Assessment of thoracic ultrasound in complementary diagnosis and in follow up of community-acquired pneumonia (cap)

Abstract

BackgroundChest X-ray (CXR) is the primary diagnostic tool for community-acquired pneumonia (CAP). Some authors recently proposed that thoracic ultrasound (TUS) could valuably flank or even reliably substitute CXR in the diagnosis and follow-up of CAP. We investigated the clinical utility of TUS in a large sample of patients with CAP, to challenge the hypothesis that it may be a substitute for CXR.MethodsOut of 645 consecutive patients with a CXR-confirmed CAP diagnosed in the emergency room of our hospital over a three-years period, 510 were subsequently admitted to our department of Internal Medicine. These patients were evaluated by TUS by a well-trained operator who was blinded of the initial diagnosis. TUS scans were performed both at admission and repeated at day 4-6th and 9-14th during stay.ResultsTUS identified 375/510 (73.5%) of CXR-confirmed lesions, mostly located in posterior-basal or mid-thoracic areas of the lungs. Pleural effusion was detected in 26.9% of patients by CXR and in 30.4% by TUS. TUS documented the change in size of the consolidated areas as follows: 6.3 ± 3.4 cm at time 0, 2.5 ± 1.8 at 4-6 d, 0.9 ± 1.4 at 9-14 d. Out of the 12 patients with delayed CAP healing, 7 of them turned out to have lung cancer.ConclusionsTUS allowed to detect lung consolidations in over 70% of patients with CXR-confirmed CAP, but it gave false negative results in 26.5% of cases. Our longitudinal results confirm the role of TUS in the follow-up of detectable lesions. Thus, TUS should be regarded as a complementary and monitoring tool in pneumonia, instead of a primary imaging modality.

Streptococcus pneumoniae’s Virulence and Host Immunity: Aging, Diagnostics, and Prevention

“…Currently, thoracic ultrasounds are being investigated as a method for diagnosing CAP ( 299 ). When compared to chest X-rays, thoracic ultrasounds identified 73.5% of the lung consolidations confirmed by chest X-rays, with about 27% false negative results.…”

The lung ultrasound: facts or artifacts? In the era of COVID-19 outbreak

“…B-lines can resolve rapidly in response to treatment, and, therefore, LUS data must be interpreted in the context of previous interventions [33,34]. B-lines can be seen in several of pulmonary conditions, including pulmonary fibrosis or interstitial lung disease, ARDS, trauma, asthma, and pneumonitis (Table 3) [31,32,[35][36][37][38][39]. However, the coexistence of diffuse B-lines echo-pattern with the presence of heterogeneous lung echo-texture, irregular thickened pleura and presence of scattered "shred sign" could help in diagnosing multifocal pneumonia complicated by ARDS on the related severe degree of hypoxemia, but the ultrasound findings for a consolidation are not specific and must necessarily be correlated with the clinical history, as in the case of aspiration pneumonia (Fig.…”

“…They are generated by distinct mechanisms: while reverberation due to acoustic impedance difference (soft tissue/metals; bile/cholesterol; soft tissue/gas) is the mechanism of generating comet tail artifacts, the B lines are caused by resonant vibration due to bubble tetrahedral complexes or their equivalents (Fig. 14c, d) [14,37]. Using pneumothorax and interstitial syndrome as examples, the lung comets and B-lines have distinct roles in disease diagnosis and the potential pitfalls if they are simply lumped together and called comet tail artifacts (Table 3) [44].…”

Accuracy of lung ultrasonography in the hands of non-imaging specialists to diagnose and assess the severity of community-acquired pneumonia in adults: a systematic review

“…The database search identified 7285 individual, nonduplicate articles, and one potential article was identified through the reference lists (figure 1). Twelve studies had little or no information about the physician performing LUS [17][18][19][20][21][22][23][24][25][26][27][28] and we contacted the corresponding authors of these studies. Based on additional information provided by the study authors, two studies were included 18 27 and two studies were excluded.…”