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Lung Ultrasound Will Soon Replace Chest Radiography in the Diagnosis of Acute Community-Acquired Pneumonia

  • Respiratory Infections (F Arnold, Section Editor)
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Abstract

Acute community-acquired pneumonia should be diagnosed early to avoid most complications. The common diagnostic tools were represented by blood tests and chest X-ray with CT scan coming as a second-line exploration. The presence of air in the pulmonary parenchyma has long been thought of as not explorable by ultrasound. However, since the 1990s, several teams have described a semiology of ultrasonography of pulmonary diseases. Moreover, the safety of the technique and the development of mobile and ultra-portable devices have offered it as a first-line examination by a non-radiologist physician. The authors describe in this article ultrasonography as a way of learning the technique, and the main results observed in the literature. In conclusion, they propose it as the first-line examination instead of chest X-ray, and to reserve chest CT scan for complicated cases.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Angus DC, Wax RS. Epidemiology of sepsis: an update. Crit Care Med. 2001;29(7 Suppl):S109–16.

    Article  CAS  PubMed  Google Scholar 

  2. Brun-Buisson C, Meshaka P, Pinton P, Vallet B, EPISEPSIS Study Group. EPISEPSIS: a reappraisal of the epidemiology and outcome of severe sepsis in French intensive care units. Intensive Care Med. 2004;30(4):580–8.

    Article  CAS  PubMed  Google Scholar 

  3. Graffelman AW, le Cessie S, Knuistingh Neven A, Wilemssen FEJA, Zonderland HM, van den Broek PJ. Can history and exam alone reliably predict pneumonia? J Fam Pract. 2007;56(6):465–70.

    CAS  PubMed  Google Scholar 

  4. Emerman CL, Dawson N, Speroff T, Siciliano C, Effron D, Rashad F, et al. Comparison of physician judgment and decision aids for ordering chest radiographs for pneumonia in outpatients. Ann Emerg Med. 1991;20(11):1215–9.

    Article  CAS  PubMed  Google Scholar 

  5. Woodhead M, Blasi F, Ewig S, Garau J, Huchon G, Ieven M, et al. Guidelines for the management of adult lower respiratory tract infections--full version. Clin Microbiol Infect Off Publ Eur Soc Clin Microbiol Infect Dis. 2011;17 Suppl 6:E1–59.

    Google Scholar 

  6. Woodhead M. New guidelines for the management of adult lower respiratory tract infections. Eur Respir J. 2011;38(6):1250–1.

    Article  CAS  PubMed  Google Scholar 

  7. Hagaman JT, Rouan GW, Shipley RT, Panos RJ. Admission chest radiograph lacks sensitivity in the diagnosis of community-acquired pneumonia. Am J Med Sci. 2009;337(4):236–40.

    Article  PubMed  Google Scholar 

  8. Self WH, Courtney DM, McNaughton CD, Wunderink RG, Kline JA. High discordance of chest x-ray and computed tomography for detection of pulmonary opacities in ED patients: implications for diagnosing pneumonia. Am J Emerg Med. 2013;31(2):401–5.

    Article  PubMed  Google Scholar 

  9. Swingler GH, Zwarenstein M. WITHDRAWN: chest radiograph in acute respiratory infections. Cochrane Database Syst Rev. 2009;4:CD001268.

    Google Scholar 

  10. Claessens Y-E, Debray M-P, Tubach F, Brun A-L, Rammaert B, Hausfater P, et al. Early chest computed tomography scan to assist diagnosis and guide treatment decision for suspected community-acquired pneumonia. Am J Respir Crit Care Med. 2015;192(8):974–82.

    Article  PubMed  Google Scholar 

  11. Haga T, Fukuoka M, Morita M, Cho K, Tatsumi K. Computed tomography for the diagnosis and evaluation of the severity of community-acquired pneumonia in the elderly. Intern Med Tokyo Jpn. 2016;55(5):437–41.

    Article  Google Scholar 

  12. Brenner DJ, Hall EJ. Computed tomography--an increasing source of radiation exposure. N Engl J Med. 2007;357(22):2277–84.

    Article  CAS  PubMed  Google Scholar 

  13. Ross AM, Genton E, Holmes JH. Ultrasonic examination of the lung. J Lab Clin Med. 1968;72(4):556–64.

    CAS  PubMed  Google Scholar 

  14. Volpicelli G, Elbarbary M, Blaivas M, Lichtenstein DA, Mathis G, Kirkpatrick AW, et al. International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med. 2012;38(4):577–91.

    Article  PubMed  Google Scholar 

  15. Bouhemad B, Mongodi S, Via G, Rouquette I. Ultrasound for « lung monitoring » of ventilated patients. Anesthesiology. 2015;122(2):437–47.

    Article  PubMed  Google Scholar 

  16. •Lichtenstein DA, Mezière GA. Relevance of lung ultrasound in the diagnosis of acute respiratory failure: the BLUE protocol. Chest. 2008;134(1):117–25. The first tool with algorithm which included ultrasound in pulmonary disease.

