perfect agreement, with a Cohen’s kappa coefficient of K = 0.89 ± 0.04 SD, p = 0.000. Sensitivity of LUS was superior to CXR in detection of consolidations. Conclusion: Lung ultrasound is a reliable method for the detection of pneumonia consolidation in hospitalized children, with sensitivity and specificity superior to CXR. LUS should be used for rapid and safe evaluation of child pneumonia.

The Accuracy of Lung Ultrasound in Pneumonia Diagnosis: Evidence-Based Case Report

Background: There are various microorganisms which caused pneumonia in developing countries such as Indonesia. The diagnosjs of pneumonia is still mainly confirmed by Chest X-ray which is unspecific to determine the etiology of pneumonia due to its low accuracy. On the other hand, the higher accuracy diagnostic tool, Computed Tomography (CT) scan, is not cost-effective. Therefore, an alternative diagnostic tool with high precision, affordability, and user-friendly is highly needed. Lung ultrasound (LUS) is an alternative diagnostic device. This study aims to investigate the diagnostic accuracy level of LUS in diagnosing pneumonia. Methods: Literature-researches was done in five databases namely PubMed/MEDLINE, ScienceDirect, Proquest, Cochrane and EBSCO/MEDLINE using keywords according to the clinical scenario. The articles were appraised with CEEBM worksheet. Results: Four articles met the inclusion and exclusion criteria. Sensitivity of LUS ranged around 85-97% and specificity ranged around 8694%. All appraised articles recommended the use of LUS for its high sensitivity in confirming diagnosjs of pneumonia and other lung diseases, and its favorable bedside use especially for critically ill patients. Lung US was also considered as being more inexpensive with less radiation exposure compared to CT scan or other radiographic imaging. Conclusion: Examination using LUS had a high diagnostic value in confirming the diagnosis of pneumonia.

Low Sensitivity of Admission Lung US Compared to Chest CT for Diagnosis of Lung Involvement in a Cohort of 82 Patients with COVID-19 Pneumonia.

Background and Objectives: The potential role of lung ultrasound (LUS) in characterizing lung involvement in Coronavirus disease 2019 (COVID-19) is still debated. The aim of the study was to estimate sensitivity of admission LUS for the detection of SARS-CoV-2 lung involvement using Chest-CT (Computed Tomography) as reference standard in order to assess LUS usefulness in ruling out COVID-19 pneumonia in the Emergency Department (ED). Methods: Eighty-two patients with confirmed COVID-19 and signs of lung involvement on Chest-CT were consecutively admitted to our hospital and recruited in the study. Chest-CT and LUS examination were concurrently performed within the first 6–12h from admission. Sensitivity of LUS was calculated using CT findings as a reference standard. Results: Global LUS sensitivity in detecting COVID-19 pulmonary lesions was 52%. LUS sensitivity ranged from 8% in case of focal and sporadic ground-glass opacities (mild disease), to 52% for a crazy-paving pattern (moderate disease) and up to 100% in case of extensive subpleural consolidations (severe disease), although LUS was not always able to detect all the consolidations assessed at Chest-CT. LUS sensitivity was higher in detecting a typical Chest-CT pattern (60%) and abnormalities showing a middle-lower zone predominance (79%). Conclusions: As admission LUS may result falsely negative in most cases, it should not be considered as a reliable imaging tool in ruling out COVID-19 pneumonia in patients presenting in ED. It may at least represent an expanded clinical evaluation that needs integration with other diagnostic tests (e.g., nasopharyngeal swab, Chest-CT).

The Impact of Lung Ultrasound on Coronavirus Disease 2019 Pneumonia Suspected Patients Admitted to Emergency Departments.

