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.

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. - ISSN 0953-6205. - S0953:6205(17)(2017), pp. 30302-30303. [10.1016/j.ejim.2017.07.034]

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

FERRARI, SARA;Cabassi, Aderville;
2017

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.
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. - ISSN 0953-6205. - S0953:6205(17)(2017), pp. 30302-30303. [10.1016/j.ejim.2017.07.034]
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/11381/2835602
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