    Article  PubMed  PubMed Central  Google Scholar 

  17. American College of Emergency Physicians. Emergency ultrasound guidelines. Ann Emerg Med. 2009;53(4):550–70.

    Article  Google Scholar 

  18. Tutino L, Cianchi G, Barbani F, Batacchi S, Cammelli R, Peris A. Time needed to achieve completeness and accuracy in bedside lung ultrasound reporting in intensive care unit. Scand J Trauma Resusc Emerg Med. 2010;18:44.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Miller J. The ultrasound revolution. Acad Emerg Med Off J Soc Acad Emerg Med. 1999;6(7):766.

    Article  CAS  Google Scholar 

  20. Avruch L, Cooperberg PL. The ring-down artifact. J Ultrasound Med Off J Am Inst Ultrasound Med. 1985;4(1):21–8.

    CAS  Google Scholar 

  21. Lichtenstein D, Mezière G, Seitz J. The dynamic air bronchogram. A lung ultrasound sign of alveolar consolidation ruling out atelectasis. Chest. 2009;135(6):1421–5.

    Article  PubMed  Google Scholar 

  22. Lichtenstein DA, Lascols N, Mezière G, Gepner A. Ultrasound diagnosis of alveolar consolidation in the critically ill. Intensive Care Med. 2004;30(2):276–81.

    Article  PubMed  Google Scholar 

  23. Targhetta R, Bourgeois JM, Marty-Double C, Coste E, Proust A, Balmes P, et al. Peripheral pulmonary lesions: ultrasonic features and ultrasonically guided fine needle aspiration biopsy. J Ultrasound Med Off J Am Inst Ultrasound Med. 1993;12(7):369–74.

    CAS  Google Scholar 

  24. Targhetta R, Chavagneux R, Balmes P, Lemerre C, Mauboussin JM, Bourgeois JM, et al. Sonographic lung surface evaluation in pulmonary sarcoidosis: preliminary results. J Ultrasound Med Off J Am Inst Ultrasound Med. 1994;13(5):381–8.

    CAS  Google Scholar 

  25. Volpicelli G, Melniker LA, Cardinale L, Lamorte A, Frascisco MF. Lung ultrasound in diagnosing and monitoring pulmonary interstitial fluid. Radiol Med (Torino). 2013;118(2):196–205.

    Article  CAS  Google Scholar 

  26. Testa A, Soldati G, Copetti R, Giannuzzi R, Portale G, Gentiloni-Silveri N. Early recognition of the 2009 pandemic influenza A (H1N1) pneumonia by chest ultrasound. Crit Care Lond Engl. 2012;16(1):R30.

    Article  Google Scholar 

  27. Sajadieh H, Afzali F, Sajadieh V, Sajadieh A. Ultrasound as an alternative to aspiration for determining the nature of pleural effusion, especially in older people. Ann N Y Acad Sci. 2004;1019:585–92.

    Article  PubMed  Google Scholar 

  28. •Targhetta R, Chavagneux R, Bourgeois JM, Dauzat M, Balmes P, Pourcelot L. Sonographic approach to diagnosing pulmonary consolidation. J Ultrasound Med Off J Am Inst Ultrasound Med. 1992;11(12):667–72. One of the first works on the subject, where a high correlation between ultrasound and the diagnosis of pneumonia was found.

    CAS  Google Scholar 

  29. Gehmacher O, Mathis G, Kopf A, Scheier M. Ultrasound imaging of pneumonia. Ultrasound Med Biol. 1995;21(9):1119–22.

    Article  CAS  PubMed  Google Scholar 

  30. Yang PC, Luh KT, Chang DB, Yu CJ, Kuo SH, Wu HD. Ultrasonographic evaluation of pulmonary consolidation. Am Rev Respir Dis. 1992;146(3):757–62.

    Article  CAS  PubMed  Google Scholar 

  31. Lichtenstein D, Goldstein I, Mourgeon E, Cluzel P, Grenier P, Rouby J-J. Comparative diagnostic performances of auscultation, chest radiography, and lung ultrasonography in acute respiratory distress syndrome. Anesthesiology. 2004;100(1):9–15.

    Article  PubMed  Google Scholar 

  32. Lichtenstein D, Peyrouset O. Is lung ultrasound superior to CT? The example of a CT occult necrotizing pneumonia. Intensive Care Med. 2006;32(2):334–5.

    Article  PubMed  Google Scholar 

  33. Bataille B, Riu B, Ferre F, Moussot PE, Mari A, Brunel E, et al. Integrated use of bedside lung ultrasound and echocardiography in acute respiratory failure: a prospective observational study in ICU. Chest. 2014;146(6):1586–93.

    Article  PubMed  Google Scholar 

  34. Gallard E, Redonnet J-P, Bourcier J-E, Deshaies D, Largeteau N, Amalric J-M, et al. Diagnostic performance of cardiopulmonary ultrasound performed by the emergency physician in the management of acute dyspnea. Am J Emerg Med. 2015;33(3):352–8.