The aim of this study was to identify the sensitivity and specificity of lung ultrasound (LUS) and show its place in diagnosing patients with known coronavirus disease 2019 (COVID-19) pneumonia, according to chest computed tomography and the COVID-19 reporting and data system (CO-RADS). Nineteen patients who admitted to a single university hospital emergency department between March 5, 2020, and April 27, 2020, describing dyspnea were included in the study and underwent LUS by a single emergency specialist. The patient population was divided into 2 groups, COVID-19 positive and negative, and the sensitivity and specificity of LUS according to chest computed tomography were calculated for COVID-19 pneumonia diagnosis. In the subgroup analysis, the patient group was divided into real-time reverse transcription-polymerase chain reaction positive (n = 7) and negative (n = 12), and sensitivity and specificity were calculated according to the CO-RADS. According to the CO-RADS, significant differences were detected between the LUS positive and negative groups in terms of COVID-19 pneumonia presence. Only 1 patient was evaluated as CO-RADS 2 in the LUS positive group, and 2 patients were evaluated as CO-RADS 4 in the LUS negative group (P = 0.04). The sensitivity of LUS according to the CO-RADS for COVID-19 pneumonia diagnosis was measured to be 77.78% (95% confidence interval [CI], 39.9%-97.1%), specificity was 90% (95% CI, 55.5%-99.75%), positive predictive value was 87.5% (95% CI, 51.35%-97.8%), and accuracy was 84.21% (95% CI, 60.4%-96.62%; P = 0.004). In conclusion, LUS is easily used in the diagnosis of COVID-19 pneumonia because it has bedside application and is fast, easy to apply, reproducible, radiation free, safe for pregnant women, and cheap.

Lung ultrasound has greater accuracy than conventional respiratory assessment tools for the diagnosis of pleural effusion, lung consolidation and collapse: asystematic review.

In mechanically ventilated adults in intensive care, what is the accuracy of lung ultrasound (LUS) for the diagnosis of pleural effusion, lung consolidation and lung collapse when compared with chest radiograph (CXR) and lung auscultation, with computed tomography (CT) as the reference standard? Systematic review with meta-analysis of prospective cohort studies. Adult patients admitted to intensive care, with diagnostic uncertainty at enrolment regarding pleural effusion, lung consolidation and/or collapse/atelectasis. The diagnostic accuracy of LUS as the index test was estimated against CXR and/or lung auscultation as comparators, with thoracic CT scan as the reference standard. Measures of diagnostic accuracy. Seven eligible studies were identified, five of which (with 253 participants) were included in the meta-analysis. It was found that LUS had a pooled sensitivity of 92% and 91% in the diagnosis of consolidation and pleural effusion, respectively, and pooled specificity of 92% for both pathologies. CXR had a pooled sensitivity of 53% and 42% and a pooled specificity of 78% and 81% in the diagnosis of consolidation and pleural effusion, respectively. A meta-analysis for lung auscultation was not possible, although a single study reported a sensitivity and specificity of 8% and 100%, respectively, for diagnosing consolidation, and a sensitivity and specificity of 42% and 90%, respectively, for diagnosing pleural effusion. This systematic review with meta-analysis demonstrated high sensitivity of LUS compared with CXR, with similar specificities when diagnosing pleural effusion and lung consolidation/collapse. PROSPERO CRD42018095555.

Lung ultrasound in diagnosing neonatal respiratory distress syndrome: a meta-analysis

Background Neonatal respiratory distress syndrome (NRDS) is commonly diagnosed by clinical sign and symptoms, blood gas analysis, and chest x-ray. In the past, lung ultrasound (LUS) was not standard for NRDS examination. Many studies show that ultrasound diagnostic tool for NRDS is accurate, reliable, low cost, easy to use, and safe because due to no ionizing radiation.
 Objective To determine the sensitivity and specificity of LUS in diagnosing NRDS.
 Methods This meta-analysis study was conducted LUS as a diagnostic tool for NRDS. Inclusion criteria were all studies from PubMed, Embase, and The Cochrane Library, without any limitation on published journals, as well as using keywords or search terms of ultrasound, neonatal, and respiratory distress syndrome. Statistical analysis was undertaken using MedCalc® version 18.2 software.
 Results Seven studies with a total of 580 patients met the inclusion criteria. Proportional meta-analysis obtained random effects models, with total sensitivity of LUS was 97.2% (95% CI for I2 74.24 to 92.88; P<0.0001) and specificity of LUS was 94.8% (95% CI for I2 88.60 to 98.03; P<0.00001).
 Conclusion Lung ultrasound should be considered as a diagnostic tool for NRDS because it is high in sensitivity and specificity, inexpensive, safe, as well as limited radiation exposure.

Lung ultrasound for detecting pneumothorax in injured children: preliminary experience at a community-based Level II pediatric trauma center.

