Thoracic ultrasound: An adjunctive and valuable imaging tool in emergency, resource-limited settings and for a sustainable monitoring of patients

Abstract

Imaging workup of patients referred for elective assessment of chest disease requires an articulated approach: Imaging is asked for achieving timely diagnosis. The concurrent or subsequent use of thoracic ultrasound (TUS) with conventional (chest X-rays-) and more advanced imaging procedures (computed tomography and magnetic resonance imaging) implies advantages, limitations and actual problems. Indeed, despite TUS may provide useful imaging of pleura, lung and heart disease, emergency scenarios are currently the most warranted field of application of TUS: Pleural effusion, pneumothorax, lung consolidation. This stems from its role in limited resources subsets; actually, ultrasound is an excellent risk reducing tool, which acts by: (1) increasing diagnostic certainty; (2) shortening time to definitive therapy; and (3) decreasing problems from blind procedures that carry an inherent level of complications. In addition, paediatric and newborn disease are particularly suitable for TUS investigation, aimed at the detection of congenital or acquired chest disease avoiding, limiting or postponing radiological exposure. TUS improves the effectiveness of elective medical practice, in resource-limited settings, in small point of care facilities and particularly in poorer countries. Quality and information provided by the procedure are increased avoiding whenever possible artefacts that can prevent or mislead the achievement of the correct diagnosis. Reliable monitoring of patients is possible, taking into consideration that appropriate expertise, knowledge, skills, training, and even adequate equipment’s suitability are not always and everywhere affordable or accessible. TUS is complementary imaging procedure for the radiologist and an excellent basic diagnostic tool suitable to be shared with pneumologists, cardiologists and emergency physicians.

Development and implementation of a comprehensive ultrasound curriculum for undergraduate medical students – a feasibility study

“…In the literature there is extensive support for eFAST, FEEL (Focused Echocardiography in Emergency Life Support) and thoracic ultrasound to aide the care for critically ill patients [14, 22, 23, 30, 31]. The European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) recommends a pre-clinical course to enhance student understanding of anatomy, physiology and pathology utilizing ultrasound and a clinical course which is supposed to teach students how to use ultrasound effectively as a problem-solving tool in the diagnosis of disease, recommending the combination of lectures and a peer-teaching concept [6].…”

Artificial Intelligence (AI) and Lung Ultrasound in Infectious Pulmonary Disease

“…In this regard, it must be strongly reiterated that quantifying erratic and unreliable measurements by machine counting methods is only a mystifying and misleading approach, without advantages, and is de facto dangerous in patient management. These beliefs are detrimental for the other best-supported ultrasound practices in any subset, including emergency and pediatrics ( 28 , 29 ). Lung ultrasound allows detecting lung consolidations in many patients with CXR-confirmed Community-Acquired Pneumonia, even giving, regretfully, false-negative results in a quarter of cases.…”

Ultrasound guiding the rapid diagnosis and treatment of perioperative pneumothorax: A case report

“…The negative predictive value for the diagnosis of pneumothorax by pleural slide sign has been reported as 100%. Pneumothorax can thus be excluded quickly and accurately by the existence of the surface pleural slide sign[ 13 ]. When pneumothorax is present, the visceral and parietal pleurae will be separated by gas.…”