Lung Ultrasound B-lines as a Surrogate Marker for High Left Ventricular Diastolic Pressures; a bed-side Diagnostic tool

Background: We studied the diagnostic accuracy of B-lines (comet-tail sign) on bedside lung US, NT-proBNP, E/e` on ECHO in differentiation of the causes of acute dyspnea in the emergency setting. Major advantages include bedside availability, no radiation, high feasibility and reproducibility, and cost efficiency. Methods: Our prospective study was performed at the alazhar university hospital, Cairo, Egypt, between July 2019 and March 2020. All patients underwent lung ultrasound examinations, along with TTE, laboratory testing, including rapid NT-proBNP testing. Results: The median E/e’ levels in patients with B-profile were 18, compared with a median of 7.4 in the subjects with A-profile (P =< 0.0001 CI = -9.649 to -7.044). It was found that the sensitivity and the specificity of detecting B-profile on ultrasound is high when E/e’ > 15.5 (95.0% and 83.0% consecutively), which concluded the high correlation between finding B profile on U/S chest and elevated left ventricle filling pressure in a patient presenting with picture of suggestive of heart failure Conclusion: Chest ultrasound can be used as screening test for the evaluation of patients with suspicion of heart failure with excellent sensitivity and good specificity.

Limited Chest Ultrasound to Replace CXR in Diagnosis of Pneumothorax Post Image-Guided Transthoracic Interventions

Purpose: To assess the diagnostic accuracy of limited chest ultrasound in detecting pneumothorax following percutaneous transthoracic needle interventions using chest X-ray (CXR) as the reference standard. Methods: With IRB approval, after providing consent, asymptomatic patients after percutaneous transthoracic needle interventions were enrolled to undergo limited chest ultrasound in addition to CXR. A chest Radiologist blinded to the patient’s prior imaging performed a bedside ultrasound, scanning only the first 3 anterior intercostal spaces. Pneumothorax diagnosed on CXR was categorized as small or large and on ultrasound as grades 1, 2, or 3 when detected in 1, 2, or 3 intercostal spaces, respectively. Results: 38 patients underwent 36 biopsies (34 lungs, 1 pleura, and 1 mediastinum) and 2 coil localizations. CXR showed pneumothorax in 13 patients. Ultrasound was positive in 10 patients, with 9 true-positives, 1 false-positive, 4 false-negatives, and 24 true-negatives. The false positive results were due to apical subpleural bullae. The false-negative results occurred in 2 small apical and 2 focal pneumothoraces at the needle entry sites. Four pneumothoraces were categorized as large on CXR, all of which were categorized as grade 3 on ultrasound. Sensitivity and specificity of US for detection of pneumothorax of any size were 69.23% (95%CI 38.6%, 90.1%) and 96.0% (95%CI 79.6%, 99.9%), and for detection of large pneumothorax were 100% (95%CI 39.8%, 100%) and 100% (95%CI 89.7%, 100%). Conclusions: Results of this prospective study is promising. Limited chest ultrasound could potentially replace CXR in the management of postpercutaneous transthoracic needle intervention patients.

DIAGNOSTIC ACCURACY OF ULTRASOUND IN THE DETECTION OF PNEUMOTHORAX IN CHEST TRAUMA PATIENTS WITH CT AS THE GOLD STANDARD

Background: To study the diagnostic accuracy of ultrasound in the detection of pneumothorax in 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: By chest ultrasound, pneumothorax was detected in 15 of 24 patients. The sensitivity of chest ultrasound for the diagnosis of pneumothorax was 62.5%, specificity was 100%, positive predictive value (PPV) was 100%, negative predictive value (NPV) was 54.14% and accuracy was 75%. Conclusion: Chest ultrasound can play an important role in the emergency department aiding a physician for bedside rapid and accurate diagnosis of pneumothorax without interruption in the resuscitation process and without transferring the patient to the radiology section. Keywords: Ultrasound, CT, Pneumothorax

Is chest ultrasonography a reliable tool for the emergency diagnosis of traumatic pneumothorax. An Updated Meta-Analysis

Aims: A commonly encountered problem in emergency care is pneumothorax, identified by air present in pleural space, occurring spontaneously, principally because of trauma or pathogenic factors like a central venous catheter, mechanical ventilation, and biopsy. Employing Chest ultrasound for diagnosing pneumothorax in an emergency is currently investigated by many researchers. The present meta-analysis aimed to assess Chest ultrasound’s diagnostic accuracy in diagnosing the pneumothorax during emergencies. Material and Methods: Literature search of published articles in MEDLINE, Embase, Ovid, Scopus, and Journal on web databases from 2000 up to November 2020 were reviewed for the pre-described outcomes. Results: 12 articles were finally chosen for quantitative analysis. The overall sensitivity of ultrasound scan in pneumothorax diagnosis was 89% (95 % CI – 86 – 91%). Specificity was 96% (CI – 95% – 97%). The diagnostic odds ratio was 193.94 (59.009 – 637.40) at 95% CI, thus demonstrating greater chest ultrasound accuracy in diagnosing pneumothorax. Conclusion: A definite evidence of chest ultrasound accuracy was noted in pneumothorax.

A newborn with anterolateral diaphragmatic defect: An unusual anomaly?

Background: Anterolateral defect of diaphragm is unusual and has been reported less than 5 times in literature. Case Presentation: We are reporting a case with typical initial presentation of a congenital diaphragmatic hernia. A chest x-ray raised suspicion of a cystic lesion or diaphragmatic eventration which was excluded by chest ultrasound. At operation he was found to have a localised and large anterolateral defect with a very thick sac which was plicated to bridge the diaphragmatic defect. Conclusion: A rare variant and should be differentiated from other variants using imaging.