Ultrasound (US) has been used in the adult trauma population with reported moderate to high sensitivities, but data are scarce in the pediatric trauma population. The purpose of this study was to specifically examine the sensitivity and specificity of one lung US methodology (single-point anterior exam) in the pediatric trauma population when compared to chest radiography or CT. We conducted a retrospective review of pediatric trauma patients who received lung US as an extension of the focused assessment with sonography for trauma (FAST) exam. We compared lung US findings with chest radiography and CT scans. Two hundred twenty-six pediatric trauma patients underwent lung US exam with confirmatory exams; 11 pneumothoraces (4.8%) were observed. Of those 11, 6 were evaluated as false negatives on the lung US. Analyses resulted in 45.5% sensitivity, 98.6% specificity and 96.0% accuracy. Pneumothoraces undetected by lung US were small and apical and were likely not observed because of their size and location. None of the false negatives required intervention. All true positives were associated with lung contusions. Pneumothorax is less common in the pediatric than the adult trauma population, and when encountered in children pneumothorax is often occult and might be associated with lung contusions. Existing evidence supports the usefulness of chest US in detecting pneumothorax in adults and suggests that it can be translated to injured children. However, our findings suggest that the sensitivity of lung US as a single-point anterior exam extension of the FAST exam might not be as reliable in the pediatric trauma population as in adults. Other methodologies using lung US might improve sensitivity.

Bedside lung ultrasound in the diagnosis of pneumonia in very old patients

In several studies mainly undertaken in emergency departments, lung ultrasound (LUS) has a sensitivity similar and/or superior to the one of chest X-ray (CXR) in the diagnosis of pneumonia. The aim was to evaluate if LUS may be applied as first step imaging examination in the diagnosis of pneumonia also in medical/geriatric setting other than in emergency departments. We reviewed the clinical files of 128 very old patients (61 M and 67 F, age ranging from 78 to 94 yrs, mean 84.8 year) discharged in a period of 20 months with diagnosis of pneumonia in which both CXR and LUS were performed. The majority of patients had co-morbidities and/or motor disability and/or cognitive impairment. The sensitivity of LUS resulted in 82.03% (105/128) and those of CXR 75.78% (97/128): the difference was statistically not significant. Only the presence of pleural effusion resulted significantly higher with LUS when compared with the one observed with CXR (55.46% vs 37.5%, P=0.0039). The superiority of LUS with respect to CXR, although statistically not significant, suggests the use of ultrasound as a first step examination not only in emergency departments or in pediatric setting but also in very old patients with symptoms suspicious of pneumonia. The use of LUS in frail old patients with multiple co-morbidities can be easily carried out at the bedside and provides diagnostic information avoiding delaying the appropriate antimicrobial treatment.

Are Subpleural Consolidations on Lung Ultrasound Early Findings of Acute Chest Syndrome?

Background: Acute chest syndrome (ACS) is a common complication in patients with sickle cell disease (SCD) and is a leading cause of morbidity and mortality.Chest X-ray (CXR) is recommended for evaluating ACS in patients with SCD because clinical findings alone have a low sensitivity. Children with SCD are repeatedly exposed to diagnostic radiation for the evaluation of ACS. Lung ultrasound (LUS) has been compared to CXR as an alternative imaging modality for evaluating ACS, and a lung consolidation > 1 cm is sensitive and specific for diagnosing patients with ACS. Consolidations < 1 cm, or subpleural consolidations, can detect pneumonia earlier than CXR; however, the significance of these findings for evaluating ACS is unknown. We evaluated LUS with consolidations <1 cm to determine if they could identify patients with ACS.Methods: This is a prospective observational study that took place from November 2014-July 2016 in 2 urban pediatric emergency departments (EDs). The study population consisted of a convenience sample of patients with SCD from birth to 18 years of age at risk for ACS and who received a clinically-indicated CXR for suspected ACS. ACS was defined as a new pulmonary infiltrate on CXR together with the presence of fever, cough, chest pain, or respiratory symptoms. LUS were performed to evaluate for lung consolidation and determine the sensitivity, specificity, positive and negative likelihood ratios (LR+ and LR-) of LUS to identify ACS. In a subanalysis, the charts of patients who had a negative CXR interpreted by a pediatric radiologist or consolidation < 1 cm on LUS at the time of enrollment were reviewed for development of ACS within 7 days of the visit. The development of ACS in patients with subpleural findings on LUS was compared to patients with negative ultrasound findings. Fischer’s-Exact Test was used to determine significance between the 2 groups with α = 0.05.Results: One hundred sixty-eight patients were enrolled. ACS was diagnosed in 14% of patients, while a CXR was negative in 150 cases. The sensitivity of LUS to predict ACS was 91%, specificity was 91%, LR+ 10.5, LR- 0.1. Thirty-six cases had subpleural consolidation on LUS and 3 patients (8%) developed ACS. Of the 114 patients with negative LUS, 7 (6%) developed ACS. There was no statistical difference between these groups with p-value of 0.7.Conclusions: Patients with subpleural consolidations on LUS were no more likely to develop ACS than those patients with a negative LUS. The small number of patients who developed ACS may have failed to show a statistical difference between these groups. Further studies with serial ultrasound examinations are needed to better define the significance of this finding. DisclosuresMorris:MAST: Research Funding; Pfizer: Consultancy; Calithera: Consultancy; Nourish Life: Patents & Royalties: I am the inventor of IP owned by UCSF-Benioff Children’s Hospital that is licensed to NL; Endeavor: Consultancy; Nestle: Honoraria.

