scholarly journals Lung ultrasound volume sweep imaging for respiratory illness: a new horizon in expanding imaging access

2021 ◽  
Vol 8 (1) ◽  
pp. e000919
Author(s):  
Thomas J Marini ◽  
Justin M Weis ◽  
Timothy M Baran ◽  
Jonah Kan ◽  
Steven Meng ◽  
...  
Keyword(s):  
Clinical Diagnosis ◽  
Lung Ultrasound ◽  
Video Clip ◽  
High Sensitivity ◽  
Respiratory Illness ◽  
Diagnostic Value ◽  
X Ray ◽  
Brief Training ◽  
Hospitalised Patients ◽  
Chest X Ray

BackgroundRespiratory illness is a leading cause of morbidity in adults and the number one cause of mortality in children, yet billions of people lack access to medical imaging to assist in its diagnosis. Although ultrasound is highly sensitive and specific for respiratory illness such as pneumonia, its deployment is limited by a lack of sonographers. As a solution, we tested a standardised lung ultrasound volume sweep imaging (VSI) protocol based solely on external body landmarks performed by individuals without prior ultrasound experience after brief training. Each step in the VSI protocol is saved as a video clip for later interpretation by a specialist.MethodsDyspneic hospitalised patients were scanned by ultrasound naive operators after 2 hours of training using the lung ultrasound VSI protocol. Separate blinded readers interpreted both lung ultrasound VSI examinations and standard of care chest radiographs to ascertain the diagnostic value of lung VSI considering chest X-ray as the reference standard. Comparison to clinical diagnosis as documented in the medical record and CT (when available) were also performed. Readers offered a final interpretation of normal, abnormal, or indeterminate/borderline for each VSI examination, chest X-ray, and CT.ResultsOperators scanned 102 subjects (0–89 years old) for analysis. Lung VSI showed a sensitivity of 93% and a specificity of 91% for an abnormal chest X-ray and a sensitivity of 100% and a specificity of 93% for a clinical diagnosis of pneumonia. When any cases with an indeterminate rating on chest X-ray or ultrasound were excluded (n=38), VSI lung ultrasound showed 92% agreement with chest X-ray (Cohen’s κ 0.83 (0.68 to 0.97, p<0.0001)). Among cases with CT (n=21), when any ultrasound with an indeterminate rating was excluded (n=3), there was 100% agreement with VSI.ConclusionLung VSI performed by previously inexperienced ultrasound operators after brief training showed excellent agreement with chest X-ray and high sensitivity and specificity for a clinical diagnosis of pneumonia. Blinded readers were able to identify other respiratory diseases including pulmonary oedema and pleural effusion. Deployment of lung VSI could benefit the health of the global community.

Diagnostic value of ultrasound in cases of pneumonia admitted at intensive care unit: A comparative study with chest x-ray

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Sherif Farouk Ibrahim ◽  
Waleed Abdalla Ibrahim ◽  
Hossam Mohamed Khalaf Ahmed
Keyword(s):  
Lung Ultrasound ◽  
Acute Infection ◽  
Retrospective Chart Review ◽  
Diagnostic Algorithm ◽  
High Sensitivity ◽  
Diagnostic Value ◽  
Adequate Treatment ◽  
X Ray ◽  
Diagnostic Uncertainty ◽  
Chest X Ray

Abstract Background Pneumonia is consistently among the leading causes of morbidity and mortality worldwide. Defined as acute infection of the lung parenchyma, it is caused by a wide variety of microorganisms, including bacteria, viruses, and fungi. However, pneumonia is often misdiagnosed even now. Early and effective antibiotic treatment is important. An adequate treatment is thus reliant on an early diagnosis of pneumonia, yet the diagnosis is not always clear at presentation to the emergency department (ED). In a retrospective chart review of patients admitted with pneumonia, 22% of patients presented some reason for diagnostic uncertainty that could result in delayed antibiotics delivery. Objective The aim of the study was to evaluate the efficacy of LUS in the diagnosis of pneumonia. Methods This is a prospective observational study which was conducted on 36 consecutive patients with suspected pneumonia. All patients were admitted to the Hospital, in the period from May 2019 to January 2020. Results Chest x-ray diagnosed pneumonia in 66.7% of patients, while lung U/S diagnosed pneumonia in 75% of patients. Lung ultrasound was more sensitive and highly specific for diagnosis of pneumonia as sensitivity and specificity of lung ultrasound was 96.3% and 88.9% respectively while for chest xray was 81.5% and 77.8% respectively. Accuracy of lung ultrasound was 94.4% and that of chest x-ray was 80.6% in relation to CT chest the gold standard with accuracy 100%. Superiority of lung US findings over CXR findings could be explained by high sensitivity & specificity of lung US in diagnosing pneumonia in comparison with chest x ray as high resolution CT is a gold standred for the study. Conclusion LUS is a sensitive and highly specific diagnostic tool in pneumonia. Therefore, we hypothesize that Lung US may be considered as the first imaging test inpatients with suspicion of pneumonia. It should be noted, however, that the ability of LUS to detect lung consolidations located in peri-hilar regions is limited. A diagnostic algorithm of pneumonia which includes Lung US should be validated in prospective studies. Monitoring there solution of pneumonia can be another application of Lung US inpatients with pneumonia.

