Value of Additional Upfront Systematic Lung Ultrasound in the Workup of Patients With Unilateral Pleural Effusion

2020 ◽  
Author(s):  
Keyword(s):  
Pleural Effusion ◽  
Lung Ultrasound

scholarly journals Lung ultrasound findings in patients with novel SARS-CoV-2

2020 ◽  
Vol 6 (4) ◽  
pp. 00238-2020
Author(s):  
Mark E. Haaksma ◽  
Micah L.A. Heldeweg ◽  
Jorge E. Lopez Matta ◽  
Jasper M. Smit ◽  
Jessica D. van Trigt ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Time Course ◽  
Lung Ultrasound ◽  
Arterial Oxygen Tension ◽  
Dynamic Compliance ◽  
Arterial Oxygen ◽  
Clinical Parameters ◽  
Duration Of Symptoms ◽  
Ultrasound Findings ◽  
B Lines

BackgroundOver 2 million people worldwide have been infected with severe acute respiratory distress syndrome-coronavirus-2 (SARS CoV-2). Lung ultrasound has been proposed to diagnose and monitor it, despite the fact that little is known about the ultrasound appearance due to the novelty of the illness. The aim of this manuscript is to characterise the lung ultrasonographic appearance of critically ill patients with SARS-CoV-2 pneumonia, with particular emphasis on its relationship with the time course of the illness and clinical parameters.MethodsAdult patients from the intensive care unit of two academic hospitals who tested positive for SARS-CoV-2 were included. Images were analysed using internationally recognised techniques which included assessment of the pleura, number of B-lines, pathology in the PLAPS (posterolateral alveolar and/or pleural syndrome) point, bedside lung ultrasound in emergency profiles, and the lung ultrasound score. The primary outcomes were frequencies, percentages and differences in lung ultrasound findings overall and between short (≤14 days) and long (>14 days) durations of symptoms and their correlation with clinical parameters.ResultsIn this pilot observational study, 61 patients were included with 76 examinations available for analysis. 26% of patients had no anterior lung abnormalities, while the most prevalent pathological ultrasound findings were thickening of the pleura (42%), ≥3 B-lines per view (38%) and presence of PLAPS (74%). Patients with “long” duration of symptoms presented more frequently with a thickened and irregular pleura (32 (21%) versus 11 (9%)), C-profile (18 (47%) versus 8 (25%)) and pleural effusion (14 (19%) versus 3 (5%)), compared to patients with short duration of symptoms. Lung ultrasound findings did not correlate with arterial oxygen tension/inspiratory oxygen fraction ratio, fluid balance or dynamic compliance.ConclusionSARS-CoV-2 results in significant, but not specific, ultrasound changes, with decreased lung sliding, thickening of the pleura and a B-profile being the most commonly observed. With time, a thickened and irregular pleura, C-profile and pleural effusion become more common findings. When screening patients, a comprehensive ultrasound protocol might be necessary.

scholarly journals Lung ultrasound in a tertiary intensive care unit population: a diagnostic accuracy study

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Jasper M. Smit ◽  
Mark E. Haaksma ◽  
Michiel H. Winkler ◽  
Micah L. A. Heldeweg ◽  
Luca Arts ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Pleural Effusion ◽  
Diagnostic Accuracy ◽  
Lung Ultrasound ◽  
Diagnostic Accuracy Study ◽  
Reference Test ◽  
Interstitial Syndrome ◽  
Thoracic Ct ◽  
Accuracy Study ◽  
Respiratory Conditions

