Clinical Applicability of Lung Ultrasound Methods in the Emergency Department to Detect Pulmonary Congestion on Computed Tomography

Abstract

Background B-lines on lung ultrasound are seen in decompensated heart failure, but their diagnostic value in consecutive patients in the acute setting is not clear. Chest CT is the superior method to evaluate interstitial lung disease, but no studies have compared lung ultrasound directly to congestion on chest CT.

Purpose To examine whether congestion on lung ultrasound equals congestion on a low-dose chest CT as the gold standard.

Materials and Methods In a single-center, prospective observational study we included consecutive patients ≥ 50 years of age in the emergency department. Patients were concurrently examined by lung ultrasound and chest CT. Congestion on lung ultrasound was examined in three ways: I) the total number of B-lines, II) ≥ 3 B-lines bilaterally, III) ≥ 3 B-lines bilaterally and/or bilateral pleural effusion. Congestion on CT was assessed by two specialists blinded to all other data.

Results We included 117 patients, 27 % of whom had a history of heart failure and 52 % chronic obstructive pulmonary disease. Lung ultrasound and CT were performed within a median time of 79.0 minutes. Congestion on CT was detected in 32 patients (27 %). Method I had an optimal cut-point of 7 B-lines with a sensitivity of 72 % and a specificity of 81 % for congestion. Method II had 44 % sensitivity, and 94 % specificity. Method III had a sensitivity of 88 % and a specificity of 85 %.

Conclusion Pulmonary congestion in consecutive dyspneic patients ≥ 50 years of age is better diagnosed if lung ultrasound evaluates both B-lines and pleural effusion instead of B-lines alone.

Zusammenfassung

Hintergrund B-Linien im Lungenultraschall treten bei dekompensierter Herzinsuffizienz auf; ihr diagnostischer Wert bei aufeinanderfolgenden Patienten in der Akutaufnahme ist jedoch nicht eindeutig. Brust-CT ist die überlegene Methode zur Beurteilung interstitieller Lungenerkrankungen, doch keine Studien haben bisher den Lungenultraschall direkt mit Stauungen in der Brust-CT verglichen.

Ziel Untersuchung, ob eine Stauung im Lungenultraschall einer Stauung in einer niedrigdosierten Thorax-CT als Goldstandard entspricht.

Material und Methoden In einer prospektiven Beobachtungsstudie eines Zentrums wurden aufeinanderfolgende Patienten der Notaufnahme im Alter ≥ 50 Jahren eingeschlossen. Die Patienten wurden gleichzeitig mit Lungenultraschall und Brust-CT untersucht. Die Stauung im Lungenultraschall wurde auf 3 Arten begutachtet: I) Gesamtzahl der B-Linien, II) ≥ 3 B-Linien bilateral, III) ≥ 3 B-Linien bilateral und/oder bilateraler Pleuraerguss. Die Stauung in der CT wurde von 2 Spezialisten beurteilt, mit Verblindung für alle anderen Daten.

Ergebnisse Eingeschlossen wurden 117 Patienten, davon 27 % mit Herzinsuffizienz in der Vorgeschichte und 52 % mit chronisch obstruktiver Lungenerkrankung. Lungenultraschall und CT wurden innerhalb einer medianen Zeitspanne von 79,0 Minuten durchgeführt. Bei 32 Patienten (27 %) wurde eine Stauung in der CT festgestellt. Methode I hatte einen optimalen Schnittpunkt von 7 B-Linien mit einer Sensitivität von 72 % und einer Spezifität von 81 % für Stauungen. Methode II hatte eine Sensitivität von 44 % und eine Spezifität von 94 %. Bei Methode III betrug die Sensitivität 88 % und die Spezifität 85 %.

Schlussfolgerung Eine Lungenstauung bei aufeinanderfolgenden dyspnoischen Patienten ≥ 50 Jahren ist besser zu diagnostizieren, wenn der Lungenultraschall sowohl B-Linien als auch Pleuraerguss anstelle von B-Linien alleine bewertet.

Key words

lung ultrasound - computed tomography - dyspnea - emergency department - pulmonary congestion

Publication History

Received: 24 June 2019

Accepted: 19 September 2019

Article published online:
24 October 2019

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