scholarly journals Lung ultrasound assessment for pneumothorax following transbronchial lung cryobiopsy

2021 ◽  
pp. 00045-2021
Author(s):  
Christian B. Laursen ◽  
Pia Iben Pietersen ◽  
Niels Jacobsen ◽  
Casper Falster ◽  
Amanda Dandanell Juul ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Lung Ultrasound ◽  
Patient Discharge ◽  
Clinical Impact ◽  
Chest X Ray ◽  
Ultrasound Assessment ◽  
Prolonged Observation ◽  
Transbronchial Lung Cryobiopsy ◽  
Design And Methods

BackgroundIatrogenic pneumothorax is a common and clinically important transbronchial cryobiopsy (TBCB) complication. A study was conducted to assess the diagnostic accuracy and clinical impact of immediate postprocedure lung ultrasound for diagnosing iatrogenic pneumothorax in patients suspected of interstitial lung disease (ILD) undergoing TBCB.Study design and methodsIn patients undergoing TBCB due to suspected ILD, LUS of the anterior surface of the chest was performed immediately after the TBCB procedure prior to extubation. Presence of lung point was used as a definite sign of pneumothorax. Chest X-ray (CXR) performed routinely 2 h after TBCB was used as reference standard.ResultsA total of 141 consecutive patients were included. Postprocedure LUS identified definite pneumothorax in 5 patients (3.6%)(95%CI: 1.5–8.3%). 2-hour CXR identified 19 patients (13.5%)(95%CI: 8.7–20.2%) with pneumothorax following TBCB. The diagnostic accuracy of LUS for diagnosing pneumothorax was: sensitivity 21.1% (95% CI: 6.1–45.6%), specificity 99.2% (95% CI: 95.5–100.0%), positive predictive value 80.0% (95%CI: 28.4–99.5%), and negative predictive value 89.0% (95%CI: 82.5–93.7%). Postprocedure LUS had a clinical impact in 5 patients (3.6%) (95%CI: 1.5–8.3), in which 4 had pleural drain inserted prior to extubation and 1 patient had prolonged observation prior to extubation.InterpretationLUS performed immediately following TBCB have a clinical impact by identifying patients with pneumothorax in need of immediate treatment prior to extubation, and to monitor pneumothorax size during in the operating room. Supplementary imaging prior to patient discharge is however still needed since the majority of pneumothoraxes develop later in the postprocedure period.

scholarly journals Comparison of Lung Ultrasound to X-ray for Diagnosis of Pulmonary Complications after Cardiac Surgery in Children

2020 ◽  
Vol 18 (1) ◽  
pp. 47-51
Author(s):  
Smriti Mahaju Bajracharya ◽  
Pragati Shrestha ◽  
Apurb Sharma
Keyword(s):  
Cardiac Surgery ◽  
Positive Predictive Value ◽  
Diagnostic Accuracy ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Lung Ultrasound ◽  
Pulmonary Complications ◽  
Lung Ultrasonography ◽  
X Ray ◽  
Chest X Ray

Background: The purpose of this study was to compare diagnostic performance of lung ultrasound in comparison to chest X-ray to detect pulmonary complication after cardiac surgery in children.Methods: A prospective observational study was conducted in tertiary center of Nepal. 141 consecutive paediatric patients aged less than 14 years scheduled for cardiac surgery were enrolled during the 6 months period. Ultrasound was done on the first post-operative day of cardiac surgery and compared to chest X-ray done on the same day to detect pleural effusion, consolidation, atelectasis and pneumothorax.Results: Sensitivity, specificity, positive and negative predictive values and diagnostic accuracy were calculated using standard formulas. lung ultrasonography had overall sensitivity of 60 %, specificity of 72.4%, positive predictive value of 31.9% and negative predictive value of 89.3% and diagnostic accuracy of 70.2% for diagnosing consolidation. Similarly, lung ultrasonography had overall sensitivity of 90%, specificity of 82.6%, positive predictive value of 46.1% and negative predictive value of 98% and diagnostic accuracy of 83.6 % for diagnosing pleural effusion. For atelectasis, ultrasonography had sensitivity of 50%, specificity of 76.9%, positive predictive value of 30.7% and negative predictive value of 88.2% and diagnostic accuracy of 72.3%. No pneumothoraxes were detected during our study period. Conclusions: Lung ultrasound is an alternative non-invasive technique which is able to diagnose pulmonary complications after cardiac surgery with acceptable diagnostic accuracy with no proven complications but with decreasing exposure to ionizing radiation and possibly cost.Keywords: Cardiac surgery; children; lung ultrasound; pulmonary complications

scholarly journals Clinical Impact of Vertical Artifacts Changing with Frequency in Lung Ultrasound