Accuracy of lung ultrasound for the diagnosis of consolidations when compared to chest computed tomography

ObjectivesDespite emerging evidences on the clinical usefulness of lung ultrasound (LUS), international guidelines still do not recommend the use of sonography for the diagnosis of pneumonia. Our study assesses the accuracy of LUS for the diagnosis of lung consolidations when compared to chest computed tomography (CT). MethodsThis was a prospective study on an emergency department population complaining of respiratory symptoms of unexplained origin. All patients who had a chest CT scan performed for clinical reasons were consecutively recruited. LUS was targeted to evaluate lung consolidations with the morphologic characteristics of pneumonia, and then compared to CT. ResultsWe analyzed 285 patients. CT was positive for at least one consolidation in 87 patients. LUS was feasible in all patients and in 81 showed at least one consolidation, with a good inter-observer agreement (k = 0.83), sensitivity 82.8% (95% CI 73.2%-90%) and specificity 95.5% (95% CI 91.5%-97.9%). Sensitivity raised to 91.7% (95% CI 61.5%-98.6%) and specificity to 97.4% (95% CI 86.5%-99.6%) in patients complaining of pleuritic chest pain. In a subgroup of 190 patients who underwent also chest radiography (CXR), the sensitivity of LUS (81.4%, 95% CI 70.7%-89.7%) was significantly superior to CXR (64.3%, 95% CI 51.9%-75.4%) (P<.05), whereas specificity remained similar (94.2%, 95% CI 88.4%-97.6% vs. 90%, 95% CI 83.2%-94.7%). ConclusionsLUS represents a reliable diagnostic tool, alternative to CXR, for the bedside diagnosis of lung consolidations in patients with respiratory complains.

Diagnosis of Radio-Occult Pulmonary Conditions by Real-Time Chest Ultrasonography in Patients with Pleuritic Pain

The evaluation of pleuritic pain in the emergency department (ED) presents a considerable challenge for the attending physician. Chest radiography (CXR) is a basic test, but its sensitivity is low, and often more sophisticated imaging techniques are needed. Our aim is to assess the diagnostic value of bedside B-mode lung ultrasound (LUS) in the visualization of radio-occult pulmonary lesions. Forty-nine patients complaining of pleuritic pain with negative CXR were prospectively studied by LUS. Detection of at least one of the following sonographic signs in the painful thoracic area was considered diagnostic: (i) the absence of pleural sliding; (ii) the focal alveolar-interstitial syndrome (AIS), defined by multiple artifacts B-line; (iii) the peripheral alveolar consolidation (PAC), defined by hypoechoic subpleural images; and (iv) the pleural disruption with thickening and irregularity of the line, with or without localized effusion. The final diagnoses were confirmed by spiral CT scanning ( n = 12) and follow-up ( n = 37). Final diagnoses were chest wall pain ( n = 30), pleuropneumonia ( n = 14), pulmonary embolism ( n = 4), lung metastasis ( n = 1). In 18 patients of the group with pulmonary conditions, LUS showed signs of pleurisy. They were PAC ( n = 12), AIS ( n = 17), pleural disruption ( n = 17). If any sign is considered, the sensitivity of LUS in the diagnosis of radio-occult lesions was 94.7%, specificity was 96.7%, positive and negative predictive values were 94.7% and 96.7%, respectively, and accuracy was 95.9%. In patients with pleuritic pain of unknown cause, real-time LUS enables the diagnosis of radio-occult lung and pleural lesions. (E-mail: gio.volpicelli@tin.it)