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Lung ultrasound: a new tool for the emergency physician

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Abstract

Patients with dyspnea are routinely assessed with physical examination, lung auscultation and chest X-rays. Auscultation and bedside radiography have a low accuracy in the critically ill. Chest X-ray images remain suboptimal in more than one-third of cases and are poorly correlated to lung CT images. Lung ultrasound is invaluable as a bedside diagnostic tool of the dyspneic patient since, in a few minutes, it may help distinguish the typical features of most common causes of dyspnea. The lung has been improperly considered to be poorly accessible using ultrasound, because air prevents the progression of the ultrasound beam with production of reverberation artifacts under the lung surface. This article reviews the scanning technique, and the normal and pathological findings of lung ultrasound, and underscores its utility in providing the emergency physician with a new, fast and reliable diagnostic tool.

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References

  1. Lichtenstein DA et al (2007) Ultrasound in the management of thoracic disease. Crit Care Med 35(5 suppl.):S250–S261

    Google Scholar 

  2. Lichtenstein DA et al (2004) Comparative diagnostic performances of auscultation, chest radiography and lung ultrasonography in acute respiratory distress syndrome. Anestesiology 100(1):9–15

    Google Scholar 

  3. Knudsen CW et al (2004) Diagnostic value of B-type natriuretic peptide and chest radiographic findings in patients with acute dyspnea. Am J Med 15:363–368

    Google Scholar 

  4. Onwuanyi A et al (2007) Acute decompensated heart failure: pathophysiology and treatment. Am J Cardiol 99(6B):25D–30D

    Google Scholar 

  5. Studler U et al (2008) Accuracy of chest radiographs in the emergency diagnosis of heart failure. Eur Radiol 18:1644–1652

    Google Scholar 

  6. Jambrick Z et al (2004) Usefulness of ultrasound lung comets as nonradiologic sign of extravascular lung water. Am J Cardiol 93:1265–1270

    Google Scholar 

  7. Agricola E et al (2008) Ultrasound comet tail images: a marker of pulmonary edema. A comparative study with wedge pressure and extravascular lung water. Chest 127(5):1690–1695

    Google Scholar 

  8. Frassi F et al (2007) Clinical and echocardiographic determinants of ultrasound lung comets. Eur J Echocardiogr 8:474–479

    Google Scholar 

  9. Picano E et al (2006) Ultrasound lung comets: a clinically useful sign of extravascular lung water. J Am Soc Echocardiogr 19(3):356–363

    Google Scholar 

  10. Sodati G et al (2008) Acute heart failure: new diagnostic perspectives emergency for the emergency physician. Intern Emerg Med 3:37–41

    Google Scholar 

  11. Gargani L et al (2008) Ultrasound lung comets for the differential diagnosis of acute cardiogenic dyspnoea: a comparison with natriuretic peptides. Eur J Heart Fail 10:70–77

    Google Scholar 

  12. Lichtenstein DA et al (2008) Relevance of lung ultrasound in the diagnosis of acute respiratory failure. The BLUE protocol. Chest 134(1):117–125

    Google Scholar 

  13. Frassi F et al (2007) Prognostic value of extravascular lung water assessed with ultrasound lung comets by chest sonography in patients with dyspnea and/or chest pain. J Card Fail 13(10):830–835

    Google Scholar 

  14. Lichtenstein DA et al (1998) A lung ultrasound sign allowing bedside distinction between pulmonary edema and COPD: the comet tail artifact. Intensive Care Med 24:1331–1334

    Google Scholar 

  15. Soldati G et al (2006) Chest ultrasonography in lung contusion. Chest 130:533–538

    Google Scholar 

  16. Copetti R et al (2008) Chest sonography: a useful tool to differentiate acute cardiogenic pulmonary edema from acute respiratory distress syndrome. Cardiovasc Ultrasound 6:16

    Google Scholar 

  17. Volpicelli G et al (2008) Usefulness of lung ultrasound in the bedside distinction between pulmonary edema and exacerbation of COPD. Emerg Radiol 15:145–151

    Google Scholar 

  18. Volpicelli G et al (2006) Bedside lung ultrasound in the assessment of alveolar-interstitial syndrome. Am J Emerg Med 24:689–696

    Google Scholar 

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Correspondence to Alfredo Barillari.

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Barillari, A., Fioretti, M. Lung ultrasound: a new tool for the emergency physician. Intern Emerg Med 5, 335–340 (2010). https://doi.org/10.1007/s11739-010-0381-x

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  • DOI: https://doi.org/10.1007/s11739-010-0381-x

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