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
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