Maria García-Uría Santos, Raquel Piñero, Sandra Jahnke, Nieves López Laguna

AIM

To evaluate the utility of point-of-care lung ultrasound (US) as an alternative to plain chest X-ray (CXR) and computed tomography (CT) scan in patients presenting with chest pain and dyspnea.

CASE REPORT

A 62-year-old male came to the Emergency Department complaining for sudden chest pain and dyspnea for the previous 18 hours.

The patient described a continuous pain not related to exercise nor food intake or postural changes. He denied nausea, vomiting, palpitations or fever.

His past medical history was significant for smoking and Chronic Obstructive Pulmonary Disease (COPD).

Physical examination revealed normal blood pressure, tachycardia without tachypnea and normal blood oxygen saturation levels. The cardiopulmonary auscultation was normal as well as the reminder of the examination.

At the beginning, a differential diagnosis was made between an acute heart failure, an acute Coronary Syndrome, Pneumothorax or Pulmonary Embolism.

The electrocardiogram was normal. In order to establish a definite diagnosis we decided to perform a bedside lung US evaluation where we found out A-lines were present but there were no B-lines visualized.

There were no lung sliding in an anterior view of the right hemithorax, and we observed the presence of “lung point” confirming the diagnosis of a right-sided pneumothorax.

A CXR revealed a right pneumothorax with a 35% volume that required a pleural drainage tube placement. After the intervention the patient was admitted so as to perform a definite surgical procedure.

CONCLUSION

Point-of-care lung US appears to be a useful tool for a fast and accurate evaluation of pneumothorax and other potential medical emergencies with several advantages, such as lack of radiation and high reliability.

Physicians working at Emergency and Critical Care Units should train US skills and be updated in order to improve and speed up the diagnosis and ensure an effective treatment of this kind of pathologies.