{"id":729,"date":"2015-05-27T16:23:28","date_gmt":"2015-05-27T16:23:28","guid":{"rendered":"http:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/?p=729"},"modified":"2017-08-21T11:45:38","modified_gmt":"2017-08-21T11:45:38","slug":"primary-care-corner-with-geoffrey-modest-md-lung-ultrasound-to-diagnose-pneumonia","status":"publish","type":"post","link":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2015\/05\/27\/primary-care-corner-with-geoffrey-modest-md-lung-ultrasound-to-diagnose-pneumonia\/","title":{"rendered":"Primary Care Corner with Geoffrey Modest MD: Lung ultrasound to diagnose pneumonia?"},"content":{"rendered":"

By: Dr. Geoffrey Modest<\/strong>
\nAn Italian prospective study was just published looking at the merits of ultrasound in diagnosing pneumonia (see Am J Emerg Med 2015 May; 33:620.). Prior studies have found that chest xray (CXR) is not so sensitive, 43.5% in one study when compared to chest CT (which is considered the gold standard). details:<\/p>\n

–275 patients with respiratory complaints (60% dyspnea, 25% cough, 10% purulent sputum, 15% pleuritic chest pain) and underwent chest CT. Mean age 71, 53.3% women.
\n–Chest CT was positive for pneumonia (PNA) in 87 patients, with “almost perfect” concordance between the readings of 2 radiologists.
\n–lung ultrasound (LUS), done within 3 hours of the CT, and was positive in 81 patients. 72 of them (88.9%) also had a positive chest CT<\/p>\n

–the 9 false positives were: 3 lung cancer nodules, 3 cases of impaired ventilation not due to PNA, 3 cases of fibrotic bands
\n–the 15 false negatives were: 3 cases of posterior consolidations (the LUS was only performed on anterior-lateral chest), 5 cases of deep infection without contact with the pleura
\n–overall sensitivity was 82.8% (73.2-90%) and specificity was 95.5% (91.5-97.9%)
\n–interobserver variability: “almost perfect”
\n–in subgroup of patients with pleuritic chest pain: sensitivity was 91.7% and specificity was 97.4%
\n–in subgroup wihtout pleuritic chest pain: sensitivity was 81.3% and specificity was 95% (other studies found LUS less reliable with deep-seated infections)<\/p>\n

–CXR was done in addition to LUS in 190 patients:<\/p>\n

–sensitivity of LUS was 81.4% and of CXR was 64.3% (difference significant with p=0.036); specificities were similar (94.2% vs 90%)<\/p>\n

–so, overall, LUS rules in consolidation well (+ likelihood ratio of 18.2), and is moderately good in ruling out consolidation ( – LR=0.18)<\/p>\n

so, pretty inmpressive. This study confirms the relatively poor showing of CXR in diagnosing PNA, and found that LUS was really quite good, and the usual ultrasound concern of intra-observer variability was minimal. Although this needs to be validated in other settings, this study does hold out the promise of a noninvasive and nonradiation-associated evaluation of pneumonia.<\/p>\n","protected":false},"excerpt":{"rendered":"

By: Dr. Geoffrey Modest An Italian prospective study was just published looking at the merits of ultrasound in diagnosing pneumonia (see Am J Emerg Med 2015 May; 33:620.). Prior studies have found that chest xray (CXR) is not so sensitive, 43.5% in one study when compared to chest CT (which is considered the gold standard). […]<\/p>\n

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