scholarly journals Value of a chest X-ray and CT to diagnose acute heart failure in acute patients with dyspnoea: a prospective comparative diagnostic study in the emergency department

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
K Miger ◽  
A Fabricius-Bjerre ◽  
A.S Overgaard Olesen ◽  
N Host ◽  
N Kober ◽  
...  
Keyword(s):  
Heart Failure ◽  
Emergency Department ◽  
False Negative ◽  
Chest Ct ◽  
Pulmonary Congestion ◽  
Acute Setting ◽  
X Ray ◽  
Chest X Ray ◽  
Universal Definition ◽  
Definition Of

Abstract Background and purpose Diagnosing heart failure (HF) remains difficult in the acute setting where multiple diagnoses are in play. Objective evidence of pulmonary congestion by chest X-ray (CXR) is one criteria for the recent universal definition of heart failure (UniHF). But, since CXR is known to have a low diagnostic value, we hypothesized that a chest CT (CT) would outdo the CXR to diagnose decompensated HF in acute breathless patients. This study's primary objective was to examine if the CT has higher accuracy than the CXR to diagnose HF in the acute setting; and, secondly, to identify what pre-test characteristics would predict a false negative CXR or CT. Methods We performed a single-centre, prospective observational study and included consecutive adult patients with dyspnoea in the emergency department. Patients underwent immediate clinical examination, blood tests, CXR, CT and an echocardiogram. Congestion on CXR and CT was defined as the congruent verdict by two expert thorax radiologists, blinded to each others reading and all other clinical data. The absence of congestion was defined as the congruent verdict of “no congestion”. Congestion of CXR and CT was held up against UniHF ascertained by an expert panel of cardiologists where the pulmonary congestion component primarily was based on elevated filling pressures from the simultaneous comprehensive echocardiogram. Univariate- and multivariate logistic analyses identified factors associated with a false negative chest x-ray and CT. Results Of 228 patients with a mean age of 74,5 years, 129 (56,5%) were male, 98 (43%) had UniHF, and 139 (61.0%) had pulmonary disease. Congestion on the CXR diagnosed UniHF with a 54% sensitivity and 95% specificity, with almost similar figures for the CT with 54% and 99% respectively. A marginally better performance of the CT was shown by a significantly lower Akaike Information Criterion for pulmonary congestion by CT than for CXR. However, the net reclassification improvement by CT was 4% (p:0.5586). The CXR and CT were false negative for UniHF in 46% (45/98) for both modalities (Table 1). The only independent pre-test predictor of a false negative radiology examination in multivariable logistic regression analysis was NT-proBNP (CXR: OR 1.670 per log(BNP), p: <0.001) and CT: OR 1.693 per log(BNP), p: <0.001). Conclusions For the first time, CT has been directly compared with CXR to diagnose HF in consecutive breathless patients from the emergency department. The chest CT was marginally more specific than the CXR to diagnose HF, but with a similar sensitivity. Approximately half the patients obeying the universal definition of HF have no definite congestion on CXR nor CT, and these can only be identified by a high proBNP. FUNDunding Acknowledgement Type of funding sources: None. Table 1

scholarly journals Simple Pneumonia or Something More?: A Case Report and Discussion of Unexpected Empyema Identified by Point-of-Care Ultrasound

CJEM ◽  
2015 ◽  
Vol 18 (5) ◽  
pp. 391-394
Author(s):  
Michael Romano ◽  
Tomislav Jelic ◽  
Jordan Chenkin
Keyword(s):  
Emergency Department ◽  
Point Of Care ◽  
Fluid Collection ◽  
Chest Ct ◽  
Point Of Care Ultrasound ◽  
X Ray ◽  
Level Of Consciousness ◽  
Chest X Ray ◽  
Ultrasound Assessment ◽  
Higher Sensitivity

AbstractThere is evidence to suggest that point-of-care ultrasound assessment of the lungs has a higher sensitivity and specificity than chest radiography for the diagnosis of pneumonia. It is unknown if the same is true for pneumonia complications. We present and discuss the case of a 61-year-old woman who presented to the emergency department with confusion, decreased level of consciousness, and signs of sepsis. A chest x-ray revealed a right sided infiltrate. An ultrasound of the patient’s lungs was performed, and revealed a complex loculated fluid collection consistent with an empyema. A chest CT confirmed the diagnosis, and immediate percutaneous drainage was performed.

