Assessment of thoracic ultrasound in complementary diagnosis and in follow up of community-acquired pneumonia (cap)

Maria D'Amato, Gaetano Rea, Vincenzo Carnevale, Maria Arcangela Grimaldi, Anna Rita Saponara, Eric Rosenthal, Michele Maria Maggi, Lucia Dimitri, Marco Sperandeo

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: Chest X-ray (CXR) is the primary diagnostic tool for community-acquired pneumonia (CAP). Some authors recently proposed that thoracic ultrasound (TUS) could valuably flank or even reliably substitute CXR in the diagnosis and follow-up of CAP. We investigated the clinical utility of TUS in a large sample of patients with CAP, to challenge the hypothesis that it may be a substitute for CXR. Methods: Out of 645 consecutive patients with a CXR-confirmed CAP diagnosed in the emergency room of our hospital over a three-years period, 510 were subsequently admitted to our department of Internal Medicine. These patients were evaluated by TUS by a well-trained operator who was blinded of the initial diagnosis. TUS scans were performed both at admission and repeated at day 4-6th and 9-14th during stay. Results: TUS identified 375/510 (73.5%) of CXR-confirmed lesions, mostly located in posterior-basal or mid-thoracic areas of the lungs. Pleural effusion was detected in 26.9% of patients by CXR and in 30.4% by TUS. TUS documented the change in size of the consolidated areas as follows: 6.3 ± 3.4 cm at time 0, 2.5 ± 1.8 at 4-6 d, 0.9 ± 1.4 at 9-14 d. Out of the 12 patients with delayed CAP healing, 7 of them turned out to have lung cancer. Conclusions: TUS allowed to detect lung consolidations in over 70% of patients with CXR-confirmed CAP, but it gave false negative results in 26.5% of cases. Our longitudinal results confirm the role of TUS in the follow-up of detectable lesions. Thus, TUS should be regarded as a complementary and monitoring tool in pneumonia, instead of a primary imaging modality.

Original languageEnglish
Article number52
JournalBMC Medical Imaging
Volume17
Issue number1
DOIs
Publication statusPublished - Aug 31 2017

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Pneumonia
Thorax
X-Rays
Lung
Pleural Effusion
Internal Medicine
Hospital Emergency Service
Lung Neoplasms

Keywords

  • Community acquired pneumonia (CAP)
  • Complementary diagnostic tool
  • Follow-up
  • Thoracic ultrasound (TUS)

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Assessment of thoracic ultrasound in complementary diagnosis and in follow up of community-acquired pneumonia (cap). / D'Amato, Maria; Rea, Gaetano; Carnevale, Vincenzo; Grimaldi, Maria Arcangela; Saponara, Anna Rita; Rosenthal, Eric; Maggi, Michele Maria; Dimitri, Lucia; Sperandeo, Marco.

In: BMC Medical Imaging, Vol. 17, No. 1, 52, 31.08.2017.

Research output: Contribution to journalArticle

D'Amato, Maria ; Rea, Gaetano ; Carnevale, Vincenzo ; Grimaldi, Maria Arcangela ; Saponara, Anna Rita ; Rosenthal, Eric ; Maggi, Michele Maria ; Dimitri, Lucia ; Sperandeo, Marco. / Assessment of thoracic ultrasound in complementary diagnosis and in follow up of community-acquired pneumonia (cap). In: BMC Medical Imaging. 2017 ; Vol. 17, No. 1.
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abstract = "Background: Chest X-ray (CXR) is the primary diagnostic tool for community-acquired pneumonia (CAP). Some authors recently proposed that thoracic ultrasound (TUS) could valuably flank or even reliably substitute CXR in the diagnosis and follow-up of CAP. We investigated the clinical utility of TUS in a large sample of patients with CAP, to challenge the hypothesis that it may be a substitute for CXR. Methods: Out of 645 consecutive patients with a CXR-confirmed CAP diagnosed in the emergency room of our hospital over a three-years period, 510 were subsequently admitted to our department of Internal Medicine. These patients were evaluated by TUS by a well-trained operator who was blinded of the initial diagnosis. TUS scans were performed both at admission and repeated at day 4-6th and 9-14th during stay. Results: TUS identified 375/510 (73.5{\%}) of CXR-confirmed lesions, mostly located in posterior-basal or mid-thoracic areas of the lungs. Pleural effusion was detected in 26.9{\%} of patients by CXR and in 30.4{\%} by TUS. TUS documented the change in size of the consolidated areas as follows: 6.3 ± 3.4 cm at time 0, 2.5 ± 1.8 at 4-6 d, 0.9 ± 1.4 at 9-14 d. Out of the 12 patients with delayed CAP healing, 7 of them turned out to have lung cancer. Conclusions: TUS allowed to detect lung consolidations in over 70{\%} of patients with CXR-confirmed CAP, but it gave false negative results in 26.5{\%} of cases. Our longitudinal results confirm the role of TUS in the follow-up of detectable lesions. Thus, TUS should be regarded as a complementary and monitoring tool in pneumonia, instead of a primary imaging modality.",
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AU - Carnevale, Vincenzo

AU - Grimaldi, Maria Arcangela

AU - Saponara, Anna Rita

AU - Rosenthal, Eric

AU - Maggi, Michele Maria

AU - Dimitri, Lucia

AU - Sperandeo, Marco

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AB - Background: Chest X-ray (CXR) is the primary diagnostic tool for community-acquired pneumonia (CAP). Some authors recently proposed that thoracic ultrasound (TUS) could valuably flank or even reliably substitute CXR in the diagnosis and follow-up of CAP. We investigated the clinical utility of TUS in a large sample of patients with CAP, to challenge the hypothesis that it may be a substitute for CXR. Methods: Out of 645 consecutive patients with a CXR-confirmed CAP diagnosed in the emergency room of our hospital over a three-years period, 510 were subsequently admitted to our department of Internal Medicine. These patients were evaluated by TUS by a well-trained operator who was blinded of the initial diagnosis. TUS scans were performed both at admission and repeated at day 4-6th and 9-14th during stay. Results: TUS identified 375/510 (73.5%) of CXR-confirmed lesions, mostly located in posterior-basal or mid-thoracic areas of the lungs. Pleural effusion was detected in 26.9% of patients by CXR and in 30.4% by TUS. TUS documented the change in size of the consolidated areas as follows: 6.3 ± 3.4 cm at time 0, 2.5 ± 1.8 at 4-6 d, 0.9 ± 1.4 at 9-14 d. Out of the 12 patients with delayed CAP healing, 7 of them turned out to have lung cancer. Conclusions: TUS allowed to detect lung consolidations in over 70% of patients with CXR-confirmed CAP, but it gave false negative results in 26.5% of cases. Our longitudinal results confirm the role of TUS in the follow-up of detectable lesions. Thus, TUS should be regarded as a complementary and monitoring tool in pneumonia, instead of a primary imaging modality.

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KW - Complementary diagnostic tool

KW - Follow-up

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