Lung ultrasound in internal medicine: A bedside help to increase accuracy in the diagnosis of dyspnea

Tiziano Perrone, Alessia Maggi, Carmelo Sgarlata, Ilaria Palumbo, Elisa Mossolani, Sara Ferrari, Ariel Melloul, Roberta Mussinelli, Michele Boldrini, Ambra Raimondi, Aderville Cabassi, Francesco Salinaro, Stefano Perlini

Research output: Contribution to journalArticle

Abstract

Background Dyspnea is one of the most frequent causes of admission in Internal Medicine wards, leading to a sizeable utilization of medical resources. Study design and methods The role of bedside lung ultrasound (LUS) was evaluated in 130 consecutive patients (age: 81 ± 9 years), in whom blindly collected LUS results were compared with data obtained by clinical examination, medical history, blood analysis, and chest X-ray. Dyspnea etiology was classified as “cardiac” (n = 80), “respiratory” (n = 36) or “mixed” (n = 14), according to the discharge diagnosis (congestive heart failure either alone [n = 80] or associated with pneumonia [n = 14], pneumonia [n = 24], and obstructive disventilatory syndrome [n = 12]). An 8-window LUS protocol was applied to evaluate B-line distribution, “interstitial syndrome” pattern, pleural effusion and images of static or dynamic air bronchogram/focal parenchymal consolidation. Results The presence of a generalized “interstitial syndrome” at the initial LUS evaluation allowed to discriminate “cardiac” from “pulmonary” Dyspnea with high sensitivity (93.75%; confidence intervals: 86.01%–97.94%) and specificity (86.11%; 70.50%–95.33%). Positive and negative predictive values were 93.76% (86.03%–97.94%) and 86.09% (70.47%–95.32%), respectively. Moreover, LUS diagnostic accuracy for the diagnosis of pneumonia was not inferior to that of chest X-ray. Conclusions Bedside LUS evaluation contributes with high sensitivity and specificity to the differential diagnosis of Dyspnea. This holds true not only in the emergency setting, but also in the sub-acute Internal Medicine arena. A wider use of this portable technique in our wards is warranted.

Original languageEnglish
Pages (from-to)61-65
Number of pages5
JournalEuropean Journal of Internal Medicine
Volume46
DOIs
Publication statusPublished - Dec 1 2017

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Internal Medicine
Dyspnea
Lung
Pneumonia
Thorax
X-Rays
Pleural Effusion
Ultrasonography
Emergencies
Differential Diagnosis
Heart Failure
Air
Confidence Intervals
Sensitivity and Specificity

Keywords

  • Bedside ultrasound
  • Diagnosis
  • Internal medicine
  • Lung congestion
  • Lung ultrasound
  • Pneumonia

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Lung ultrasound in internal medicine : A bedside help to increase accuracy in the diagnosis of dyspnea. / Perrone, Tiziano; Maggi, Alessia; Sgarlata, Carmelo; Palumbo, Ilaria; Mossolani, Elisa; Ferrari, Sara; Melloul, Ariel; Mussinelli, Roberta; Boldrini, Michele; Raimondi, Ambra; Cabassi, Aderville; Salinaro, Francesco; Perlini, Stefano.

In: European Journal of Internal Medicine, Vol. 46, 01.12.2017, p. 61-65.

Research output: Contribution to journalArticle

Perrone, T, Maggi, A, Sgarlata, C, Palumbo, I, Mossolani, E, Ferrari, S, Melloul, A, Mussinelli, R, Boldrini, M, Raimondi, A, Cabassi, A, Salinaro, F & Perlini, S 2017, 'Lung ultrasound in internal medicine: A bedside help to increase accuracy in the diagnosis of dyspnea', European Journal of Internal Medicine, vol. 46, pp. 61-65. https://doi.org/10.1016/j.ejim.2017.07.034
Perrone, Tiziano ; Maggi, Alessia ; Sgarlata, Carmelo ; Palumbo, Ilaria ; Mossolani, Elisa ; Ferrari, Sara ; Melloul, Ariel ; Mussinelli, Roberta ; Boldrini, Michele ; Raimondi, Ambra ; Cabassi, Aderville ; Salinaro, Francesco ; Perlini, Stefano. / Lung ultrasound in internal medicine : A bedside help to increase accuracy in the diagnosis of dyspnea. In: European Journal of Internal Medicine. 2017 ; Vol. 46. pp. 61-65.
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abstract = "Background Dyspnea is one of the most frequent causes of admission in Internal Medicine wards, leading to a sizeable utilization of medical resources. Study design and methods The role of bedside lung ultrasound (LUS) was evaluated in 130 consecutive patients (age: 81 ± 9 years), in whom blindly collected LUS results were compared with data obtained by clinical examination, medical history, blood analysis, and chest X-ray. Dyspnea etiology was classified as “cardiac” (n = 80), “respiratory” (n = 36) or “mixed” (n = 14), according to the discharge diagnosis (congestive heart failure either alone [n = 80] or associated with pneumonia [n = 14], pneumonia [n = 24], and obstructive disventilatory syndrome [n = 12]). An 8-window LUS protocol was applied to evaluate B-line distribution, “interstitial syndrome” pattern, pleural effusion and images of static or dynamic air bronchogram/focal parenchymal consolidation. Results The presence of a generalized “interstitial syndrome” at the initial LUS evaluation allowed to discriminate “cardiac” from “pulmonary” Dyspnea with high sensitivity (93.75{\%}; confidence intervals: 86.01{\%}–97.94{\%}) and specificity (86.11{\%}; 70.50{\%}–95.33{\%}). Positive and negative predictive values were 93.76{\%} (86.03{\%}–97.94{\%}) and 86.09{\%} (70.47{\%}–95.32{\%}), respectively. Moreover, LUS diagnostic accuracy for the diagnosis of pneumonia was not inferior to that of chest X-ray. Conclusions Bedside LUS evaluation contributes with high sensitivity and specificity to the differential diagnosis of Dyspnea. This holds true not only in the emergency setting, but also in the sub-acute Internal Medicine arena. A wider use of this portable technique in our wards is warranted.",
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AU - Perrone, Tiziano

