Lung Ultrasound: A Leading Diagnostic Tool

A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Point-of-Care Diagnostics and Devices".

Deadline for manuscript submissions: closed (30 September 2022) | Viewed by 57441

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Guest Editor
Department of Bioengineering, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
Interests: computer vision; medical image processing; ultrasound imaging; lung ultrasound

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Guest Editor
Diagnostic and Interventional Ultrasound Unit, Valle del Serchio General Hospital, Lucca, Italy
Interests: pulmonary medicine; intensive care; interventional ultrasound; thoracic ultrasound; non-invasive hemodynamics
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Special Issue Information

Dear Colleagues,

Today, the diagnostic value of the artefactual information provided by lung ultrasound (LUS) is widely recognized by physicians. By carefully observing LUS images, an expert physician can derive important information regarding the nature of a pulmonary disease. The mechanisms at the basis of the vertical artifacts have also been investigated, and similar events have been replicated on lung models in various research laboratories. As a result, plausible hypotheses on the genesis of artefactual information have been suggested, allowing the physician to link the observed artifacts to a pathological distribution of the alveoli.

Over the years, thoracic ultrasound has been extensively applied to assess numerous pleural and lung diseases (effusions, pneumothorax, consolidations, interstitial diseases involving the surface of the lung and, recently, COVID-19 pulmonary involvement). Sometimes, its diagnostic capability is reported as being better than that of traditional imaging techniques (chest radiography and CT). Even though the debate on the safety of ultrasound is still open, thoracic ultrasound is mostly accepted as an inexpensive and minimally invasive technique, and due to this additional aspect, LUS is becoming a leading diagnostic tool in the work-up of many cardiorespiratory diseases.

Given the success of this Special Issue and the current pandemic context that is highlighting the importance of lung ultrasound, the deadline for manuscript submissions has been extended to 30 September 2022.

We look forward to your contribution.

Dr. Marcello Demi
Dr. Gino Soldati
Guest Editors

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Keywords

  • Essential physics of lung ultrasound imaging
  • Diagnostic signs provided by lung ultrasound
  • Guidelines in clinical care practice
  • Biological effects of pulsed ultrasound
  • Theoretical and physical lung modeling
  • Visual and computer aided image analysis
  • Spectral analysis of the radiofrequency (RF) signal
  • Clinical and open ultrasound platforms.

Published Papers (24 papers)

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Editorial

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5 pages, 201 KiB  
Editorial
Lung Ultrasound: A Leading Diagnostic Tool
by Marcello Demi and Gino Soldati
Diagnostics 2023, 13(10), 1710; https://doi.org/10.3390/diagnostics13101710 - 12 May 2023
Viewed by 1091
Abstract
Thoracic ultrasound is an important diagnostic tool employed by many clinicians in well-defined applications [...] Full article
(This article belongs to the Special Issue Lung Ultrasound: A Leading Diagnostic Tool)

