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Imaging |

Lung Ultrasonography Compared to Computed Tomography Scan in the Detection of Pulmonary Pathology In Noncritically-Ill Medical/Surgical Patients

Stephen Milan; Pramil Vaghasia; Gerardo Chiricolo; Claudia Lapidus; Tony George; Keerthana Keshava; Jeremy Weingarten; Liziamma George
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New York Methodist Hospital, Brooklyn, NY


Chest. 2014;146(4_MeetingAbstracts):579A. doi:10.1378/chest.1994938
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Abstract

SESSION TITLE: Ultrasound and Other Imaging Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: To compare lung ultrasonography (LUS) and chest CT (CT) in detecting pulmonary pathology (consolidation, alveolo-interstial syndrome (AIS), pleural effusion, pneumothorax) in hospitalized, non-critically ill medical/surgical patients.

METHODS: Subjects older than 18 years of age admitted to the Med-Surg ward who underwent a medically indicated CT scan were included. Patients were excluded if chest wall abnormalities were present or patient refusal. LUS was performed on all patients in the 24 hour period following CT. LUS was performed by a pulmonologist and read by a single certified ultrasonographer. CT studies were evaluated for consolidation, AIS and pneumothorax by a single chest radiologist. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and odds ratio (OR) were calculated for each hemithorax using SAS 9.4.

RESULTS: 53 patients underwent LUS in the 24 hour period after CT was performed. There were no pneumothoraces identified and this parameter was not further analyzed. Consolidation pattern was identified in 26 images. Sensitivity, specificity, PPV and NPV for identifying consolidation by ultrasound were 76.5%, 69.0%, 54.2% and 86.0% respectively, with OR* 7.24 (2.83, 18.5). AIS pattern was identified in 9 images. Sensitivity, specificity, PPV and NPV for identifying AIS by ultrasound were 60.0%, 81.3%, 34.6% and 92.5% respectively, with OR* 6.53 (2.05, 20.82). Effusion pattern was identified in 30 images. Sensitivity, specificity, PPV and NPV for identifying effusion by ultrasound were 75.0%, 97.0%, 93.8% and 86.5% respectively, with OR* 96 (19.8, 465.6). *OR (95% Confidence Interval)

CONCLUSIONS: LUS proved to be sensitive in detecting consolidation (76.5), AIS (60%) and pleural effusion (75%). LUS had the highest specificity among pleural effusion (97%); adequate specificity was also present among AIS (81%) and consolidation (69%). LUS appears to be most accurate for determining the presence of pleural effusion overall (OR 96). This data suggests that LUS can be used effectively as an initial modality to detect lung pathology at the point of care.

CLINICAL IMPLICATIONS: LUS provides a point of care evaluation that is both sensitive and specific in the detection of the above pulmonary pathology. With the accumulating evidence of effectiveness of LUS compared with CT, it is clear that this modality is becoming a fundamental tool in thoracic imaging among non-critically ill hospitalized patients with acute pathology.

DISCLOSURE: The following authors have nothing to disclose: Stephen Milan, Pramil Vaghasia, Gerardo Chiricolo, Claudia Lapidus, Tony George, Keerthana Keshava, Jeremy Weingarten, Liziamma George

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