AU - Maggi, Alessia

AU - Sgarlata, Carmelo

AU - Palumbo, Ilaria

AU - Mossolani, Elisa

AU - Ferrari, Sara

AU - Melloul, Ariel

AU - Mussinelli, Roberta

AU - Boldrini, Michele

AU - Raimondi, Ambra

AU - Cabassi, Aderville

AU - Salinaro, Francesco

AU - Perlini, Stefano

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N2 - Background Dyspnea is one of the most frequent causes of admission in Internal Medicine wards, leading to a sizeable utilization of medical resources. Study design and methods The role of bedside lung ultrasound (LUS) was evaluated in 130 consecutive patients (age: 81 ± 9 years), in whom blindly collected LUS results were compared with data obtained by clinical examination, medical history, blood analysis, and chest X-ray. Dyspnea etiology was classified as “cardiac” (n = 80), “respiratory” (n = 36) or “mixed” (n = 14), according to the discharge diagnosis (congestive heart failure either alone [n = 80] or associated with pneumonia [n = 14], pneumonia [n = 24], and obstructive disventilatory syndrome [n = 12]). An 8-window LUS protocol was applied to evaluate B-line distribution, “interstitial syndrome” pattern, pleural effusion and images of static or dynamic air bronchogram/focal parenchymal consolidation. Results The presence of a generalized “interstitial syndrome” at the initial LUS evaluation allowed to discriminate “cardiac” from “pulmonary” Dyspnea with high sensitivity (93.75%; confidence intervals: 86.01%–97.94%) and specificity (86.11%; 70.50%–95.33%). Positive and negative predictive values were 93.76% (86.03%–97.94%) and 86.09% (70.47%–95.32%), respectively. Moreover, LUS diagnostic accuracy for the diagnosis of pneumonia was not inferior to that of chest X-ray. Conclusions Bedside LUS evaluation contributes with high sensitivity and specificity to the differential diagnosis of Dyspnea. This holds true not only in the emergency setting, but also in the sub-acute Internal Medicine arena. A wider use of this portable technique in our wards is warranted.

AB - Background Dyspnea is one of the most frequent causes of admission in Internal Medicine wards, leading to a sizeable utilization of medical resources. Study design and methods The role of bedside lung ultrasound (LUS) was evaluated in 130 consecutive patients (age: 81 ± 9 years), in whom blindly collected LUS results were compared with data obtained by clinical examination, medical history, blood analysis, and chest X-ray. Dyspnea etiology was classified as “cardiac” (n = 80), “respiratory” (n = 36) or “mixed” (n = 14), according to the discharge diagnosis (congestive heart failure either alone [n = 80] or associated with pneumonia [n = 14], pneumonia [n = 24], and obstructive disventilatory syndrome [n = 12]). An 8-window LUS protocol was applied to evaluate B-line distribution, “interstitial syndrome” pattern, pleural effusion and images of static or dynamic air bronchogram/focal parenchymal consolidation. Results The presence of a generalized “interstitial syndrome” at the initial LUS evaluation allowed to discriminate “cardiac” from “pulmonary” Dyspnea with high sensitivity (93.75%; confidence intervals: 86.01%–97.94%) and specificity (86.11%; 70.50%–95.33%). Positive and negative predictive values were 93.76% (86.03%–97.94%) and 86.09% (70.47%–95.32%), respectively. Moreover, LUS diagnostic accuracy for the diagnosis of pneumonia was not inferior to that of chest X-ray. Conclusions Bedside LUS evaluation contributes with high sensitivity and specificity to the differential diagnosis of Dyspnea. This holds true not only in the emergency setting, but also in the sub-acute Internal Medicine arena. A wider use of this portable technique in our wards is warranted.

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KW - Diagnosis

KW - Internal medicine

KW - Lung congestion

KW - Lung ultrasound

KW - Pneumonia

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