Research

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12 pages, 4289 KiB  
Article
Lung Ultrasound Artifacts Interpreted as Pathology Footprints
by Marcello Demi, Gino Soldati and Alessandro Ramalli
Diagnostics 2023, 13(6), 1139; https://doi.org/10.3390/diagnostics13061139 - 16 Mar 2023
Cited by 5 | Viewed by 1519
Abstract
Background: The original observation that lung ultrasound provides information regarding the physical state of the organ, rather than the anatomical details related to the disease, has reinforced the idea that the observed acoustic signs represent artifacts. However, the definition of artifact does not [...] Read more.
Background: The original observation that lung ultrasound provides information regarding the physical state of the organ, rather than the anatomical details related to the disease, has reinforced the idea that the observed acoustic signs represent artifacts. However, the definition of artifact does not appear adequate since pulmonary ultrasound signs have shown valuable diagnostic accuracy, which has been usefully exploited by physicians in numerous pathologies. Method: A specific method has been used over the years to analyze lung ultrasound data and to convert artefactual information into anatomical information. Results: A physical explanation of the genesis of the acoustic signs is provided, and the relationship between their visual characteristics and the surface histopathology of the lung is illustrated. Two important sources of potential signal alteration are also highlighted. Conclusions: The acoustic signs are generated by acoustic traps that progressively release previously trapped energy. Consequently, the acoustic signs highlight the presence of acoustic traps and quantitatively describe their distribution on the lung surface; they are not artifacts, but pathology footprints and anatomical information. Moreover, the impact of the dynamic focusing algorithms and the impact of different probes on the visual aspect of the acoustic signs should not be neglected. Full article
(This article belongs to the Special Issue Lung Ultrasound: A Leading Diagnostic Tool)
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12 pages, 1903 KiB  
Article
One-Year Follow-Up Lung Ultrasound of Post-COVID Syndrome—A Pilot Study
by Martin Altersberger, Anna Grafeneder, Yerin Cho, Roland Winkler, Ralf Harun Zwick, Gebhard Mathis and Martin Genger
Diagnostics 2023, 13(1), 70; https://doi.org/10.3390/diagnostics13010070 - 26 Dec 2022
Cited by 3 | Viewed by 1457
Abstract
(1) Background: Millions of people worldwide were infected with COVID-19. After the acute phase of the disease, many suffer from prolonged symptoms, the post-COVID syndrome, especially the phenotype with lung residuals. Many open questions regarding lung ultrasound (LUS) have to be answered. One [...] Read more.
(1) Background: Millions of people worldwide were infected with COVID-19. After the acute phase of the disease, many suffer from prolonged symptoms, the post-COVID syndrome, especially the phenotype with lung residuals. Many open questions regarding lung ultrasound (LUS) have to be answered. One essential question is the means for optimal following-up of patients with post-COVID-19 residuals with LUS; (2) Methods: A retrospective data analysis of patients after acute COVID-19 infection diagnosed with post-COVID syndrome in the state hospital of Steyr and the rehabilitation center of Hochegg was performed. LUS examinations following a 12-zone scanning protocol were performed, and the LUS score quantified comet tail artifacts. A total of 16 patients were evaluated twice with LUS from May 2020 until June 2021. (3) Results: All patients’ reverberation artifacts were reduced over time. The initial LUS score of 17.75 (SD 4.84) points was decreased over the duration of the second rehabilitation to 8,2 (SD 5.94). The difference in the Wilcoxon test was significant (p < 0.001); (4) Conclusions: Lung ultrasound was a valuable tool in the follow-up of post-COVID-syndrome with lung residuals in the first wave of COVID-19. A reduction in reverberation artifacts was demonstrated. Further studies about the clinical significance have to follow. Full article
(This article belongs to the Special Issue Lung Ultrasound: A Leading Diagnostic Tool)
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14 pages, 1089 KiB  
Article
Pre-Dialysis B-Line Quantification at Lung Ultrasound Is a Useful Method for Evaluating the Dry Weight and Predicting the Risk of Intradialytic Hypotension
by Marco Allinovi, Giulia Palazzini, Gianmarco Lugli, Iacopo Gianassi, Lorenzo Dallari, Selene Laudicina, Marco Gregori, Francesco Rossi, Daniele Giannerini, Roberta Cutruzzulà, Egrina Dervishi, Maria Biagini and Calogero Lino Cirami
Diagnostics 2022, 12(12), 2990; https://doi.org/10.3390/diagnostics12122990 - 29 Nov 2022
Cited by 4 | Viewed by 1923
Abstract
Intradialytic hypotension (IDH) is a frequent and well-known complication of hemodialysis, occurring in about one third of patients. An integrated approach with different methods is needed to minimize IDH episodes and their complications. In this prospective observational study, recruited patients underwent a multiparametric [...] Read more.