Lung Ultrasound versus Chest X-Ray for the Detection of Fluid Overload in Critically Ill Children: A Systematic Review

2021 ◽  
Author(s):  
Emily Schapka ◽  
Jerica Gee ◽  
John W. Cyrus ◽  
Gregory Goldstein ◽  
Kara Greenfield ◽  
...  
Keyword(s):  
Systematic Review ◽  
Critically Ill ◽  
Lung Ultrasound ◽  
Fluid Overload ◽  
Volume Overload ◽  
High Sensitivity ◽  
Critically Ill Children ◽  
Eligibility Criteria ◽  
X Ray ◽  
Chest X Ray

AbstractFluid overload is a common complication of critical illness, associated with increased morbidity and mortality. Pulmonary fluid status is difficult to evaluate clinically and many clinicians utilize chest X-ray (CXR) to identify fluid overload. Adult data have shown lung ultrasound (LUS) to be a more sensitive modality. Our objective was to determine the performance of LUS for detecting fluid overload, with comparison to CXR, in critically ill children. We conducted a systematic review using multiple electronic databases and included studies from inception to November 15, 2020. The sensitivity and specificity of each test were evaluated. Out of 1,209 studies screened, 4 met eligibility criteria. Overall, CXR is reported to have low sensitivity (44–58%) and moderate specificity (52–94%) to detect fluid overload, while LUS is reported to have high sensitivity (90–100%) and specificity (94–100%). Overall, the quality of evidence was moderate, and the gold standard was different in each study. Our systematic review suggests LUS is more sensitive and specific than CXR to identify pulmonary fluid overload in critically ill children. Considering the clinical burden of fluid overload and the relative ease of obtaining LUS, further evaluation of LUS to diagnose volume overload is warranted.

scholarly journals Lung Ultrasound: new Opportunities for a Cardiologist

Kardiologiia ◽  
2020 ◽  
Vol 60 (1) ◽  
pp. 81-92
Author(s):  
A. Z. Arystan ◽  
Y. T. Khamzina ◽  
V. V. Benberin ◽  
D. V. Fettser ◽  
Y. N. Belenkov
Keyword(s):  
Lung Ultrasound ◽  
Ultrasound Examination ◽  
Cost Effective ◽  
Diagnostic Value ◽  
Ultrasound Finding ◽  
Time Saving ◽  
X Ray ◽  
Cardiac Decompensation ◽  
Chest X Ray

This review focused on ultrasound examination of lungs, a useful complement to transthoracic echocardiography (EchoCG), which is superior to chest X-ray in the diagnostic value. The lung acoustic window always remains open and allows obtaining high-quality images in most cases. For a cardiologist, the major points of the method application are determination of pleural effusion and lung congestion. This method has a number of advantages: it is time-saving; cost-effective; portable and accessible; can be used in a real-time mode; not associated with radiation; reproducible; and highly informative. The ultrasound finding of wet lungs would indicate threatening, acute cardiac decompensation long before appearance of clinical, auscultative, and radiological signs of lung congestion. Modern EchoCG should include examination of the heart and lungs as a part of a single, integrative ultrasound examination.

scholarly journals Implementing Lung Ultrasound in the Outpatient Management of COVID-19 Pneumonia: A Pilot Study to Update Local Guidelines

2021 ◽  
Vol 8 ◽  
Author(s):  
Chloé Chevallier Lugon ◽  
Aileen Kharat ◽  
Paola M. Soccal ◽  
Idris Guessous ◽  
Hervé Spechbach ◽  
...  
Keyword(s):  
Systematic Approach ◽  
Lung Ultrasound ◽  
High Sensitivity ◽  
Descriptive Statistics ◽  
X Rays ◽  
Single Center ◽  
X Ray ◽  
Ambulatory Patients ◽  
Chest X Ray

