28 Nov Lung ultrasound for etiological diagnosis of pneumonia in the emergency department: correlation with bronchoalveolar lavage results
Lung ultrasound for etiological diagnosis of pneumonia in the emergency department: correlation with bronchoalveolar lavage results
27 November 2025
Lorenzo Pelagatti, Iacopo Vannini, Francesca Mangani, Gian Maria Rossolini, Giovanni Volpicelli, Simone Vanni & Peiman Nazerian
Background
Pneumonia is the leading cause of death from infectious diseases worldwide.
Lung ultrasound (LUS) is highly accurate for chest infections diagnosis, yet its correlation with causative pathogens remains unclear.
Respiratory cultures, combined with molecular techniques represent the gold standard, achieving etiological diagnosis in 90–95% of cases. We compared LUS findings with bronchoalveolar lavage (BAL) sample analyses; to our knowledge, no prior studies have investigated this in the emergency department (ED).
Materials and methods
Bronchoalveolar lavage (BAL)-LUS is a prospective observational non-profit study conducted in the ED, aiming to assess whether there is a correlation between the LUS sonographic appearance, assessed blindly across 12 lung fields, and the etiopathogenetic agent of pneumonia (bacterial and viral) detected with molecular syndromic panels (MSPs) and respiratory cultures obtained with BAL.
Results
Two participants were lost to follow-up (one each from the AI and VR groups). In the first assessment, the Traditional group achieved the highest mean RACE score (15.77), followed by AI (13.39) and VR (13.23).
64 patients were enrolled (mean age 73.3 ± 14.6) with 11 diagnosed as viral pneumonia and 53 as bacterial pneumonia. Bacterial pneumonias were more commonly associated with consolidation (2.9 ± 2.2 vs. 1.5 ± 0.9, p < 0.01) and a higher incidence of pleural effusion (0.9 ± 1.3 vs. 0.3 ± 0.6, p < 0.01).
Viral pneumonias were more often associated with interstitial syndrome (4.9 ± 3.3 vs. 0.5 ± 1.3, p < 0.01) and small subpleural consolidations (0.9 ± 1.8 vs. 0.2 ± 0.6, p = 0.01). The mean LUS score was significantly higher in bacterial than in viral pneumonia with a AUC of 0.81 (95% CI 0.68–0.93).
Conclusion
Viral pneumonia is usually associated with interstitial syndrome and small subpleural consolidations; on the other hand, bacterial pneumonia is usually associated with consolidation, and pleural effusion.
READ MORE HERE: https://link.springer.com/article/10.1186/s13089-025-00470-0
Sorry, the comment form is closed at this time.