Pulmonary ultrasound in the diagnosis and differential diagnosis of congestion in heart failure

Introduction. In recent years, the issue of informative value of lung ultrasound for diagnosis, differential diagnosis and prognosis determination in cardiac patients, especially in decompensated heart failure, has been actively discussed. The relevance of this method lies in the absence of invasiveness, radiation exposure and the possibility to perform lung sonography at the patient's bedside. The purpose of this review was to assess and analyze the available literature on this issue. Materials and methods. Scientific publications were searched and selected from PubMed and Google Scholar from 1982 to 2020. Results and Discussion. Pulmonary ultrasound can be used as an accurate tool for detection and differential diagnosis of extravascular fluid in patients with heart failure. Literature analysis indicates high prognostic value of the method, as well as its possible use for dynamic monitoring in real time. Lung sonography shows higher sensitivity and specificity of the method than chest radiography, physical examination, natriuretic peptide level. In isolation, this method has lower specificity than sensitivity, but when complemented by natriuretic peptide levels and echocardiography, it increases accuracy and speed of diagnosis. Conclusion. Lung ultrasound has a sufficient evidence base and good potential for use in clinical practice as a complementary component to traditional methods of determining congestion in heart failure.

Emergency Physicians Performing Point-of-Care Lung Sonography to Diagnose Pneumonia: A Prospective Multicenter Study

Objective: There has always been some issues in the accurate diagnosis of pneumonia, a common cause of emergency department (ED) visits and revisits, which is typically made based on the patient’s clinical syndrome. This is made more difficult due to the traditional chest radiography having limited accuracy. This prospective multicenter study was conducted to determine the diagnostic accuracy of a point-of-care lung sonography performed by emergency physicians for the diagnosis of pneumonia in an acute care setting. This was compared with chest computed tomography (CT), the diagnostic gold standard. Methods: ED patients who presented with signs and symptoms of pneumonia were eligible to enroll in the study. After enrollment, point-of-care lung sonography was performed on patients by emergency physicians who had passed a focused teaching course on lung sonographic findings of pneumonia. All enrolled patients were followed up. Patients who underwent a chest CT during their hospital admission course were finally included and analyzed. Results: Emergency physicians who performed a point-of-care lung sonography had a sensitivity of 100%, specificity of 75%, positive predictive value of 88.88%, negative predictive value of 100%, and an overall accuracy of 90% in the diagnosis of pneumonia. Conclusion: These emergency physicians could accurately diagnose pneumonia, with a point-of-care lung sonography, after completing a focused sonography course.

Lung sonography can improve the specificity of determination of left-sided double-lumen tracheal tube position in both novices and experts: a randomised prospective study

Objective Lung sonography can be helpful to determine the position of a left-sided double-lumen tube (DLT). However, clinical experience is required for correct assessment. We investigated whether lung sonography can improve the diagnostic efficacy of determining the DLT position in novices and experts. Methods In this randomised prospective clinical study, 88 patients were allocated to two groups using auscultation or lung sonography for initial assessment of the DLT position. In each group, two repeated assessments were performed; the first was performed by a novice, and the second was performed by an expert. The final DLT position was confirmed by fibre-optic bronchoscopy. The primary outcome was the diagnostic efficacy (including overall accuracy, sensitivity, and specificity) in confirming the DLT position. Results In both the novices and experts, the specificity of determining the DLT position was significantly higher with lung sonography than auscultation (60.0% vs. 21.7% and 66.7% vs. 37.5%, respectively). Additionally, the predictability of an incorrect position was similar between the novices and experts using lung sonography (area under the curve of 0.665 and 0.690, respectively). Conclusions Lung sonography can improve the diagnostic efficacy of detecting an incorrect DLT position in both novices and experts.

Lung Sonography in Obstetrics during COVID-19

In the current coronavirus SARS-CoV-2 pandemic, certain patients are becoming seriously ill. Lung pathologies are common, and some patients even go on to develop acute respiratory distress syndrome (ARDS), which requires intubation and artificial respiration of the critically ill patient. Imaging of the lung is absolutely necessary to obtain a diagnosis, assess the course of disease and for treatment. Particularly in gynecology and obstetrics (OBGYN), ultrasound scans of the lung can be a useful additional tool when caring for pregnant patients in the delivery room. As obstetricians use ultrasound imaging a lot in routine clinical practice, in the current pandemic setting, routine prenatal imaging screening could be expanded by the addition of ultrasound scans of the lung. Lung sonography can offer important additional information, particularly in obstetrics where the indications for radiation-emitting imaging are particularly restrictive. If there is a sonographic suspicion of lung involvement, then, depending on the symptoms and the morphological extent of the ultrasound findings, it may be necessary to consider admitting the patient to hospital for close fetal and maternal monitoring.