Intradialytic hypotension (IDH) is a frequent and well-known complication of hemodialysis, occurring in about one third of patients. An integrated approach with different methods is needed to minimize IDH episodes and their complications. In this prospective observational study, recruited patients underwent a multiparametric evaluation of fluid status through a lung ultrasound (LUS) with the quantification of B-lines, a physical examination, blood pressure, NT-proBNP and chest X-rays. The evaluation took place immediately before and at the end of the dialysis session, and the patients were divided into IDH and no-IDH groups. We recruited a total of 107 patients. A pre-dialysis B-line number ≥ 15 showed a high sensitivity in fluid overload diagnosis (94.5%), even higher than a chest X-ray (78%) or physical examination (72%) alone. The identification at the beginning of dialysis of <8 B-lines in the overall cohort or <20 B-lines in patients with NYHA 3–4 class are optimal thresholds for identifying those patients at higher risk of experiencing an IDH episode. In the multivariable analysis, the NYHA class, a low pre-dialysis systolic BP and a low pre-dialysis B-line number were independent risk factors for IDH. At the beginning of dialysis, the B-line quantification at LUS is a valuable and reliable method for evaluating fluid status and predicting IDH episodes. A post-dialysis B-line number <5 may allow for an understanding of whether the IDH episode was caused by dehydration, probably due to due to an overestimation of the dry weight. Full article
(This article belongs to the Special Issue Lung Ultrasound: A Leading Diagnostic Tool)
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12 pages, 3542 KiB  
Article
B-Lines Lung Ultrasonography Simulation Using Finite Element Method
by Fellipe Allevato Martins da Silva, Eduardo Moreno and Wagner Coelho de Albuquerque Pereira
Diagnostics 2022, 12(11), 2751; https://doi.org/10.3390/diagnostics12112751 - 10 Nov 2022
Cited by 3 | Viewed by 1612
Abstract
Introduction: Lung Ultrasonography (LUS) is a fast technique for the diagnosis of patients with respiratory syndromes. B-lines are seen in response to signal reverberations and amplifications into sites with peripheral lung fluid concentration or septal thickening. Mathematical models are commonly applied in biomedicine [...] Read more.
Introduction: Lung Ultrasonography (LUS) is a fast technique for the diagnosis of patients with respiratory syndromes. B-lines are seen in response to signal reverberations and amplifications into sites with peripheral lung fluid concentration or septal thickening. Mathematical models are commonly applied in biomedicine to predict biological responses to specific signal parameters. Objective: This study proposes a Finite-Element numerical model to simulate radio frequency ultrasonic lines propagated from normal and infiltrated lung structures. For tissue medium, a randomized inhomogeneous data method was used. The simulation implemented in COMSOL® used Acoustic Pressure and Time-Explicit models, which are based on the discontinuous Galerkin method (dG). Results: The RF signals, processed in MATLAB®, resulted in images of horizontal A-lines and vertical B-lines, which were reasonably similar to real images. Discussion: The use of inhomogeneous materials in the model was good enough to simulate the scattering response, similar to others in the literature. The model is useful to study the impact of the lung infiltration characteristics on the appearance of LUS images. Full article
(This article belongs to the Special Issue Lung Ultrasound: A Leading Diagnostic Tool)
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12 pages, 1477 KiB  
Article
Possible Role of Chest Ultrasound in the Assessment of Costo-Phrenic Angle Lesions Prior to Medical Thoracoscopy: A Retrospective Pilot Case Series
by Emanuele Giovanni Conte, Andrea Smargiassi, Filippo Lococo, Giampietro Marchetti and Riccardo Inchingolo
Diagnostics 2022, 12(11), 2587; https://doi.org/10.3390/diagnostics12112587 - 25 Oct 2022
Cited by 2 | Viewed by 1327
Abstract
Background: Pleural malignancy (PM) and malignant pleural effusion (MPE) represent an increasing burden of diseases. Costo-phrenic angle (CPA) could be involved by malignant small nodularities or thickenings in the case of MPE. The aim of this study was to evaluate whether lung ultrasound [...] Read more.
Background: Pleural malignancy (PM) and malignant pleural effusion (MPE) represent an increasing burden of diseases. Costo-phrenic angle (CPA) could be involved by malignant small nodularities or thickenings in the case of MPE. The aim of this study was to evaluate whether lung ultrasound (LUS), performed prior to medical thoracoscopy (MT), could detect pleural abnormalities in CPA not easily detectable by chest computed tomography scan (CCT). Methods: Patients suspected for PM and MPE were retrospectively recruited. Patients underwent both LUS examination with a linear array and CCT prior to diagnostic medical thoracoscopy. LUS pathological findings in CPA were compared with pathological findings detected by CCT. Findings were confirmed by subsequent MT, the gold standard for PMs. Results: Twenty-eight patients were recruited. LUS detected 23 cases of pleural abnormalities in CPA. CCT was detected 12 pleural abnormalities. Inter-rater agreement between the two techniques was minimal (Cohen’s Kappa: 0.28). MT detected PMs in CPA in 22 patients. LUS had a sensitivity of 100% and specificity of 83%. CCT had a sensitivity of 54% and specificity of 100%. A better sensitivity for CCT was reached analysing only all abnormalities > 5 mm (64.3%). Conclusions: LUS examination, in the case of PMs, could change and speed up diagnostic workup. Full article