Background: Lung ultrasound (LUS) has a good performance with a high sensitivity and specificity for the diagnosis of pneumonia compared with chest X-ray, and it has been extensively used to assess patients during the COVID-19 pandemic. This study aims to evaluate the potential advantages of the regular use of LUS for the assessment of the severity and prognosis of COVID-19 pneumonia and to propose an adapted protocol with its inclusion in current local validated and published guidelines.Methods: This is a single-center prospective study conducted during the first (April–May 2020) and second (October 2020–January 2021) waves of the SARS-CoV2 pandemic in Switzerland. All adult patients presenting to dedicated test centers with a suspicion of mild-to-moderate COVID-19 pneumonia and not requiring hospitalization at the time of diagnosis were included. Patients with confirmed COVID-19 pneumonia were referred to an ambulatory follow-up unit at our institution for reassessment, with the inclusion of the use of LUS in a random selection. Descriptive statistics were calculated for demographics using percentages, means, and standard deviations according to the distribution of variables.Results: Eighty-eight ambulatory patients with a confirmed COVID-19 pneumonia were included (men = 57 [59%]; mean age, 52.1 ± 13.5 years). Among these, 19 (21%) were hospitalized and none died. Twenty-five lung assessments by ultrasound were performed during the follow-up consultation. All were consistent with the clinical examination and confirmed the clinician's opinion.Conclusion: The use of a standardized pleuro-pulmonary ultrasound protocol for ambulatory patients with COVID-19 could help to reduce the use of chest X-rays and improve overall management at the time of referral and eventual follow-up. However, a specific study including LUS in a systematic approach should be performed to evaluate the outcome of patients according to findings.

scholarly journals Limitations of bedside lung ultrasound in neonatal lung diseases

2021 ◽  
Author(s):  
Xiaolei Liu ◽  
Shuyu Si ◽  
Yiyi Guo ◽  
Hui Wu
Keyword(s):  
Lung Diseases ◽  
Neonatal Intensive Care ◽  
Lung Ultrasound ◽  
Clinical Symptoms ◽  
Low Cost ◽  
High Sensitivity ◽  
Ct Scanning ◽  
X Ray ◽  
Neonatal Lung ◽  
Chest X Ray

Lung ultrasound is a technique that has rapidly developed in recent years. It is a low-cost, radiation-free, and easy-to-operate tool that can be repeatedly performed at the bedside. Compared to chest X-ray, lung ultrasound has high sensitivity and specificity in the diagnosis of neonatal respiratory distress syndrome, transient tachypnoea of newborns and pneumothorax. Lung ultrasound has been widely used in neonatal intensive care units. However, it has limitations in some other lung diseases and cannot fully substitute for chest X-ray or CT. This review describes these limitations in detail and highlights that if clinical symptoms are not effectively alleviated after medical treatment or the clinical presentation is not compatible with the ultrasound appearances, then chest X-ray or CT scanning should be performed to avoid misdiagnosis and mistreatment.

scholarly journals A prospective observational study depicting role of lung ultrasound in pediatric pneumonias

2021 ◽  
Vol 8 (9) ◽  
pp. 1566
Author(s):  
Ashish Saklani ◽  
Ashwani Tomar ◽  
Sumala Kapila ◽  
Shyam Lal Kaushik ◽  
Anjali Mahajan
Keyword(s):  
Observational Study ◽  
Prospective Observational Study ◽  
Lung Ultrasound ◽  
Imaging Modality ◽  
High Sensitivity ◽  
Radiation Hazard ◽  
X Ray ◽  
Under Five ◽  
Lobar Pneumonia ◽  
Chest X Ray

Background: Pneumonia is a major cause of morbidity and mortality in children under five years of age. Chest x-ray poses radiation hazard to children and thus an alternative safe imaging modality must be explored for pediatric pneumonias.Methods: This prospective observational study included all children below 18 years of age. Majority of patients were below five years of age. All clinically suspicious patients were subjected to chest x-ray and lung ultrasound (LUS). Chest x-ray was considered as imaging diagnostic standard for pneumonia. Consolidation and dynamic air bronchogram were looked on LUS.Results: A total of 55 patients were included in study with 26 (47.2%) as infants and up to 47 (85.3%) as under five children. Out of 55 cases 32 cases (58.20%) were diagnosed as lobar pneumonia while 23 (41.8%) as bronchopneumonia on chest x-ray. LUS demonstrated high sensitivity and specificity of 90.63% and 100% for lobar pneumonia and 86.96 and 90.63% for bronchopneumonia respectively. Dynamic air bronchogram sign was found in all cases of lobar pneumonia on LUS and with sensitivity of 73.91% in bronchopneumonia.Conclusions: LUS proved itself as highly sensitive and specific modality for detecting consolidation and owing to safe non ionizing nature of ultrasound, it must be considered as an alternative to chest x-ray as an imaging diagnostic tool for pediatric pneumonia.

scholarly journals Lung Ultrasound vs. Chest X-ray for the Radiographic Diagnosis of COVID-19 Pneumonia in a High Prevalence Population