Efficacy of Fluid Administration Followed by Lung Sonography in Hemodynamic Assessment in Acute Circulatory Failure in Critically Ill Patients

Background: Early recognition and appropriate treatment of shock have been shown to decrease mortality. Incorporation of bedside ultrasound in patients with undifferentiated shock allows for rapid evaluation of reversible causes of shock and improves accurate diagnosis in undifferentiated hypotension. The aim of the present study was to evaluate efficacy of fluid administration followed by lung sonography in hemodynamic assessment in acute circulatory failure in critically ill patients. Materials and Methods: This prospective cohort controlled randomized study was carried out on 50 Critically ill Patients who had acute circulatory failure in intensive care unit Tanta university hospital Critically ill patients of either sex aged 21-60 years when mean blood pressure was below 65 mmHg were included. Patients have been uniformly distributed in 2 categories, The patients assigned either to the Control Group (group I) or to the FALLS (fluid administration limited by lung sonography) protocol group (group II). Results: Comparison between two groups revealed that, the heart rate showed that heart rate is lower in group II in comparison to group I .Comparison between two groups revealed that, the mean arterial blood pressure changes showed that it is higher in group II in comparison to group I .Comparison between two groups revealed that, the Central venous pressure showed that no significant difference in the base line .Intensive care unit stay in group I ranged between 5 – 11 days while in group II ranged between 3 – 8 days .Survival analysis (Kaplan Mier curve), Mortality at 28 days found in group I mean 21.28 days with SE 1.898 and in group II mean 24 days with SE 1.64 with no significant difference in time but there was significant difference in number of mortalities as discussed before. Conclusion: We conclude from this study that bedside Lung Ultrasound has a good accuracy and superiority in assessment over other traditionally used methods for detecting early signs of pulmonary congestion and thus guides the fluid administration in shock management to decrease complications, mortality and intensive care stay.

Lungensonografie bei Patienten mit Verdacht auf COVID-19 – Schritt-für-Schritt

Pulmonary sonography can be a valuable aid in the differential diagnosis of a variety of cardiopulmonary diseases, including patients with COVID-19. Pulmonary sonography is an examination method that is also quickly available at the bedside without additional risks for the patient. When COVID-19 is suspected, lung sonography is a valuable component of initial diagnosis when used systematically, performed hygienically and correctly. However, the findings of pulmonary sonography must be placed in the clinical context; sonography does not replace the gold standard of PCR diagnosis. The article shows how this sonography is performed and which findings in COVID-19 are relevant.

Evaluation of the Diagnostic Value of Bedside Transthoracic Ultrasonography (TTUS) and Lower Extremity Three-Points Compression Duplex in the Diagnosis of the Pulmonary Embolism

Background: The present study aimed at evaluating the diagnostic value of lung transthoracic ultrasonography (TTUS) and lower extremity sonography versus computed tomography pulmonary angiography (CTPA) in the diagnosis of pulmonary embolus (PE). Materials and Methods: This study was performed on 104 patients with clinically suspected PE. CTPA and D-dimer was performed on all patients. Wells’ deep vein thrombosis criteria (WDVTC) was evaluated and recorded at the patient’s admission. Finally, the results of adding venous and lung sonography scores to the WDVTC with and without the results of D-dimer test were analyzed for predicting the diagnosis of PE. Results: There were 104 patients clinically suspected of having a PE and enrolled in the study. A PE was confirmed in 37.5% of this cohort. WDVTC had a sensitivity and specificity of 94.87% and 80.00%, respectively, to predict PE. When adding D-dimer to the WDVTC for patients unlikely to have a PE (WDVTC≤4), the sensitivity and specificity of positive D-dimer in diagnosis of PE were 94.87% and 56.92%, respectively ( P < .001). Conclusion: According to these study results, the modification of the WDVTC along with the results of lung TTUS and lower extremity venous sonogram significantly increase the diagnostic power for PE.

Lung sonography is useful for the initial detection of left-sided double lumen tracheal tube position in both novice and expert; a randomized prospective crossover study

Background Detecting the position of the double lumen tube (DLT), lung sonography, can be an effective technique and may provide more detailed information than chest auscultation. However, the diagnostic efficacy of lung sonography for determining DLT position can differ between novice and expert.Methods We enrolled and allocated ninety patients into two groups; one group using chest auscultation and the other using lung sonography for the determination of DLT position. In both groups, two repeat-assessments were provided by two independent examiners; first by a novice, and second by an expert. The primary outcome was the overall accuracy, sensitivity, specificity, positive or negative predictive values between novice and expert in confirming the position of the left-sided DLT. In both groups, final position was confirmed by a fiberoptic bronchoscopy.Results Both using auscultation and sonography, novices and experts showed similar diagnostic efficacy. However, in patients using sonography, both novice and expert showed better outcomes than in patients using chest auscultation. In receiver operating characteristic analysis, lung sonography seemed to showe a better predictability in incorrect DLT position than chest auscultation, especially by experts.Conclusion Lung sonography showed a better diagnostic efficacy for detecting DLT position than chest auscultation. Furthermore, using lung sonography, novice investigator may perform similar assessment for identifying incorrect DLT position to expert.