If anyone following SonoSpot does not know who Dr. Michael Blaivas is, you should. As the Greeks have varying Gods for varying reasons, he basically is one of the Gods of point-of-care US. On this current issue of the Journal of US in Medicine by AIUM, he discusses lung ultrasound and its ability to diagnose pneumonia.
As he discusses, pneumonia used to be diagnosed by the physical exam and history taking, but then studies have shown that those factors are not the most reliable. Comparing auscultation in expert hands with chest radiograph, the failure of the exam is evident, while physicians are under more pressure to not miss anything ever. On the opposite end, if we “think” its pneumonia and dont get a radiograph and prescribe antibiotics, physicians get the argument from the other side, having to do with antibiotic resistance and thus being a part of the reason for the end of the world according to the CDC. Ok, maybe not is those words, but close enough. Then, we get the chest Xray and still can miss a pneumonia – we have all had those patients that got admitted, got worse, got a CT chest and a pneumonia was clear on the CT but not at all on the chest Xray. This is especially true when we start thinking pulmonary embolus with that hypoxic, tachycardic, afebrile or low-grade fever patient.
Of course, lung ultrasound (aka thoracic ultrasound) has proven to be better than chest Xray in many clinical settings as shown in several studies. We can easily visualize pleural effusions, pneumothorax, and pulmonary edema. In attempting to visualize the various lung areas for pneumonia, the same technique is used. Dividing the chest into 8 total areas (4 on each side – 2 anterior and 2 lateral), using the low frequency phased array probe, you fan through each quadrant of each side on the semi-reclined patient. Neonates and young infants should have the linear array probe used.
Tune in tomorrow for a complete review of lung ultrasound, with images, clips and more!