Lung Ultrasound in the Diagnosis and Follow-up of Community-Acquired Pneumonia

Reißig, Angelika; Copetti, Roberto; Mathis, Gebhard; Mempel, Christine; Schüler, Andreas; Zechner, Peter; Aliberti, Stefano; Neumann, Rotraud; Kroegel, Claus; Hoyer, Heike

doi:10.1378/chest.12-0364

Cited by 371 publications

(339 citation statements)

References 14 publications

(22 reference statements)

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“…Besides, it is noteworthy to highlight the situations that related to false positive and false negative results. The specificity derived from our analysis was lower than previous studies, which was partly caused by the false-positive conditions on LUS: pleural adhesions, bullous emphysema, fluid bronchogram, past interstitial pathology, neoplasia, pulmonary infarction, sepsis of other origins, main-stem intubation on the contralateral side (17,18,20,24). By contrast, the false negative results usually occurred when the consolidation was located far away from pleura and hided deep in the lung parenchyma.…”

Section: Discussioncontrasting

confidence: 70%

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Effectiveness of lung ultrasonography for diagnosis of pneumonia in adults: a systematic review and meta-analysis

Yang¹,

Ying²,

Wang³

et al. 2016

J. Thorac. Dis.

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Background: Pneumonia is usually presented as a forgotten killer, and an early diagnosis could largely improve the prognostic outcomes. Lung ultrasound (LUS) has been universally applied in evaluating multiple pulmonary diseases including pneumonia. However, the diagnosis accuracy of LUS for pneumonia in adults is still uncertain. Hence, we performed a systematic review of the current literature to assess the diagnosis accuracy of LUS for pneumonia in adults.Methods: PubMed and EMBASE were searched for clinical trials that assessed the detection accuracy of LUS for pneumonia in adult patients. We extracted descriptive and quantitative information from eligible studies that met strict inclusion criteria and calculated pooled sensitivity, specificity and pooled diagnostic likelihood ratios (LR). Summary receiver operating characteristic (sROC) curve was used to assess the overall performance of LUS-based assays.Results: We reviewed 1,072 articles and selected 38 for detailed review. 14 articles containing 1,911 participants met all inclusion criteria and were included in the final analysis. LUS exhibited a pooled sensitivity of 0.904 (0.884-0.921), specificity of 0.884 (0.861-0.904), positive LR of 6.6 (3.7-11.7), negative LR of 0.08 (0. 04-0.19) and the area under curve (AUC) was 0.9611. Interestingly, when CT alone, CT combined with clinical presentations, and microbiology was set as the gold standard of pneumonia respectively, LUS demonstrated a pooled sensitivity of 90.9%, 95.0%, 53.3%, and a pooled specificity of 89.7%, 91.3% and 67.9%. In extension, we compared the diagnostic efficiency of LUS for pneumonia with chest X-ray (CXR) in 1,343 patients. The AUC for LUS and CXR was 0.972 and 0.867 respectively and the Z statistic of the two sROC curves was 2.31.Conclusions: Our study indicated that LUS is a robust diagnostic tool for pneumonia with high accuracy.Utilization of LUS would facilitate the estimation of pneumonia at bedside. be based on swift and accurate recognition. The signs and symptoms localizing to the respiratory system, commonly referring as dyspnea, cough and fever, laboratory alterations (leukocytosis and increased c-reactive protein/procalcitonin) in conjunction with radiographic pulmonary infiltrate, point to convincing diagnosis of pneumonia. Imaging evaluation approaches recommended on current guidelines are chest radiograph and chest computerized tomography (CT) (2,3). However, limitations for their use exist (4). Surprisingly, a recent study compared CXR to chest CT scan for suspected CAP. They found up to 30% false positive and false negative rate of CXR in emergency department (ED), which doubted the value of CXR on pneumonia diagnosis (5). Thus, it's reasonable to figure out the alternative way to provide promising imaging evidence of pneumonia.Ultrasonography is gaining more attention in critical care and emergency medicine. A good body of studies has proven that ultrasonography is highly effective in evaluating multiple pulmonary diseases, such as metastatic lymph node of lung c...

