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Lung Ultrasound in Pneumonia Diagnosis

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Cardiopulmonary Point of Care Ultrasound

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Abstract

Interest in lung ultrasound (LUS) has been growing over time, thanks also to the COVID-19 outbreak. Clinical aspects such as fever, cough and purulent sputum are fundamental for diagnosing pneumonia, along with laboratory exams (leucocytosis and procalcitonin elevation). An imaging technique is however required for diagnosis, and the gold standard has been represented for a long time by a chest X-ray (CXR) or a CT scan. Nevertheless, LUS is useful in diagnosis, monitoring of the response to therapy and follow up. These features have demonstrated to be very useful in various settings, such as emergency departments, wards and intensive care units. Multiple scanning protocols of the thorax have been proposed; at the moment, the most advantageous in terms of diagnostic accuracy and time-consume is the one considering six scanning fields for each side. POCUS findings correspond to anatomo-pathologic modifications found in pneumonia. Among the most common POCUS signs we found B lines, pleural abnormalities (thickness and irregularity), meta-pneumonic effusions and consolidations with either static or dynamic air bronchogram. For what concerns assessment and follow up of the severity of illness, it is useful to adopt the lung ultrasound aeration score, assigning a score from 0 to 3 for each field explored; the sum of the points obtained ranges from 0 to 36 (see chapter for more details). During the pandemic era LUS has been very useful for mass screening of patients attending the emergency departments allowing identification of potentially positive patients, even if the findings were not illness-specific. For this reason, usefulness of LUS for COVID-19 diagnosis will need to be re-evaluated at the end of the pandemic.

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Abbreviations

BLUE:

Bedside Lung Ultrasound in Emergency

CAD:

Computer aided diagnosis

CAP:

Community Acquired Pneumonia

COVID 19:

Coronavirus Disease 19

CT:

Computed tomography

CXR:

Chest x-ray

ED:

Emergency department

ICU:

Intensive care unit

LUS:

Lung Ultrasound

PCT:

Procalcitonin

POCUS:

Point of care ultrasound

PSI:

Pneumonia severity index

VAP:

Ventilator Associated Pneumonia

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Authors and Affiliations

  1. Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, via Savi 10, 56126, Pisa, Italy

    Francesco Corradi, Francesco Forfori, Giada Cucciolini & Danila Trunfio

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  1. Francesco Corradi
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  2. Francesco Forfori
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  4. Danila Trunfio
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Correspondence to Francesco Corradi .

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Editors and Affiliations

  1. Department of Anaesthetics and Critical Care, Royal Brompton and Harefield Hospitals, London, UK

    Hatem Soliman-Aboumarie

  2. Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil

    Marcelo Haertel Miglioranza

  3. Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy

    Luna Gargani

  4. San Luigi Gonzaga University Hospital, Orbassano, Italy

    Giovanni Volpicelli

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Corradi, F., Forfori, F., Cucciolini, G., Trunfio, D. (2023). Lung Ultrasound in Pneumonia Diagnosis. In: Soliman-Aboumarie, H., Haertel Miglioranza, M., Gargani, L., Volpicelli, G. (eds) Cardiopulmonary Point of Care Ultrasound. Springer, Cham. https://doi.org/10.1007/978-3-031-29472-3_10

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