Diagnostics ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 401
Author(s):  
Natalia Buda ◽  
Agnieszka Skoczylas ◽  
Marcello Demi ◽  
Anna Wojteczek ◽  
Jolanta Cylwik ◽  
...  
Keyword(s):  
Interstitial Lung Disease ◽  
Pulmonary Edema ◽  
Predictive Value ◽  
Area Under Curve ◽  
Lung Ultrasound ◽  
Ultrasound Examination ◽  
Clinical Impact ◽  
Study Group ◽  
Pleural Line ◽  
Design And Methods

Background: This study concerns the application of lung ultrasound (LUS) for the evaluation of the significance of vertical artifact changes with frequency and pleural line abnormalities in differentiating pulmonary edema from pulmonary fibrosis. Study Design and Methods: The study was designed as a diagnostic test. Having qualified patients for the study, an ultrasound examination was performed, consistent with a predetermined protocol, and employing convex and linear transducers. We investigated the possibility of B-line artifact conversion depending on the set frequency (2 MHz and 6 MHz), and examined pleural line abnormalities. Results: The study group comprised 32 patients with interstitial lung disease (ILD) (and fibrosis) and 30 patients with pulmonary edema. In total, 1941 cineloops were obtained from both groups and analyzed. The employment of both types of transducers (linear and convex) was most effective (specificity 91%, specificity 97%, positive predictive value (PPV) 97%, negative predictive value (NPV) 91%, LR(+) 27,19, LR(−) 0.097, area under curve (AUC) = 0.936, p = 7 × 10−6). Interpretation: The best accuracy in differentiating the etiology of B-line artifacts was obtained with the use of both types of transducers (linear and convex), complemented with the observation of the conversion of B-line artifacts to Z-line.

scholarly journals Limited diagnostic accuracy and clinical impact of single-operator peroral cholangioscopy for indeterminate biliary strictures

Endoscopy ◽  
2019 ◽  
Vol 52 (02) ◽  
pp. 107-114 ◽  
Author(s):  
Adriaan B. de Vries ◽  
Frans van der Heide ◽  
Rinze W. F. ter Steege ◽  
Jan Jacob Koornstra ◽  
Karel T. Buddingh ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Patient Management ◽  
Clinical Impact ◽  
Biliary Strictures ◽  
Brush Cytology ◽  
Peroral Cholangioscopy ◽  
Single Operator ◽  
Sensitivity Specificity ◽  
Targeted Biopsies

Abstract Background Single-operator peroral cholangioscopy (sPOCS) is considered a valuable diagnostic modality for indeterminate biliary strictures. Nevertheless, studies show large variation in its characteristics and measures of diagnostic accuracy. Our aim was to estimate the diagnostic accuracy of sPOCS visual assessment and targeted biopsies for indeterminate biliary strictures. Additional aims were: estimation of the clinical impact of sPOCS and comparison of diagnostic accuracy with brush cytology. Methods A retrospective single-center study of adult patients who underwent sPOCS for indeterminate biliary strictures was performed. Diagnostic accuracy was defined as sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). The clinical impact of sPOCS was assessed by review of medical records, and classified according to its influence on patient management. Results 80 patients were included, with 40 % having primary sclerosing cholangitis (PSC). Prior ERCP was performed in 88 %, with removal of a biliary stent prior to sPOCS in 55 %. The sensitivity, specificity, PPV, and NPV for sPOCS visual impression and targeted biopsies were 64 %, 62 %, 41 %, and 84 %, and 15 %, 65 %, 75 %, and 69 %, respectively. The clinical impact of sPOCS was limited; outcome changed management in 17 % of patients. Sequential brush cytology sensitivity, specificity, PPV, and NPV were 47 %, 95 %, 80 %, and 83 %. Conclusions The diagnostic accuracy of sPOCS for indeterminate biliary strictures was found to be inferior to brush cytology, with a low impact on patient management. These findings are obtained from a select patient population with a high prevalence of PSC and plastic stents in situ prior to sPOCS.