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Section: Discussioncontrasting

confidence: 70%

“…Among all 14 studies, 11 were carried out in emergency department (ED) or medical wards (10,(15)(16)(17)(18)(19)(20)(22)(23)(24)(25), and 3 were conducted in intensive care unit (ICU) (14,21,26). Hemithorax was used as the study unit for result interpretation in one study (23), while others counted by patient.…”

Section: Characteristics Of Selected Studiesmentioning

confidence: 99%

Effectiveness of lung ultrasonography for diagnosis of pneumonia in adults: a systematic review and meta-analysis

Yang¹,

Ying²,

Wang³

et al. 2016

J. Thorac. Dis.

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“…22 By adding changes in ultrasound pattern detected in each region of interest, ultrasound scores or re-aeration have been proposed and correlated to reference methods for quantifying lung aeration changes (computed tomography, extravascular lung water, pulmonary wedge pressure, PV curves, lung lavage for alveolar proteinosis). 4,[22][23][24][25][26][27] Bedside transthoracic lung ultrasound has been demonstrated to be accurate for assessing re-aeration following fluid depletion in patients with hemodynamic pulmonary edema, PEEP-induced alveolar recruitment in ARDS, 4 lung re-aeration resulting from efficient antimicrobial therapy in patients with community-acquired 28 or ventilator-associated pneumonia, 22 and derecruitment observed at the early phase of acute lung injury 29 or during a spontaneous breathing trial. 30 Two different lung ultrasound scores have been proposed to assess lung recruitment and derecruitment induced by various treatments and lung diseases.…”

Section: Methods Based On Transthoracic Lung Ultrasoundmentioning

confidence: 99%

Measurement of Alveolar Recruitment at the Bedside: The Beginning of a New Era in Respiratory Monitoring?

et al. 2013

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“…By observing shape and echo-genic characteristics, it is possible to differentiate benign from malignant lesions. A cuneal shape or air bronchogram (Reissig and Kroegel, 2007;Sperandeo et al, 2011;Reissig et al, 2012) within a hypoechoic mass is highly suggestive of chronic inflammation (Figures 1, 2 and Table 3). Anatomically, pulmonary inflammation usually affects a segment or part of a segment of lung tissue, which leads to a cuneiform shape because of the bronchial construction.…”

Section: Discussionmentioning

confidence: 99%

Clinical value of ultrasound-guided percutaneous biopsy of pulmonary lesions

Yang

Ruan

et al. 2015

Genet. Mol. Res.

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ABSTRACT. The purpose of this study was to evaluate the applicability of ultrasound-guided percutaneous biopsy for the diagnosis and differentiation of various pulmonary lesions in a Chinese population. A total of 338 pulmonary lesions were biopsied with 18-gauge cutting needles, guided by ultrasound, and sent for histopathological analysis. The ultrasonographic characteristics of these lesions, procedure complications, and histopathological diagnoses were analyzed. Sufficient specimen for histopathologic analysis was obtained in 95.64% (351/367), and mild complications occurred in 2.72% (10/367) of the patients. Accurate diagnosis was obtained in 94.03% (315/335) of the patients; 16 were lost to follow-up. Using the combination of shape and echogenicity to distinguish benign vs malignant lesions, diagnostic sensitivity and specificity were 57.39 and 95.65%, respectively. No significant difference was found between malignant and benign lesions in blood flow signals. Ultrasound-guided core biopsy is valuable for the diagnosis, management, and prognosis of unknown pulmonary lesions. Shape and echogenicity on ultrasonography correlate well with histopathology and provide useful information for distinguishing between Ultrasound-guided percutaneous biopsy benign and malignant lesions. On the contrary, color Doppler is of little value for this purpose.

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Lung Ultrasound in the Diagnosis and Follow-up of Community-Acquired Pneumonia

Cited by 371 publications

References 14 publications

Effectiveness of lung ultrasonography for diagnosis of pneumonia in adults: a systematic review and meta-analysis

Effectiveness of lung ultrasonography for diagnosis of pneumonia in adults: a systematic review and meta-analysis

Measurement of Alveolar Recruitment at the Bedside: The Beginning of a New Era in Respiratory Monitoring?

Clinical value of ultrasound-guided percutaneous biopsy of pulmonary lesions

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