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Do We Still Need A Chest X-Ray For Detecting Pneumonia Or Is It Time For POC LUS?

Krystian Sporysz

LEARNING OBJECTIVE

This case report shows us the imprortance of using point-of-care lung ultrasound.

This is a brand new technique for diagnosing pneumonia. Patients in critical condition do not cooperate while doing chest X-ray, but it is very easy to perform lung ultrasound.

AIM

Point-of-care Lung Ultrasound has became a new and modern technique for detecting pneumonia.

Bedside lung ultrasound examination is performed by physycian who knows the patient.

It is fast, easy to learn, and most importantly free of radiation.

While most frequently performed diagnostic procedure is a chest X-ray, however, in patients with symptoms of respiratory failure and in severe general condition the usefulness of a chest X-ray is limited.

The causes of that are: the limitation to only one projection (due to patient position), limited sensitivity and specificity in the differential diagnosis of dyspnea causes.

METHODS

Bedside lung ultrasound was performer on a 70-years-old patient, admitted to the Emergency Department on account of resting dyspnea lasting for several hours and peripheral edema that has been increasing for about a week.

Patient negated chest pain, pain in general, and symptoms of infection.

Coexising conditions: sick sinus syndrome, tachycardia-bradycardia syndrome, arterial hypertension, chronic heart failure, status post VVIR stimulator implantation.

RESULTS

On admission the patient was confused. Pale and sweating skin. Noninvasive pulse oxymetry showed 85%, blood pressure was 170/110 mmHg, heart beat was irregular, approximately 130/min.

Auscultation revealed bilateral crackles above the inferior angles of the shoulder blades.

ECG showed tachyarythmia-atrial fibrillation with ventricle heart rate 140/min. Arterial blood gas test revealed characteristics of partial respiratory failure.

Lab tests showed hyponatremia, elevated inflammation markers.

Chest X-ray description: right pleural cavity free effusion in the left pleural cavity cannot be ruled out- the left costophrenic angle is covered by the enlarged heart. The visible lung zones are free of consolidations. Considerable perihilar congestion of the pulmonary circulation.

CONCLUSION

Current use of lung ultrasound offers a vast wariety of diagnostic oportunities to a performing physician.

In a described case, thanks to the use of ultrasonography, we were able to diagnose pulmonary edema and pneumonia in a few  minutes after the admission of the patient and then start the appropriate treatment.

No sign of pneumonia in chest X-ray were highlighted due to their location behind the enlargement of the cardiac silhouette.

That is why ultrasound is far better, because it can be used in a real time examination and in every probe locations on the patient chest.

 

Picture 1. A chest X-Ray

Lung ultrasound: numerous line B artifacts forming the so called :interstitial syndrom” in lower and medial lung fields in both lungs- typical for pulmonary edema, and a consolidation in the lower lobe of the left lung with a dynamic air bronchogram corresponding with inflammatory symptoms.

 

Picture 2. B lines artifacts

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Picture 3. Lung consolidation with a dynamic air bronchogram.

 

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