scholarly journals Case Report: Semilunar Sign of Trans-Mediastinal Herniation of Giant Bullae with Tension Hydropneumothrax

2020 ◽  
Vol 56 (4) ◽  
pp. 320
Author(s):  
Anastasia Tjan ◽  
I Made Dwija Putra Ayusta ◽  
Dewa Gde Mahiswara
Keyword(s):  
Emergency Department ◽  
Case Report ◽  
Severe Disease ◽  
Chest Ct ◽  
Fluid Level ◽  
Tube Insertion ◽  
X Ray ◽  
Giant Bulla ◽  
Chest X Ray ◽  
Giant Bullae

Herniation of bulla across mediastinum is rare, while transmediastinal giant bulla herniation accompanied with hydropneumothorax is even rarer. We report a case of an 18 years old male with dyspnea came to emergency department with trans-mediastinal giant bulla herniation, which appears as semilunar sign on chest x-ray, and right hydropneumothoraks. It appeared that the giant bulla also infected by the presence of air fluid level within. Semilunar sign was seen on the contralateral left mediastinum as the hallmark finding for trans-mediastinal herniation of bulla. Chest CT further confirms the diagnosis. Subsequently chest tube insertion and symptomatic relives were given, however the patient end up dead after 2 days of observation. Heart and lung compression by the lesions were the cause of this patient poor outcome. Bullous lung disease should be evaluated thoroughly and not underestimated since it could cause severe disease progression. 

scholarly journals Strange case of biventricular heart failure

2021 ◽  
Vol 14 (1) ◽  
pp. e239658
Author(s):  
Carloalberto Biolè ◽  
Matteo Bianco ◽  
Antonella Parente ◽  
Laura Montagna
Keyword(s):  
Heart Failure ◽  
Pulmonary Embolism ◽  
Cardiac Amyloidosis ◽  
Left Ventricular ◽  
Pulmonary Congestion ◽  
Transthyretin Amyloidosis ◽  
X Ray ◽  
Infiltrative Cardiomyopathy ◽  
Mild Reduction ◽  
Chest X Ray

Acute heart failure (HF) is commonly caused by a cardiomyopathy with one or more precipitating factor. Here, a case in which a cardiomyopathy is precipitated by pulmonary embolism (PE). A 77-year-old man is admitted for breathlessness and leg swelling. A mild reduction of left ventricular (LV) ejection fraction is found, with moderately increased LV wall thickness and pulmonary hypertension; clinical examination revealed signs of congestion with bilateral leg swelling, and mild signs of left HF with the absence of pulmonary congestion on chest X-ray. The ECG showed Mobitz I second-degree atrioventricular block. The clinical scenario led us to the diagnosis of infiltrative cardiomyopathy due to cardiac amyloidosis (CA) precipitated by PE. Pulmonary embolism is an overlooked precipitant of HF and can be the first manifestation of an underlying misdiagnosed cardiomyopathy, especially CA. 3,3-Diphosphono-1,2-propanodicarboxylic acid scan is a cornerstone in the diagnosis of Transthyretin amyloidosis (ATTR) cardiac amyloidosis.

scholarly journals Focused Ultrasound In The Emergency Department For Patients With Acute Heart Failure

2015 ◽  
Vol 1 (2) ◽  
pp. 83 ◽  
Author(s):  
Frances M Russell ◽  
Matt Rutz ◽  
Peter S Pang ◽  
◽  
◽  
...  
Keyword(s):  
Heart Failure ◽  
Emergency Department ◽  
Acute Heart Failure ◽  
Efficient Method ◽  
Focused Ultrasound ◽  
Initial Diagnosis ◽  
X Ray ◽  
Diagnosis And Management ◽  
Novel Biomarkers ◽  
Chest X Ray

The emergency department (ED) plays a key role in the initial diagnosis and management of acute heart failure (AHF). Despite the advent of novel biomarkers and traditional methods of assessment, such as history, examination, and chest X-ray, diagnosis of the dyspnoeic ED patient is, at times, very challenging. Focused cardiac and pulmonary ultrasound has emerged as a valid, facile and efficient method to aid in the initial diagnosis and management of AHF.