2021 ◽  
Author(s):  
Ryan C. Gibbons ◽  
Mark Magee ◽  
Harry Goett ◽  
James Murrett ◽  
Jessica Genninger ◽  
...  
Keyword(s):  
Lung Ultrasound ◽  
Radiographic Diagnosis ◽  
X Ray ◽  
High Prevalence ◽  
Chest X Ray

scholarly journals Interest of Ultrasound in the Exploration of Rotator Cuff Lesions - Confrontation of Clinical Examination and Ultrasound Finding

2018 ◽  
Vol 5 ◽  
Author(s):  
Nessrine Akasbi ◽  
Asmae El Aissaoui ◽  
Ikrame Yazghich ◽  
Samira El Fakir ◽  
Taoufik Harzy
Keyword(s):  
Rotator Cuff ◽  
Physical Examination ◽  
Clinical Examination ◽  
High Sensitivity ◽  
Diagnostic Value ◽  
Ultrasound Finding ◽  
X Ray ◽  
Rotator Cuff Lesion ◽  
Rotator Cuff Lesions ◽  
A Prospective Study

Introduction: The aim of our study was to evaluate the interest of ultrasound in the exploration of painful shoulders evoking rotator cuff lesions and to determine the diagnostic value of the different tendon tests through a confrontation physical examination versus shoulder ultrasound. Materials and methods: A prospective study was conducted including patients consulting for shoulder pain that suggests a rotator cuff lesion. All patients underwent a clinical examination, an x ray and shoulder ultrasound.Results: The confrontation physical examination versus shoulder ultrasound showed that Jobe's test is very sensitive (100%) but less specific (27%), the Patte test, has a high sensitivity (100%) but an average specificity (51%), the Palm-Up test was fairly sensitive (91%) but not very specific (43%) and the Gerber test was more specific (95.7%) and less sensitive (38%). The comparison between x ray and ultrasound showed that ultrasound of shoulder is more efficient in the detection of calcifications and erosions of humeral head.Conclusion: Ultrasound of shoulder is more performant than physical examination and x ray in exploring the rotator cuff lesions.

scholarly journals LUNG ULTRASOUND DURING COVID-19 PANDEMICS: WHY, HOW AND WHEN?

2021 ◽  
Vol 74 (8) ◽  
pp. 1783-1788
Author(s):  
Khrystyna O. Pronyuk ◽  
Liudmyla O. Kondratiuk ◽  
Andrii D. Vysotskyi ◽  
Olga A. Golubovska ◽  
Iryna M. Nikitina
Keyword(s):  
Hospital Stay ◽  
Clinical Decision Making ◽  
Lung Ultrasound ◽  
Limited Resource ◽  
Clinical Decision ◽  
Lung Damage ◽  
Dynamic Monitoring ◽  
Initial Assessment ◽  
X Ray ◽  
Chest X Ray

The aim: To optimize diagnostic of pathological processes in lungs affected by COVID-19, dynamic monitoring and clinical decision making using lung ultrasound in limited resources settings. Materials and methods: Between the onset of pandemics and January 2021, approximately 9000 patients have been treated for confirmed COVID-19 in the Olexandrivska Clinical Hospital. Assessment of all hospitalized patients included hematology, chemistries and proinflammatory cytokines – IL-6, CRP, procalcitonin, ferritin. Diagnosis was confirmed by PCR for SARS-CoV-2 RNA. Chest X-ray was performed in all hospitalized cases, while CT was available approximately in 30% of cases during hospital stay. Lung ultrasound was proactively utilized to assess the type and extent of lung damage and to monitor the progress of disease in patients hospitalized into the ICU and Infection Unit (n=135). Ultrasound findings were recorded numerically based on scales. Results: In the setting of СOVID-19, bedside lung ultrasound has been promptly recognized as a tool to diagnose and monitor the nature and extent of lung injury. Lung ultrasound is a real time assessment, which helps determine the nature of a pathologic process affecting lungs. In this paper the accuracy of bedside LUS, chest X-ray and computer tomography are compared based on clinical cases, typical for COVID-19 lung ultrasound appearance is evaluated. Described in article data is collected in one of the biggest facility that deals with COVID-19. Chest X-ray was performed in all hospitalized cases, while CT was available approximately in 30% of cases during hospital stay. The cases presented in the paper indicate potential advantages to the use of ultrasound in limited resource healthcare settings, especially when the risk of transportation to CT outweighs the value of information obtained. Conclusions: Grading of ultrasonographic findings in the lungs was sufficient for both initial assessment with identification of high risk patients, and routine daily monitoring. Hence, lung ultrsound may be used to predict deterioration, stratify risks and make clinical decisions.

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