Abstract Background Evidence from previous studies comparing lung ultrasound to thoracic computed tomography (CT) in intensive care unit (ICU) patients is limited due to multiple methodologic weaknesses. While addressing methodologic weaknesses of previous studies, the primary aim of this study is to investigate the diagnostic accuracy of lung ultrasound in a tertiary ICU population. Methods This is a single-center, prospective diagnostic accuracy study conducted at a tertiary ICU in the Netherlands. Critically ill patients undergoing thoracic CT for any clinical indication were included. Patients were excluded if time between the index and reference test was over eight hours. Index test and reference test consisted of 6-zone lung ultrasound and thoracic CT, respectively. Hemithoraces were classified by the index and reference test as follows: consolidation, interstitial syndrome, pneumothorax and pleural effusion. Sensitivity, specificity, positive and negative likelihood ratio were estimated. Results In total, 87 patients were included of which eight exceeded the time limit and were subsequently excluded. In total, there were 147 respiratory conditions in 79 patients. The estimated sensitivity and specificity to detect consolidation were 0.76 (95%CI: 0.68 to 0.82) and 0.92 (0.87 to 0.96), respectively. For interstitial syndrome they were 0.60 (95%CI: 0.48 to 0.71) and 0.69 (95%CI: 0.58 to 0.79). For pneumothorax they were 0.59 (95%CI: 0.33 to 0.82) and 0.97 (95%CI: 0.93 to 0.99). For pleural effusion they were 0.85 (95%CI: 0.77 to 0.91) and 0.77 (95%CI: 0.62 to 0.88). Conclusions In conclusion, lung ultrasound is an adequate diagnostic modality in a tertiary ICU population to detect consolidations, interstitial syndrome, pneumothorax and pleural effusion. Moreover, one should be careful not to interpret lung ultrasound results in deterministic fashion as multiple respiratory conditions can be present in one patient. Trial registration This study was retrospectively registered at Netherlands Trial Register on March 17, 2021, with registration number NL9344.

scholarly journals Feasibility and Efficacy of Lung Ultrasound to Investigate Pulmonary Complications in Patients Who Developed Postoperative Hypoxaemia-A Prospective Study

2020 ◽  
Author(s):  
Chen Xie ◽  
Kai Sun ◽  
Yueyang You ◽  
Yue Ming ◽  
Xiaoling Yu ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Diagnostic Accuracy ◽  
Ct Scan ◽  
General Anaesthesia ◽  
Lung Ultrasound ◽  
Ambient Air ◽  
Pulmonary Complications ◽  
Radiology Department ◽  
Healthy Weight ◽  
Major Orthopaedic Surgery

Abstract Background: Postoperative pulmonary complications (PPCs) and hypoxaemia are associated with morbidity and mortality. We aimed to evaluate the feasibility and efficacy of lung ultrasound (LUS) to diagnose PPCs in patients suffering from hypoxaemia after general anaesthesia and compare the results to those of thoracic computed tomography (CT). Methods: Adult patients who received general anaesthesia and suffered from hypoxaemia in the postanaesthesia care unit (PACU) were analysed. Hypoxaemia was defined as an oxygen saturation measured by pulse oximetry (SPO2) less than 92% for more than 30 seconds under ambient air conditions. LUS was performed by two trained anaesthesiologists once hypoxaemia occurred. After LUS examination, each patient was transported to the radiology department for thoracic CT scan within 1 hour before returning to the ward. Results: From January 2019 to May 2019, 113 patients (61 men) undergoing abdominal surgery (45 patients, 39.8%), video-assisted thoracic surgery (31 patients, 27.4%), major orthopaedic surgery (17 patients, 15.0%), neurosurgery (10 patients, 8.8%) or other surgery (10 patients, 8.8%) were included. CT diagnosed 327 of 1356 lung zones as atelectasis, while LUS revealed atelectasis in 311 of the CT-confirmed zones. Pneumothorax was detected by CT scan in 75 quadrants, 72 of which were detected by LUS. Pleural effusion was diagnosed in 144 zones on CT scan, and LUS detected 131 of these zones. LUS was reliable in diagnosing atelectasis (sensitivity 98.0%, specificity 96.7% and diagnostic accuracy 97.2%), pneumothorax (sensitivity 90.0%, specificity 98.9% and diagnostic accuracy 96.7%) and pleural effusion (sensitivity 92.9%, specificity 96.0% and diagnostic accuracy 95.1%). Conclusions: Lung ultrasound is feasible, efficient and accurate in diagnosing different aetiologies of postoperative hypoxia in healthy-weight patients in the PACU.

