0
Critical Care |

Pneumonia and Lung Ultrasound in the Intensive Care Unit

Ana Parra, MD; Purificacion Perez, MD; Joaquim Serra, PhD; Oriol Roca, PhD; Joan Ramon Masclans, PhD; Jordi Rello, PhD
Author and Funding Information

Vall d'Hebron University Hospital, Barcelona, Spain


Chest. 2014;145(3_MeetingAbstracts):171A. doi:10.1378/chest.1806646
Text Size: A A A
Published online

Abstract

SESSION TITLE: Critical Care Cases

SESSION TYPE: Case Reports

PRESENTED ON: Saturday, March 22, 2014 at 04:15 PM - 05:15 PM

INTRODUCTION: Lung ultrasound (LUS) may be useful in the differential diagnosis of Chest-X-Ray (CXR) opacifications in critically ill patients. To confirm this hypothesis we present three cases with a nonspecific CXR in which LUS was key point for the initial diagnosis and management, confirmed after works by the CT-scan as gold standard.

CASE PRESENTATION: Case Report 1: A 51-year old woman with productive cough and fever. CXR showed completed opacification of right hemithorax. LUS showed Tissue-Like pattern with a large hypoechoic image suggestive of pneumonia complicated by lung abscess. This finding was crucial for treatment in order to drain the abscess. CT scan confirmed the diagnostic. Case Report 2: A 63-year old woman presented cough, fever and chest pain. CXR showed a right hemithorax opacification. LUS observed a Tissue-Like sign and a large septated pleural effusion. In contrast, CT scan showed a non-loculated effusion. A bedside chest-tube insertion drained less than 200ml. LUS reconfirmed the diagnosis of loculations and urokinase was administrated with good result. Case Report 3: A 64-year old man presented 4 days of high fever. Left hemithorax opacity was objectified in CXR. LUS discarded pleural effusion and showed a Tissue-Like pattern in the left lung and B-line pattern in the right lung. CT-scan confirmed a left lung pneumonic consolidation and basal right lung ground glass areas without pleural effusion.

DISCUSSION: Although, CT scan is the gold standard in differential diagnoses of pulmonary pathology, it has some risks, especially in unstable critically ill patients. In those cases, a non-invasive bedside tool would be preferable. Many studies suggest that LUS is an accuracy diagnostic tool in pulmonary pathologies like pleural effusion or consolidation. As reported in these cases, LUS could be useful for the diagnosis, leading for an early management of abscess, necrosis, acute respiratory distress syndrome and loculated effusion.

CONCLUSIONS: The use of ultrasonography in the ICU would be promoted as a reliable, low-cost, radiation-free and bedside tool. Diagnosis of CXR opacities in critically ill patients by LUS is feasible and safe. Bedside LUS may confirm local complications leading to an early management.

Reference #1: Gardelli G. Chest ultrasonography in the ICU. Respir Care 2012; 57: 773-81.

Reference #2: ILC-LUS, ICC-LUS. International evidence-based recommendations for the point-of-care lung ultrasound. Intensive Care Med 2012; 38:577-591.

Reference #3: Lichtenstein. The BLUE protocol. Chest 2008; 134: 117-25.

DISCLOSURE: The following authors have nothing to disclose: Ana Parra, Purificacion Perez, Joaquim Serra, Oriol Roca, Joan Ramon Masclans, Jordi Rello

No Product/Research Disclosure Information


Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
Guidelines
Feverish illness in children: assessment and initial management in children younger than 5 years.
National Collaborating Centre for Women's and Children's Health | 8/28/2009
Clinical practice guidelines for hospital-acquired pneumonia and ventilator-associated pneumonia in adults.
Association of Medical Microbiology and Infectious Disease Canada | 8/28/2009
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543