Lung Ultrasound in Coronary Care Unit, an Important Diagnostic Tool for Concomitant Pneumonia

Background: In the setting of a coronary care unit (CCU), the early detection of pneumonia is of paramount important to prevent severe complications. This study was designed aiming to evaluate the diagnostic accuracy of lung ultrasound (LUS) in the detection of pneumonia and compared with chest X-ray (CXR). Method: We enrolled 110 consecutive patients admitted to the CCU of Federico II University Hospital. Each patient underwent CXR and bedside LUS on admission. The final diagnosis (pneumonia vs. no pneumonia) was established by another clinician reviewing clinical and laboratory data independent of LUS results and possibly prescribing chest contrast-enhanced CT (n = 34). Results: The mean age was 70 ± 11 years old, and 68% were males. Pneumonia was clinically diagnosed in 26 (23%) patients. LUS was positive for pneumonia in 24 patients (sensitivity 92%, specificity 81%). Chest radiography was positive for pneumonia in nine patients (sensitivity 43%, specificity 95%). Using CT scan as a reference, LUS exhibited 92% sensitivity and a specificity of 96%. In ROC curve analysis, the diagnostic accuracy of CXR and LUS for the diagnosis of pneumonia was 0.86 (95% CI 0.77–0.94), which was higher than CXR 0.68 (95% CI 0.55–0.84), p < 0.05. Conclusion: Based on the findings of the present study, the accuracy of LUS in the detection of pneumonia was significantly higher than chest X-ray with comparable sensibility to CT scan.

[1]  S. Rajsic,et al.  Lung Sonography in Critical Care Medicine , 2022, Diagnostics.

[2]  R. Gopar-Nieto,et al.  Pulmonary Congestion Assessed by Lung Ultrasound and Cardiovascular Outcomes in Patients With ST-Elevation Myocardial Infarction , 2022, Frontiers in Physiology.

[3]  S. Salvadori,et al.  Operative Use of Thoracic Ultrasound in Respiratory Medicine: A Clinical Study , 2022, Diagnostics.

[4]  F. Javaudin,et al.  Contribution of lung ultrasound in diagnosis of community-acquired pneumonia in the emergency department: a prospective multicentre study , 2021, BMJ Open.

[5]  S. Chaitra,et al.  Diagnostic Accuracy of Bedside Lung Ultrasound in Emergency Protocol for the Diagnosis of Acute Respiratory Failure , 2021, Journal of medical ultrasound.

[6]  N. de Luca,et al.  Lung ultrasound: a narrative review and proposed protocol for patients admitted to Cardiac Rehabilitation Unit. , 2021, Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace.

[7]  Xiao-juan Wang,et al.  Factors associated with acute myocardial infarction in older patients after hospitalization with community-acquired pneumonia: a cross-sectional study , 2021, BMC Geriatrics.

[8]  N. Taniguchi,et al.  Point-of-care lung ultrasound for the assessment of pneumonia: a narrative review in the COVID-19 era , 2021, Journal of Medical Ultrasonics.

[9]  D. Guarino,et al.  Pneumonia Lung Ultrasound Score (PLUS): A New Tool for Detecting Pneumonia in the Oldest Patients , 2020, Journal of the American Geriatrics Society.

[10]  T. Leiria,et al.  Admission Bedside Lung Ultrasound Reclassifies Mortality Prediction in Patients With ST-Segment–Elevation Myocardial Infarction , 2020, Circulation. Cardiovascular imaging.

[11]  A. Davis,et al.  Diagnosis and Treatment of Adults With Community-Acquired Pneumonia. , 2020, JAMA.

[12]  Minjia Wang,et al.  Lung Ultrasound Combined With Procalcitonin for a Diagnosis of Ventilator-Associated Pneumonia , 2019, Respiratory Care.

[13]  G. de Simone,et al.  Anterior vs lateral symmetric interstitial syndrome in the diagnosis of acute heart failure. , 2019, International journal of cardiology.

[14]  C. Mancusi,et al.  A case of pulmonary edema: The critical role of lung-heart integrated ultrasound examination. , 2018, Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace.

[15]  F. Mojoli,et al.  Lung ultrasound for diagnosis and monitoring of ventilator-associated pneumonia. , 2018, Annals of translational medicine.

[16]  W. Self,et al.  Community-Acquired Pneumonia Visualized on CT Scans but Not Chest Radiographs , 2017, Chest.

[17]  S. Vanni,et al.  Diagnostic accuracy of lung ultrasonography combined with procalcitonin for the diagnosis of pneumonia: a pilot study , 2016, Critical Ultrasound Journal.

[18]  A. Nouvenne,et al.  Lung ultrasound and chest x-ray for detecting pneumonia in an acute geriatric ward , 2016, Medicine.

[19]  Y. Claessens,et al.  Diagnostic accuracy of C-reactive protein and procalcitonin in suspected community-acquired pneumonia adults visiting emergency department and having a systematic thoracic CT scan , 2015, Critical Care.

[20]  Antonio Pagano,et al.  Lung ultrasound for diagnosis of pneumonia in emergency department , 2015, Internal and Emergency Medicine.

[21]  M. Maule,et al.  Lung Ultrasound ‐ Implemented Diagnosis of Acute Decompensated Heart Failure in the , 2022 .

[22]  S. Vanni,et al.  Accuracy of lung ultrasound for the diagnosis of consolidations when compared to chest computed tomography , 2015, Critical Ultrasound Journal.

[23]  Y. Tao,et al.  Lung ultrasonography: an effective way to diagnose community-acquired pneumonia , 2014, Emergency Medicine Journal.

[24]  S. Barbic,et al.  Point-of-care ultrasonography for the diagnosis of acute cardiogenic pulmonary edema in patients presenting with acute dyspnea: a systematic review and meta-analysis. , 2014, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[25]  M. A. Chavez,et al.  Lung ultrasound for the diagnosis of pneumonia in adults: a systematic review and meta-analysis , 2014, Respiratory Research.

[26]  W. Self,et al.  High discordance of chest x-ray and computed tomography for detection of pulmonary opacities in ED patients: implications for diagnosing pneumonia. , 2013, The American journal of emergency medicine.

[27]  A. Sargsyan,et al.  International evidence-based recommendations for point-of-care lung ultrasound , 2012, Intensive Care Medicine.

[28]  L. Gargani.  Lung ultrasound: a new tool for the cardiologist , 2011, Cardiovascular ultrasound.

[29]  V. Noble,et al.  Emergency thoracic ultrasound in the differentiation of the etiology of shortness of breath (ETUDES): sonographic B-lines and N-terminal pro-brain-type natriuretic peptide in diagnosing congestive heart failure. , 2009, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[30]  M. Gheorghiade,et al.  Ultrasound lung comets for the differential diagnosis of acute cardiogenic dyspnoea: A comparison with natriuretic peptides ☆ , 2008, European journal of heart failure.