Effectiveness of chest radiography, lung ultrasound and thoracic computed tomography in the diagnosis of congestive heart failure

Abstract

Hydrostatic pulmonary edema is as an abnormal increase in extravascular water secondary to elevated pressure in the pulmonary circulation, due to congestive heart failure or intravascular volume overload. Diagnosis of hydrostatic pulmonary edema is usually based on clinical signs associated to conventional radiography findings. Interpretation of radiologic signs of cardiogenic pulmonary edema are often questionable and subject. For a bedside prompt evaluation, lung ultrasound (LUS) may assess pulmonary congestion through the evaluation of vertical reverberation artifacts, known as B-lines. These artifacts are related to multiple minimal acoustic interfaces between small water-rich structures and alveolar air, as it happens in case of thickened interlobular septa due to increase of extravascular lung water. The number, diffusion and intensity of B lines correlates with both the radiologic and invasive estimate of extravascular lung water. The integration of conventional chest radiograph with LUS can be very helpful to obtain the correct diagnosis. Computed tomography (CT) is of limited use in the work up of cardiogenic pulmonary edema, due to its high cost, little use in the emergencies and radiation exposure. However, a deep knowledge of CT signs of pulmonary edema is crucial when other similar pulmonary conditions may occasionally be in the differential diagnosis.

Sensitivity and specificity of ultrasound for the diagnosis of acute pulmonary edema: a systematic review and meta-analysis

“…The sensitivity of chest radiography, BNP, and NT proBNP tests in the diagnosis of acute dyspnea ranged from 56%-93%, 86%-99% and 92%-97%, respectively, while the specificity ranged from 51%-98%, 74%-99% and 44%-93%, respectively [11,[15][16][17][20][21][22][23][24][25]. Although high sensitivity and specificity of the mentioned diagnostic methods were reported, real-time valuation of the outcome is almost impossible and the assessments are not available in the pre-hospital setting.…”

Kerley a Line in an 18-Year-Old Female With Acute Pulmonary Edema and Chronic Kidney Disease Stage V

“…A chest X-ray is commonly used to help assessing pulmonary congestion. 11 Especially, when there is not available other procedures like ultrasound or CT.…”

Accuracy of Daily Lung Ultrasound for the Detection of Pulmonary Edema Following Subarachnoid Hemorrhage

“…The SAH patient is at risk for multiple other pulmonary diseases, such as atelectasis, aspiration, and pneumonia. Physical examination and bedside radiography are, unfortunately, insensitive and non-specific for the diagnosis of pulmonary edema [14][15][16]. While transpulmonary thermodilution with pulse contour analysis may be useful in estimating global end diastolic volume and extravascular lung water in the setting of SAH, this technique requires specialized equipment as well as central venous and arterial access [17].…”