DIAGNOSTIC ACCURACY OF CHEST X-RAY IN THE DETECTION OF PNEUMOTHORAX IN BLUNT CHEST TRAUMA PATIENTS WITH CT AS THE GOLD STANDARD

2021 ◽  
Vol 5 (7) ◽  
Author(s):  
Danquale Vance Kynshikhar ◽  
Chaman Lal Kaushal ◽  
Ashwani Tomar ◽  
Neeti Aggarwal
Keyword(s):  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Gold Standard ◽  
Blunt Chest Trauma ◽  
Chest Trauma ◽  
Trauma Patients ◽  
Care Level ◽  
X Ray ◽  
Primary Health ◽  
Chest X Ray

Background: To study the diagnostic accuracy of chest X-ray in the detection of pneumothorax in blunt chest trauma patients with CT as the Gold Standard Methods: The present study was conducted from 31th July 2018 to 30th July 2019. A total of 36 patients were enrolled in the study. Results: On Chest X-Ray Supine AP view, pneumothorax was detected in 11 of 24 patients. The sensitivity of Chest X-Ray Supine AP view was 45.83%, specificity was 100%, positive predictive value (PPV) was 100%, negative predictive value (NPV) was 48% and accuracy was 63.89% for the diagnosis of pneumothorax. Conclusion: A Chest radiograph is the most preferred and relevant primary investigation in the diagnosis of pneumothorax even with the various advanced techniques that are available. X-ray being relatively cheaper and is easily available even at the peripheral centers at the primary health care level. Keywords: X-ray, CT, Pneumothorax

THE PREDICTIVE VALUE OF LUNG ULTRASOUND SCORES IN DEVELOPING BRONCHOPULMONARY DYSPLASIA: A PROSPECTIVE MULTICENTER DIAGNOSTIC ACCURACY STUDY

CHEST Journal ◽  
2021 ◽  
Author(s):  
Almudena Alonso-Ojembarrena ◽  
Iker Serna-Guerediaga ◽  
Victoria Aldecoa-Bilbao ◽  
Rebeca Gregorio-Hernández ◽  
Paula Alonso-Quintela ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Bronchopulmonary Dysplasia ◽  
Predictive Value ◽  
Lung Ultrasound ◽  
Diagnostic Accuracy Study ◽  
Accuracy Study

scholarly journals Lung ultrasound as modality in diagnosis of respiratory distress syndrome in newborn infants

2020 ◽  
Vol 7 (12) ◽  
pp. 2301
Author(s):  
Syed Tariq Ahmad ◽  
Anil Parihar ◽  
Aijaz Ahmad Bhat ◽  
Nisar Ahmad Wani
Keyword(s):  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Predictive Value ◽  
Neonatal Intensive Care ◽  
Distress Syndrome ◽  
Lung Ultrasound ◽  
Low Cost ◽  
Newborn Infants ◽  
Chest X Ray ◽  
Grade Ii

Background: The aim of this study was to evaluate the value of lung ultrasound in the diagnosis of respiratory distress syndrome (RDS) in newborn infants.Methods: From April 2019 to March 2020, all newborns admitted in neonatal intensive care unit within 72 hours of life having suspection of RDS on the basis of clinical features were enrolled in study. A total of 59 newborns were included in our study irrespective of gestational age and birth weight.Results: According to the findings of chest X-ray, there were 10 cases of grade I RDS, 16 grade II cases, 12 grade III cases, and 6 grade IV cases. Lung ultrasound was performed at bedside by a single expert. The ultrasound indexes observed in this study included pleural line, A-line, B-line, lung consolidation, air bronchograms, bilateral white lung, interstitial syndrome, lung sliding, lung pulse, comet tail artifacts etc. In our study it was found that ultrasound sonography (USG) chest has a sensitivity of 100% and specificity of 93.33% in diagnosing RDS which is consistent with other studies. In our study it was found that USG chest has a positive predictive value of 97.78%, negative predictive value of 100% and diagnostic accuracy of 98.31% for diagnosis of RDS.Conclusion: This study indicates that using an ultrasound to diagnose neonatal RDS is accurate and reliable tool. A lung ultrasound has many advantages over other techniques. Ultrasound is non-ionizing, low-cost, easy to operate, and can be performed at bedside, can be repeated several times in a day making this technique ideal for use in NICU.

scholarly journals Higher Accuracy of Lung Ultrasound over Chest X-ray for Early Diagnosis of COVID-19 Pneumonia

2021 ◽  
Vol 18 (7) ◽  
pp. 3481
Author(s):  
Javier Martínez Redondo ◽  
Carles Comas Rodríguez ◽  
Jesús Pujol Salud ◽  
Montserrat Crespo Pons ◽  
Cristina García Serrano ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Lung Ultrasound ◽  
Ultrasound Images ◽  
X Rays ◽  
Rt Pcr ◽  
X Ray ◽  
Lower Specificity ◽  
Chest X Ray ◽  
Interstitial Disease ◽  
Higher Sensitivity