    Article  PubMed  Google Scholar 

  35. Reissig A, Copetti R. Lung ultrasound in community-acquired pneumonia and in interstitial lung diseases. Respir Int Rev Thorac Dis. 2014;87(3):179–89.

    Google Scholar 

  36. Parlamento S, Copetti R, Di Bartolomeo S. Evaluation of lung ultrasound for the diagnosis of pneumonia in the ED. Am J Emerg Med. 2009;27(4):379–84.

    Article  PubMed  Google Scholar 

  37. Volpicelli G, Silva F, Radeos M. Real-time lung ultrasound for the diagnosis of alveolar consolidation and interstitial syndrome in the emergency department. Eur J Emerg Med Off J Eur Soc Emerg Med. 2010;17(2):63–72.

    Article  Google Scholar 

  38. Volpicelli G, Mussa A, Garofalo G, Cardinale L, Casoli G, Perotto F, et al. Bedside lung ultrasound in the assessment of alveolar-interstitial syndrome. Am J Emerg Med. 2006;24(6):689–96.

    Article  PubMed  Google Scholar 

  39. Pagano A, Numis FG, Visone G, Pirozzi C, Masarone M, Olibet M, et al. Lung ultrasound for diagnosis of pneumonia in emergency department. Intern Emerg Med. 2015;10(7):851–4.

    Article  PubMed  Google Scholar 

  40. •Bourcier J-E, Paquet J, Seinger M, Gallard E, Redonnet J-P, Cheddadi F, et al. Performance comparison of lung ultrasound and chest x-ray for the diagnosis of pneumonia in the ED. Am J Emerg Med. 2014;32(2):115–8. First study which demonstrated the quick positive lung ultrasound in diagnosis of acute pneumonia when compared with chest X ray.

    Article  PubMed  Google Scholar 

  41. Cortellaro F, Colombo S, Coen D, Duca PG. Lung ultrasound is an accurate diagnostic tool for the diagnosis of pneumonia in the emergency department. Emerg Med J EMJ. 2012;29(1):19–23.

    Article  PubMed  Google Scholar 

  42. Nazerian P, Volpicelli G, Vanni S, Gigli C, Betti L, Bartolucci M, et al. Accuracy of lung ultrasound for the diagnosis of consolidations when compared to chest computed tomography. Am J Emerg Med. 2015;33(5):620–5.

    Article  PubMed  Google Scholar 

  43. Sperandeo M, Carnevale V, Muscarella S, Sperandeo G, Varriale A, Filabozzi P, et al. Clinical application of transthoracic ultrasonography in inpatients with pneumonia. Eur J Clin Investig. 2011;41(1):1–7.

    Article  Google Scholar 

  44. Liu X, Lian R, Tao Y, Gu C, Zhang G. Lung ultrasonography: an effective way to diagnose community-acquired pneumonia. Emerg Med J EMJ. 2015;32(6):433–8.

    Article  PubMed  Google Scholar 

  45. Ye X, Xiao H, Chen B, Zhang S. Accuracy of lung ultrasonography versus chest radiography for the diagnosis of adult community-acquired pneumonia: review of the literature and meta-analysis. PLoS One. 2015;10(6):e0130066.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Chavez MA, Shams N, Ellington LE, Naithani N, Gilman RH, Steinhoff MC, et al. Lung ultrasound for the diagnosis of pneumonia in adults: a systematic review and meta-analysis. Respir Res. 2014;15:50.

    Article  PubMed  PubMed Central  Google Scholar 

  47. ••Reissig A, Copetti R, Mathis G, Mempel C, Schuler A, Zechner P, et al. Lung ultrasound in the diagnosis and follow-up of community-acquired pneumonia: a prospective, multicenter, diagnostic accuracy study. Chest. 2012;142(4):965–72. The first multicenter study, which included the follow up of acute pneumonia.

    Article  PubMed  Google Scholar 

  48. Schenck EJ, Rajwani K. Ultrasound in the diagnosis and management of pneumonia. Curr Opin Infect Dis. 2016;29(2):223–8.

    Article  PubMed  Google Scholar 

  49. Sartori S, Tombesi P. Emerging roles for transthoracic ultrasonography in pulmonary diseases. World J Radiol. 2010;2(6):203–14.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Reissig A, Gramegna A, Aliberti S. The role of lung ultrasound in the diagnosis and follow-up of community-acquired pneumonia. Eur J Intern Med. 2012;23(5):391–7.

    Article  PubMed  Google Scholar 

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Correspondence to Jean-Eudes Bourcier.

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Drs Bourcier, Braga, and Garnier have no conflicts of interests to declare.

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The authors of this article state that lung studies have been done and used for reference in this paper.

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This article is part of the Topical Collection on Respiratory Infections

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Bourcier, JE., Braga, S. & Garnier, D. Lung Ultrasound Will Soon Replace Chest Radiography in the Diagnosis of Acute Community-Acquired Pneumonia. Curr Infect Dis Rep 18, 43 (2016). https://doi.org/10.1007/s11908-016-0550-9

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  • DOI: https://doi.org/10.1007/s11908-016-0550-9

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