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Original Research: Chest Infections |

Lung Ultrasound in the Diagnosis and Follow-up of Community-Acquired PneumoniaMulticenter Study of Pneumonia: A Prospective, Multicenter, Diagnostic Accuracy Study

Angelika Reissig, MD; Roberto Copetti, MD; Gebhard Mathis, MD; Christine Mempel; Andreas Schuler, MD; Peter Zechner, MD; Stefano Aliberti, MD; Rotraud Neumann, MD; Claus Kroegel, MD, PhD; Heike Hoyer, MSc
Author and Funding Information

From the Department of Internal Medicine (Drs Reissig and Kroegel), Pneumology and Allergology; Institute of Diagnostic and Interventional Radiology (Dr Neumann); and Institute of Medical Statistics, Information Sciences and Documentation (Ms Hoyer), Friedrich-Schiller-University, Jena, Germany; Emergency Department (Dr Copetti), Latisana General Hospital, Latisana, Italy; Medical Practice (Dr Mathis), Rankweil, Austria; Department of Neurology (Ms Mempel), Helios Clinic, Erfurt, Germany; Department of Internal Medicine (Dr Schuler), Helfenstein Clinic, Geislingen, Germany; Department of Internal Medicine (Dr Zechner), Hospital Graz West, Graz, Austria; and Clinic of Pneumology (Dr Aliberti), University of Milan, IRCCS Fondazione Policlinico, Italy.

Correspondence to: Angelika Reissig, MD, Department of Internal Medicine, Pneumology and Allergology, Medical Clinic I, Friedrich-Schiller-University, Erlanger Allee 101, D-07740 Jena, Germany; e-mail: angelika.reissig@med.uni-jena.de


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

Funding/Support: The authors have reported to CHEST that no funding was received for this study.


Chest. 2012;142(4):965-972. doi:10.1378/chest.12-0364
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Background:  The aim of this prospective, multicenter study was to define the accuracy of lung ultrasound (LUS) in the diagnosis of community-acquired pneumonia (CAP).

Methods:  Three hundred sixty-two patients with suspected CAP were enrolled in 14 European centers. At baseline, history, clinical examination, laboratory testing, and LUS were performed as well as the reference test, which was a radiograph in two planes or a low-dose CT scan in case of inconclusive or negative radiographic but positive LUS findings. In patients with CAP, follow-up between days 5 and 8 and 13 and 16 was scheduled.

Results:  CAP was confirmed in 229 patients (63.3%). LUS revealed a sensitivity of 93.4% (95% CI, 89.2%-96.3%), specificity of 97.7% (95% CI, 93.4%-99.6%), and likelihood ratios (LRs) of 40.5 (95% CI, 13.2-123.9) for positive and 0.07 (95% CI, 0.04-0.11) for negative results. A combination of auscultation and LUS increased the positive LR to 42.9 (95% CI, 10.8-170.0) and decreased the negative LR to 0.04 (95% CI, 0.02-0.09). We found 97.6% (205 of 211) of patients with CAP showed breath-dependent motion of infiltrates, 86.7% (183 of 211) an air bronchogram, 76.5% (156 of 204) blurred margins, and 54.4% (105 of 193) a basal pleural effusion. During follow-up, median C-reactive protein levels decreased from 137 mg/dL to 6.3 mg/dL at days 13 to 16 as did signs of CAP; median area of lesions decreased from 15.3 cm2 to 0.2 cm2 and pleural effusion from 50 mL to 0 mL.

Conclusions:  LUS is a noninvasive, usually available tool used for high-accuracy diagnosis of CAP. This is especially important if radiography is not available or applicable. About 8% of pneumonic lesions are not detectable by LUS; therefore, an inconspicuous LUS does not exclude pneumonia.

Trial registry:  ClinicalTrials.gov; No.: NCT00808457; URL: www.clinicaltrials.gov

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