Background: The COVID-19 pandemic rapidly strained healthcare systems worldwide. The reference standard for diagnosis is a positive reverse transcription polymerase chain reaction (RT-PCR) test, but results are not immediate and sensibility is variable. Aim: To evaluate the diagnostic accuracy of lung ultrasound compared to chest X-ray for COVID-19 pneumonia. Design and Setting: A retrospective analysis of symptomatic patients admitted into one primary care centre in Spain between March and September 2020. Method: Patients’ chest X-rays and lung ultrasounds were categorized as normal or pathologic. RT-PCR confirmed COVID-19 infection. Pathologic lung ultrasound images were further categorized as showing either local or diffuse interstitial disease. McNemar and Fisher tests were used to compare diagnostic accuracy. Results: Most of the 212 patients presented fever at admission, either as a standalone symptom (37.74% of patients) or together with others (72.17% of patients). The positive predictive value of the lung ultrasound was 90% for the diffuse interstitial pattern and 46.92% for local pattern. The lung ultrasound had a significantly higher sensitivity (82.75%) (p < 0.001), but lower specificity (71%) than the chest X-ray (54.02% and 86%, respectively) (p = 0.008) for identifying interstitial lung disease. Moreover, sensitivity of the lung ultrasound for severe interstitial disease was 100%, and was significantly higher than the chest X-ray (58.33%) (p = 0.002). Conclusion: The lung ultrasound is more accurate than the chest X-ray for identifying patients with COVID-19 pneumonia and it is especially useful for those presenting diffuse interstitial disease.

Noninvasive Evaluation of Coronary Artery Bypass Grafts with 16-Slice Multidetector Computed Tomography

2012 ◽  
Vol 15 (1) ◽  
pp. 12 ◽  
Author(s):  
Levent Sahiner ◽  
Ali Oto ◽  
Kudret Aytemir ◽  
Tuncay Hazirolan ◽  
Musturay Karcaaltincaba ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Artery ◽  
Diagnostic Accuracy ◽  
Multidetector Computed Tomography ◽  
Coronary Artery Bypass ◽  
Predictive Value ◽  
Artery Bypass ◽  
Time Interval ◽  
Mdct Angiography ◽  
Sensitivity Specificity

<p><b>Background:</b> The aim of this study was to investigate the diagnostic accuracy of 16-slice multislice, multidetector computed tomography (MDCT) angiography for the evaluation of grafts in patients with coronary artery bypass grafting (CABG).</p><p><b>Methods:</b> Fifty-eight consecutive patients with CABG who underwent both MDCT and conventional invasive coronary angiography were included. The median time interval between the 2 procedures was 10 days (range, 1-32 days). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MDCT for the detection of occluded grafts were calculated. The accuracy of MDCT angiography for detecting significant stenoses in patent grafts and the evaluability of proximal and distal anastomoses were also investigated.</p><p><b>Results:</b> Optimal diagnostic images could not be obtained for only 3 (2%) of 153 grafts. Evaluation of the remaining 150 grafts revealed values for sensitivity, specificity, PPV, NPV, and diagnostic accuracy of the MDCT angiography procedure for the diagnosis of occluded grafts of 87%, 97%, 94%, 93%, and 92%, respectively. All of the proximal anastomoses were optimally visualized. In 4 (8%) of 50 patent arterial grafts, however, the distal anastomotic region could not be evaluated because of motion and surgical-clip artifacts. The accuracy of MDCT angiography for the detection of significant stenotic lesions was relatively low (the sensitivity, specificity, PPV, and NPV were 67%, 98%, 50%, and 99%, respectively). The number of significant lesions was insufficient to reach a reliable conclusion, however.</p><p><b>Conclusion:</b> Our study showed that MDCT angiography with 16-slice systems has acceptable diagnostic performance for the evaluation of coronary artery bypass graft patency.</p>

scholarly journals Accuracy of MSCT Coronary Angiography with 64 Row CT Scanner—Facing the Facts

2010 ◽  
Vol 4 ◽  
pp. CMC.S3864 ◽  
Author(s):  
M. Wehrschuetz ◽  
E. Wehrschuetz ◽  
H. Schuchlenz ◽  
G. Schaffler
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Positive Predictive Value ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Diagnostic Potential ◽  
Coronary Artery Stenoses ◽  
Artery Disease ◽  
Msct Angiography