(This article belongs to the Special Issue Lung Ultrasound: A Leading Diagnostic Tool)
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11 pages, 1874 KiB  
Article
Pediatric COVID-19 Follow-Up with Lung Ultrasound: A Prospective Cohort Study
by Domenico Paolo La Regina, Daniela Pepino, Raffaella Nenna, Elio Iovine, Enrica Mancino, Gianmarco Andreoli, Anna Maria Zicari, Alberto Spalice, Fabio Midulla and on behalf of the Long COVID Research Group
Diagnostics 2022, 12(9), 2202; https://doi.org/10.3390/diagnostics12092202 - 11 Sep 2022
Cited by 7 | Viewed by 1573
Abstract
During the COVID-19 pandemic, lung ultrasound (LUS) was widely used to assess SARS-CoV-2 infection. To date, there are patients with persistence of symptoms after acute infection. Therefore, it may be useful to have an objective tool to follow these patients. The aim of [...] Read more.
During the COVID-19 pandemic, lung ultrasound (LUS) was widely used to assess SARS-CoV-2 infection. To date, there are patients with persistence of symptoms after acute infection. Therefore, it may be useful to have an objective tool to follow these patients. The aim of our study was to evaluate the presence of LUS artifacts after SARS-CoV-2 infection in children and to analyze the associations between time elapsed since infection and symptomatology during acute infection. We conducted an observational study, enrolling 607 children infected with SARS-CoV-2 in the previous twelve months. All patients performed a LUS and medical history of demographic and clinical data. We observed irregular pleural lines in 27.5%, B-lines in 16.9%, and subpleural consolidations in 8.6% of the cases. These artifacts were more frequently observed in the lower lobe projections. We have observed that the frequency of artifacts decreases with increasing time since infection. In symptomatic patients during COVID infection, B-lines (p = 0.02) were more frequently found. In our sample, some children, even after months of acute infection, have ultrasound artifacts and showed an improvement with the passage of time from the acute episode. Our study provides additional evidence about LUS in children with previous COVID-19 as a support to follow these patients in the months following the infection. Full article
(This article belongs to the Special Issue Lung Ultrasound: A Leading Diagnostic Tool)
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9 pages, 1146 KiB  
Article
Lowering of the Neonatal Lung Ultrasonography Score after nCPAP Positioning in Neonates over 32 Weeks of Gestational Age with Neonatal Respiratory Distress
by Alessandro Perri, Simona Fattore, Vito D’Andrea, Annamaria Sbordone, Maria Letizia Patti, Stefano Nobile, Chiara Tirone, Lucia Giordano, Milena Tana, Francesca Priolo, Francesca Serrao, Riccardo Riccardi, Giorgia Prontera and Giovanni Vento
Diagnostics 2022, 12(8), 1909; https://doi.org/10.3390/diagnostics12081909 - 7 Aug 2022
Cited by 2 | Viewed by 1758
Abstract
Respiratory distress (RD) is one of the most common causes of admission to the neonatal intensive care unit. Correct diagnosis and timely intervention are crucial. Lung ultrasonography (LU) is a useful diagnostic tool for the neonatologist in the diagnosis of RD; the neonatal [...] Read more.
Respiratory distress (RD) is one of the most common causes of admission to the neonatal intensive care unit. Correct diagnosis and timely intervention are crucial. Lung ultrasonography (LU) is a useful diagnostic tool for the neonatologist in the diagnosis of RD; the neonatal lung ultrasonography score (nLUS) can be used in the diagnostic process, but some authors hypothesise that it is also useful for the management of some neonatal RD. The aim of this study is to analyse the changes in nLUS score before (T0) and after (T1) the start of respiratory support with nasal CPAP in neonates over 32 weeks of age with RD. Thirty-three newborns were enrolled in this retrospective study. LU was performed before and after the start of CPAP. The median nLUS scores at T0 and T1 were 9 (IQR 7–12) and 7 (IQR 4–10), respectively, and showed a significant difference (p < 0.001). The magnitude of reduction in nLUS score, expressed as a percentage, was inversely related to the need for subsequent administration of exogenous surfactant. The study suggests the usefulness of the nLUS score in assessing the response to CPAP in neonates over 32 weeks gestational age. Full article
(This article belongs to the Special Issue Lung Ultrasound: A Leading Diagnostic Tool)
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18 pages, 2949 KiB  
Article
The Role of Lung Ultrasound in SARS-CoV-19 Pneumonia Management
by Marina Lugarà, Stefania Tamburrini, Maria Gabriella Coppola, Gabriella Oliva, Valeria Fiorini, Marco Catalano, Roberto Carbone, Pietro Paolo Saturnino, Nicola Rosano, Antonella Pesce, Raffaele Galiero, Roberta Ferrara, Michele Iannuzzi, D’Agostino Vincenzo, Alberto Negro, Francesco Somma, Fabrizio Fasano, Alessandro Perrella, Giuseppe Vitiello, Ferdinando Carlo Sasso, Gino Soldati and Luca Rinaldiadd Show full author list remove Hide full author list