Hiding in plain sight: Diagnosing pleural tuberculosis using lung ultrasound

Ultrasound ◽  
2020 ◽  
pp. 1742271X2095976
Author(s):  
Wan Aireene Wan Ahmed ◽  
Mohd Jazman Che Rahim ◽  
Nurashikin Mohammad ◽  
Mohd Hashairi Fauzi ◽  
Shaik Farid Abdull Wahab
Keyword(s):  
Pleural Effusion ◽  
Chest Radiograph ◽  
Lung Ultrasound ◽  
Lower Zone ◽  
Case Presentation ◽  
Pleural Tuberculosis ◽  
Resource Limited ◽  
Novel Method ◽  
Limited Health ◽  
Cellular Components

Introduction Diagnosing pleural tuberculosis can be difficult in patients with ambiguous presentation, especially in resource-limited health centres. Thus, lung ultrasound had been studied as a novel method in helping clinicians to diagnose this condition. Case presentation A 48-year-old woman presented with worsening dyspnoea and orthopnoea for one week. She had also experienced weight loss, minimal dry cough and right-sided pleuritic chest pain for several weeks. A chest radiograph showed a right lower zone pleural effusion with no apparent lung consolidation. Lung ultrasound showed a right apical consolidation and right lower zone septated pleural effusion. Pleural fluid investigations showed exudative features of mixed lymphocytic, mesothelial and neutrophilic cellular components. Tuberculin skin test was strongly positive. She was subsequently treated for pleural tuberculosis. One month after treatment, her symptoms had improved considerably. Discussion Lung ultrasound has been found to be more effective than chest radiograph in detecting consolidation and diagnosing pneumonia. The portability and efficacy of today’s ultrasound machines, including the handheld types, show that lung ultrasound is a practical, reliable and valuable diagnostic tool in managing pulmonary conditions including tuberculosis, provided that the operators are adequately trained. Conclusion Lung ultrasound in tuberculosis is the next frontier for clinicians and researchers.

Lung Ultrasound in the Assessment of Pulmonary Complications After Lung Transplantation

2018 ◽  
Vol 41 (02) ◽  
pp. 148-156 ◽  
Author(s):  
Jesper Rømhild Davidsen ◽  
Hans Henrik Lawaetz Schultz ◽  
Daniel Pilsgaard Henriksen ◽  
Martin Iversen ◽  
Anna Kalhauge ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Lung Transplantation ◽  
Lung Ultrasound ◽  
Pulmonary Complications ◽  
Postoperative Phase ◽  
Transplant Recipients ◽  
Monitoring Tool ◽  
High Resolution Computed Tomography ◽  
Transplantation Center ◽  
Lung Transplant Recipients

Abstract Introduction Lung ultrasound (LUS) has a high diagnostic accuracy for identifying frequent conditions in the post-operative phase after lung transplantation (LTx). This study aimed to investigate the feasibility and clinical ability of LUS to identify pulmonary complications such as pleural effusions and pneumonias in the early postoperative phase after LTx. Methods A prospective cohort study of lung transplant recipients who consecutively underwent single LTx (SLTx) or double LTx (DLTx) at the National Lung Transplantation Center in Denmark from May 1 to October 31, 2015 was conducted. LUS was performed at four time points corresponding to post-transplant day 3, and weeks 2, 6, and 12 (LUS #1–4) to detect and monitor variation in pathological LUS findings over time. Concurrent with LUS #4, a high-resolution computed tomography examination of the thorax (HRCT) was also performed. Results 14 patients (1 SLTx/13 DLTx, 7 (50 %) women, mean age: 50.4 years) who had undergone the four prespecified LUS examinations were included. Pleural effusion was the most common condition and most pronounced at post-LTx week 2. Findings consistent with pneumonia increased during week 2 and subsequently decreased. Corresponding to LUS #1, 2, 3, and 4, pleural effusion occurred in 85.7 %, 92.9 %, 85.7 %, and 78.6 %, and pneumonia in 21.4 %, 28.6 %, 14.3 %, and 14.3 %, respectively. HRCT findings at post-LTx week 12 were predominantly presented by unspecific ground glass opacities. Conclusion In a post-LTx setting, LUS represents a clinical novelty as a feasible diagnostic and monitoring tool to identify pathological pulmonary complications in the early post-operative phase.

Automatic deep learning-based pleural effusion classification in lung ultrasound images for respiratory pathology diagnosis

2021 ◽  
Vol 83 ◽  
pp. 38-45
Author(s):  
Chung-Han Tsai ◽  
Jeroen van der Burgt ◽  
Damjan Vukovic ◽  
Nancy Kaur ◽  
Libertario Demi ◽  
...  
Keyword(s):  
Deep Learning ◽  
Pleural Effusion ◽  
Lung Ultrasound ◽  
Ultrasound Images ◽  
Respiratory Pathology
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