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Correspondence |

Chest Ultrasonography as a Replacement for Chest Radiography for Community-Acquired PneumoniaChest Ultrasound in Community-Acquired Pneumonia FREE TO VIEW

Andrew R. L. Medford, MBChB, MD
Author and Funding Information

From the North Bristol Lung Centre, Southmead Hospital.

Correspondence to: Andrew R. L. Medford, MBChB, MD, North Bristol Lung Centre, Southmead Hospital, Westbury-on-Trym, Bristol, BS10 5NB, England; e-mail: andrewmedford@hotmail.com


Financial/nonfinancial disclosures: The author has reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

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


Chest. 2013;143(3):877-878. doi:10.1378/chest.12-2653
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To the Editor:

The recently published prospective study by Reissig et al1 in CHEST (October 2012) has suggested the use of lung ultrasound (LUS) for diagnosis and follow-up of community-acquired pneumonia. This is an innovative study with achievement of very good specificity and sensitivity by highly trained sonographers. Clearly, there are advantages to the use of LUS over chest radiography (CXR), specifically the lack of radiation, which would make this an attractive modality in children, women who are pregnant, and young female patients. In addition, LUS can detect other ancillary findings not always evident on the CXR2 as well as facilitating pleural sampling.

What are the caveats? Like its use compared with CT scanning3 and CXR in pneumothorax,4 at the moment, the use of LUS should be seen as complementary to the CXR in community-acquired pneumonia. In smokers or adults >50 years of age, CXR is recommended at follow-up to detect any underlying proximal disease (eg, lung cancer). How does LUS compare with CXR here? UK national guidelines in adults with community-acquired pneumonia still recommend the use of CXR; LUS is not mentioned once in the document.5 Training of ultrasonographers would require at least level two Royal College of Radiology training in chest ultrasound in the United Kingdom to perform and interpret the LUS.6 In addition, acquisition and interpretation of LUS images is notoriously operator dependent, unlike interpretation of CXR (or CT scan). Finally, the CXR may also give useful ancillary information not available from the LUS (eg, mediastinal adenopathy, pulmonary vascular or cardiac disease, underlying lung disease, or metastatic disease).

In summary, LUS looks promising as an adjunctive technique in community-acquired pneumonia by adequately trained sonographers, with a particular role for those patients in whom radiation should be avoided. Otherwise, it should have a complementary role to CXR at the current time, pending further validation.

References

Reissig A, Copetti R, Mathis G, et al. Lung ultrasound in the diagnosis and follow-up of community-acquired pneumonia. A prospective, multicenter, diagnostic accuracy study. Chest. 2012;142(4):965-972. [CrossRef] [PubMed]
 
Medford AR, Entwisle JJ. Indications for thoracic ultrasound in chest medicine: an observational study. Postgrad Med J. 2010;86(1011):8-11. [CrossRef] [PubMed]
 
Medford AR, Entwisle JJ. Thoracic ultrasound in malignant pleural effusion: a real world perspective. Thorax. 2009;64(11):1005. [CrossRef] [PubMed]
 
Medford AR. Chest ultrasonography as a replacement for chest radiography in the ED. Chest. 2011;140(5):1386-1387. [CrossRef] [PubMed]
 
Lim WS, Baudouin SV, George RC, et al; Pneumonia Guidelines Committee of the BTS Standards of Care Committee. BTS guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax. 2009;64(suppl 3):iii1-iii55. [CrossRef] [PubMed]
 
Royal College of Radiologists. 2005. Ultrasound training recommendations for medical and surgical specialties. Ref No: BFCR (05)2. The Royal College of Radiologists website.http://www.rcr.ac.uk/publications.aspx.Accessed October 26, 2012.
 

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References

Reissig A, Copetti R, Mathis G, et al. Lung ultrasound in the diagnosis and follow-up of community-acquired pneumonia. A prospective, multicenter, diagnostic accuracy study. Chest. 2012;142(4):965-972. [CrossRef] [PubMed]
 
Medford AR, Entwisle JJ. Indications for thoracic ultrasound in chest medicine: an observational study. Postgrad Med J. 2010;86(1011):8-11. [CrossRef] [PubMed]
 
Medford AR, Entwisle JJ. Thoracic ultrasound in malignant pleural effusion: a real world perspective. Thorax. 2009;64(11):1005. [CrossRef] [PubMed]
 
Medford AR. Chest ultrasonography as a replacement for chest radiography in the ED. Chest. 2011;140(5):1386-1387. [CrossRef] [PubMed]
 
Lim WS, Baudouin SV, George RC, et al; Pneumonia Guidelines Committee of the BTS Standards of Care Committee. BTS guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax. 2009;64(suppl 3):iii1-iii55. [CrossRef] [PubMed]
 
Royal College of Radiologists. 2005. Ultrasound training recommendations for medical and surgical specialties. Ref No: BFCR (05)2. The Royal College of Radiologists website.http://www.rcr.ac.uk/publications.aspx.Accessed October 26, 2012.
 
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