Improvements in multislice computed tomography (MSCT) angiography of the coronary vessels have enabled the minimally invasive detection of coronary artery stenoses, while quantitative coronary angiography (QCA) is the accepted reference standard for evaluation thereof. Sixteen-slice MSCT showed promising diagnostic accuracy in detecting coronary artery stenoses haemodynamically and the subsequent introduction of 64-slice scanners promised excellent and fast results for coronary artery studies. This prompted us to evaluate the diagnostic accuracy, sensitivity, specificity, and the negative und positive predictive value of 64-slice MSCT in the detection of haemodynamically significant coronary artery stenoses. Thirty-seven consecutive subjects with suspected coronary artery disease were evaluated with MSCT angiography and the results compared with QCA. All vessels were considered for the assessment of significant coronary artery stenosis (diameter reduction ≥ 50%). Thirteen patients (35%) were identified as having significant coronary artery stenoses on QCA with 6.3% (35/555) affected segments. None of the coronary segments were excluded from analysis. Overall sensitivity for classifying stenoses of 64-slice MSCT was 69%, specificity was 92%, positive predictive value was 38% and negative predictive value was 98%. The interobserver variability for detection of significant lesions had a κ-value of 0.43. Sixty-four-slice MSCT offers the diagnostic potential to detect coronary artery disease, to quantify haemodynamically significant coronary artery stenoses and to avoid unnecessary invasive coronary artery examinations.

Influence of lesion location on the accuracy of CT derived FFR: head-to-head comparison with invasive FFR

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Moshage ◽  
S Smolka ◽  
S Achenbach ◽  
F Ammon ◽  
P Ferstl ◽  
...  
Keyword(s):  
Coronary Angiography ◽  
Positive Predictive Value ◽  
Diagnostic Accuracy ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Invasive Coronary Angiography ◽  
Roc Curve Analysis ◽  
Jude Medical ◽  
Lesion Location ◽  
Distal Vessel

Abstract Background The accuracy of CT-derived FFR (FFRCT) has been repeatedly reported. However, the influence of lesion location on accuracy is unknown. Therefore, we evaluated the diagnostic accuracy of FFRCT to detect lesion-specific ischemia and determined the influence of lesion location (proximal vs. distal vessel segments) compared to invasively measured FFR in patients with suspected CAD. Methods A total of 136 vessels in which “Dual-Source”-CT coronary angiography had been performed due to suspected CAD and who were further referred for invasive coronary angiography with invasive FFR measurement within three months of the index CT examination were retrospectively identified and screened for inclusion in this analysis. Patients with either left main coronary artery stenoses, bifurcation or ostial stenoses were excluded. Invasive FFR was measured using a pressure wire (CERTUS®, St. Jude Medical, Minnesota, USA or Verrata®, Volcano, San Diego, USA). FFRCT was calculated using an on-site prototype (cFFR Version 3.0, Siemens Healthineers, Forchheim, Germany). All vessels were analyzed by an experienced observer blinded to the results of invasive FFR. Stenoses with invasively measured FFR ≤0.80 were classified as hemodynamically significant. We evaluated the diagnostic accuracy of FFRCT in proximal vs. non-proximal vessel segments. Proximal lesions included stenoses located in segment one, six, eleven and twelve. All other stenoses were categorized as distal lesions. Results Out of 136 coronary stenoses, 47 (35%) were located in proximal segments and 89 (65%) lesions were located in distal segments. Compared to invasive FFR, the sensitivity of FFRCT to correctly identify/exclude hemodynamically significant stenoses in proximal vessel segments was 93% (95% CI: 68–99.8%) and the specificity was 100% (95% CI: 89–100%), compared to a sensitivity of 72% (95% CI: 46.5–90%) and a specificity of 87% (95% CI: 77–94%) for FFRCT in distal lesions. The positive predictive value was 100% and the negative predictive value was 97% (95% CI: 82.8–99.5%) compared to a positive predictive value of 59% (95% CI: 42–93.9%) and a negative predictive value of 93% (95% CI: 85.4–96.3%) for proximal vs. distal vessel segment, respectively. This corresponds to an accuracy of 98% vs. 84%, respectively (p=0.02). ROC-Curve analysis showed a slightly higher – albeit non-significant – area under the curve for FFRCT to detect hemodynamic relevance in proximal lesions compared to distal lesions (AUC 0.95, p&lt;0.001 vs. AUC: 0.86, p&lt;0.001, respectively, p=0.2). Conclusion FFRCT obtained using an on-site prototype shows overall a high diagnostic accuracy for detecting lesions causing ischemia as compared to invasive FFR with a trend towards better diagnostic performance in proximal vessel segments. Funding Acknowledgement Type of funding source: None

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