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Critical Care |

Diagnostic Accuracy of Transthoracic Chest Ultrasound in Patients With Acute Respiratory Failure

Maha Ghanem, MD; Ali Abd ElAzeem, MD; Hoda Makhlouf, MD
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Department of Chest Diseases - Assiut University Hospital, Assiut, Egypt


Chest. 2013;144(4_MeetingAbstracts):374A. doi:10.1378/chest.1703818
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Abstract

SESSION TITLE: Critical Care Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: To define the accuracy of chest ultrasound (CU) in patients with clinically suspected pulmonary diseases resulting in acute respiratory failure (ARF).

METHODS: This study was conducted on 59 patients with ARF. They underwent CU examination as part of their evaluation blinded to their diagnosis. We compared CU results and final diagnosis based on laboratory, chest radiography and/or CT scans. Different CU findings were assessed including horizontal A lines, vertical B lines, lung sliding (LS), alveolar consolidation (AC), and/or pleural effusion. These patterns were correlated with final clinical diagnosis.

RESULTS: For pulmonary edema (n=16), anterior-predominant bilateral B lines had 96% specificity and 95% sensitivity. For COPD and asthma (n=14), anterior-predominant A lines with lung sliding had 96% specificity and 86% sensitivity. For pneumonia (n=12), different patterns were seen; AC (n=5), anterior-predominant B lines on one side and predominant A lines on the other (n=4), and A lines plus pleural effusion (n=3) with 92% specificity and 85% sensitivity. For pulmonary embolism (n=5), unilateral anterior predominant bilateral A lines associated with LS with or without peripheral hypoechoic lesion showed 95% specificity and 79% sensitivity. For pneumothorax (n=4), absent anterior LS, anterior A lines, and a positive search for lung point yielded 100% specificity and 75% sensitivity. For all patients, CU correlated with final diagnoses in 90% of cases.

CONCLUSIONS: CU is a simple, bedside noninvasive tool that can help making a rapid diagnosis in critically ill respiratory patients with ARF. Despite its adequate sensitivity, other imaging modalities are needed to confirm or exclude the diagnosis in certain clinical situations.

CLINICAL IMPLICATIONS: CU is a bedside informative imaging techniques that can help optimizing diagnostic and therapeutic procedures in critically ill chest patients. Specific CU findings can help making rapid diagnosis in patients with ARF and chest complications.

DISCLOSURE: The following authors have nothing to disclose: Maha Ghanem, Ali Abd ElAzeem, Hoda Makhlouf

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