A recent study in the journal, Chest by ReiBig et al. that is getting quite a bit of press lately evaluates the accuracy of lung ultrasound in diagnosing community acquired pneumonia. Why this is cool? It highlights the use of lung US for pneumonia, getting closer to decreasing radiation needs for these patients (ALARA). It’s in Chest by a group of multi-disciplinary physicians (intensive care specialists, emergency medicine, radiologists). Specialists who practice in various European countries. All of that = cool!
What they state:… “At baseline, history, clinical examination, laboratory testing and LUS were performed as well as the reference test: X-ray in two planes or low-dose CT in case of inconclusive/negative X-ray but positive LUS. In patients with CAP, follow-up between day 5-8 and 13-16 was scheduled. LUS revealed a sensitivity of 93.4% with 95% confidence interval of [89.2%,96.3%], a specificity of 97.7% [93.4%,99.6%], and likelihood ratios (LR) of 40.5 [13.2,123.9] for positive and 0.07 [0.04,0.11] for negative results. A combination of auscultation and LUS increased positive LR ratio to 42.9 [10.8,170.0] and decreased negative LR to 0.04 [0.02,0.09].97.6% (205/210) of patients with CAP showed breath-dependant motion of infiltrates, 86.7% (183/211) an air bronchogram, 76.5% (156/204) blurred margins, 54.4% (105/193) a basal pleural effusion.”
Since we all still have our stethoscopes to help us with the above, unlike some new medical students, who are the future of medicine, who received pocket ultrasound machines instead of a stethoscope, because, hey, lets face it – if you can see the valvular issue why do you need to hear the murmur? If you can see the pleural effusion/pulmonary edema, why do you need to hear the rales? If you can see the pneumonia, why do you need to hear the crackles? If you can see the tamponade/pericardial effusion, why do you need to appreciate the distant heart sounds? If you can see the peristalsis, why do you need to hear for bowel sounds? – The only argument is – if your ultrasound machine breaks, you have a back up with your stethoscope. But I digress….
Bedside ultrasound for pneumonia, as recently discussed by Blaivas in the Journal of Ultrasound in Medicine, is an excellent tool to quicken the diagnosis, which apparently is quite accurate as indicated above.