Clinical Applicability of Lung Ultrasound Methods in the Emergency Department to Detect Pulmonary Congestion on Computed Tomography

2019 ◽  
Author(s):  
Kristina Cecilia Miger ◽  
Andreas Fabricius-Bjerre ◽  
Christian Peter Maschmann ◽  
Jesper Wamberg ◽  
Mathilde Marie Winkler Wille ◽  
...  
Keyword(s):  
Heart Failure ◽  
Emergency Department ◽  
Pleural Effusion ◽  
Lung Ultrasound ◽  
Decompensated Heart Failure ◽  
Diagnostic Value ◽  
Chest Ct ◽  
Chronic Obstructive ◽  
Pulmonary Congestion ◽  
B Lines

Abstract Background B-lines on lung ultrasound are seen in decompensated heart failure, but their diagnostic value in consecutive patients in the acute setting is not clear. Chest CT is the superior method to evaluate interstitial lung disease, but no studies have compared lung ultrasound directly to congestion on chest CT. Purpose To examine whether congestion on lung ultrasound equals congestion on a low-dose chest CT as the gold standard. Materials and Methods In a single-center, prospective observational study we included consecutive patients ≥ 50 years of age in the emergency department. Patients were concurrently examined by lung ultrasound and chest CT. Congestion on lung ultrasound was examined in three ways: I) the total number of B-lines, II) ≥ 3 B-lines bilaterally, III) ≥ 3 B-lines bilaterally and/or bilateral pleural effusion. Congestion on CT was assessed by two specialists blinded to all other data. Results We included 117 patients, 27 % of whom had a history of heart failure and 52 % chronic obstructive pulmonary disease. Lung ultrasound and CT were performed within a median time of 79.0 minutes. Congestion on CT was detected in 32 patients (27 %). Method I had an optimal cut-point of 7 B-lines with a sensitivity of 72 % and a specificity of 81 % for congestion. Method II had 44 % sensitivity, and 94 % specificity. Method III had a sensitivity of 88 % and a specificity of 85 %. Conclusion Pulmonary congestion in consecutive dyspneic patients ≥ 50 years of age is better diagnosed if lung ultrasound evaluates both B-lines and pleural effusion instead of B-lines alone.

Case File: Use of POCUS for assessment of dyspnea in the Emergency Department

POCUS Journal ◽  
2016 ◽  
Vol 1 (1) ◽  
pp. 2 ◽  
Author(s):  
Jennifer Meloche, MD
Keyword(s):  
Heart Failure ◽  
Emergency Department ◽  
Deep Breathing ◽  
Shortness Of Breath ◽  
Chest Discomfort ◽  
X Ray ◽  
Case File ◽  
Kingston General Hospital ◽  
Chest X Ray ◽  
Electrocardiogram Ecg

A 65 year-old man presented to the Emergency Department at Kingston General Hospital with progressive shortness of breath, fatigue, dull chest discomfort that worsened with deep breathing and exertion. The patient was referred to cardiology for congestive heart failure and ordered troponin, chest x-ray (CXR), and electrocardiogram (ECG).

scholarly journals Semilunar Sign of Trans-Mediastinal Herniation of Giant Bullae with Tension Hydropneumothrax

2021 ◽  
Vol 56 (4) ◽  
pp. 320
Author(s):  
Anastasia Tjan ◽  
I Made Dwija Putra Ayusta ◽  
Dewa Gde Mahiswara
Keyword(s):  
Emergency Department ◽  
Chest Tube ◽  
Severe Disease ◽  
Chest Ct ◽  
Fluid Level ◽  
Tube Insertion ◽  
X Ray ◽  
Giant Bulla ◽  
Chest X Ray ◽  
Giant Bullae

Herniation of bulla across mediastinum is rare, while transmediastinal giant bulla herniation accompanied with hydropneumothorax is even rarer. We report a case of an 18 years old male with dyspnea came to emergency department with trans-mediastinal giant bulla herniation, which appears as semilunar sign on chest x-ray, and righthydropneumothoraks. It appeared that the giant bulla also infected by the presence of air fluid level within. Semilunar sign was seen on the contralateral left mediastinum as the hallmark finding for trans-mediastinal herniation of bulla. Chest CT further confirms the diagnosis. Subsequently chest tube insertion and symptomatic relives were given, however the patient end up dead after 2 days of observation. Heart and lung compression by the lesions were the cause of this patient poor outcome. Bullous lung disease should be evaluated thoroughly and not underestimated since it could cause severe disease progression. 

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