Diagnostics 2022, 12(8), 1856; https://doi.org/10.3390/diagnostics12081856 - 31 Jul 2022
Cited by 7 | Viewed by 2150
Abstract
Purpose: We aimed to assess the role of lung ultrasound (LUS) in the diagnosis and prognosis of SARS-CoV-2 pneumonia, by comparing it with High Resolution Computed Tomography (HRCT). Patients and methods: All consecutive patients with laboratory-confirmed SARS-CoV-2 infection and hospitalized in COVID Centers [...] Read more.
Purpose: We aimed to assess the role of lung ultrasound (LUS) in the diagnosis and prognosis of SARS-CoV-2 pneumonia, by comparing it with High Resolution Computed Tomography (HRCT). Patients and methods: All consecutive patients with laboratory-confirmed SARS-CoV-2 infection and hospitalized in COVID Centers were enrolled. LUS and HRCT were carried out on all patients by expert operators within 48–72 h of admission. A four-level scoring system computed in 12 regions of the chest was used to categorize the ultrasound imaging, from 0 (absence of visible alterations with ultrasound) to 3 (large consolidation and cobbled pleural line). Likewise, a semi-quantitative scoring system was used for HRCT to estimate pulmonary involvement, from 0 (no involvement) to 5 (>75% involvement for each lobe). The total CT score was the sum of the individual lobar scores and ranged from 0 to 25. LUS scans were evaluated according to a dedicated scoring system. CT scans were assessed for typical findings of COVID-19 pneumonia (bilateral, multi-lobar lung infiltration, posterior peripheral ground glass opacities). Oxygen requirement and mortality were also recorded. Results: Ninety-nine patients were included in the study (male 68.7%, median age 71). 40.4% of patients required a Venturi mask and 25.3% required non-invasive ventilation (C-PAP/Bi-level). The overall mortality rate was 21.2% (median hospitalization 30 days). The median ultrasound thoracic score was 28 (IQR 20–36). For the CT evaluation, the mean score was 12.63 (SD 5.72), with most of the patients having LUS scores of 2 (59.6%). The bivariate correlation analysis displayed statistically significant and high positive correlations between both the CT and composite LUS scores and ventilation, lactates, COVID-19 phenotype, tachycardia, dyspnea, and mortality. Moreover, the most relevant and clinically important inverse proportionality in terms of P/F, i.e., a decrease in P/F levels, was indicative of higher LUS/CT scores. Inverse proportionality P/F levels and LUS and TC scores were evaluated by univariate analysis, with a P/F–TC score correlation coefficient of −0.762, p < 0.001, and a P/F–LUS score correlation coefficient of −0.689, p < 0.001. Conclusions: LUS and HRCT show a synergistic role in the diagnosis and disease severity evaluation of COVID-19. Full article
(This article belongs to the Special Issue Lung Ultrasound: A Leading Diagnostic Tool)
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15 pages, 1614 KiB  
Article
Operative Use of Thoracic Ultrasound in Respiratory Medicine: A Clinical Study
by Gino Soldati, Renato Prediletto, Marcello Demi, Stefano Salvadori and Massimo Pistolesi
Diagnostics 2022, 12(4), 952; https://doi.org/10.3390/diagnostics12040952 - 11 Apr 2022
Cited by 3 | Viewed by 3391
Abstract
For over 15 years, thoracic ultrasound has been applied in the evaluation of numerous lung diseases, demonstrating a variable diagnostic predictive power compared to traditional imaging techniques such as chest radiography and CT. However, in unselected pulmonary patients, there are no rigorous scientific [...] Read more.
For over 15 years, thoracic ultrasound has been applied in the evaluation of numerous lung diseases, demonstrating a variable diagnostic predictive power compared to traditional imaging techniques such as chest radiography and CT. However, in unselected pulmonary patients, there are no rigorous scientific demonstrations of the complementarity of thoracic ultrasound with traditional and standardized imaging techniques that use radiation. In this study 101 unselected pulmonary patients were evaluated blindly with ultrasound chest examinations during their hospital stay. Other instrumental examinations, carried out during hospitalization, were standard chest radiography, computed tomography (CT), and, when needed, radioisotopic investigation and cardiac catheterization. The operator who performed the ultrasound examinations was unaware of the anamnestic and clinical data of the patients. Diffuse fibrosing disease was detected with a sensitivity, specificity and diagnostic accuracy of 100%, 95% and 97%, respectively. In pleural effusions, ultrasound showed a sensitivity, specificity and diagnostic accuracy of 100%. In consolidations, the sensitivity, specificity and diagnostic accuracy were 83%, 98% and 93%, respectively. Low values of sensitivity were recorded for surface nodulations of less than one centimeter. Isolated subpleural ground glass densities were identified as White Lung with a sensitivity of 72% and a specificity of 86%. Only the associations Diffuse ultrasound findings/Definitive fibrosing disease, Ultrasound Consolidation/Definitive consolidation and non-diffuse ultrasound artefactual features/Definitive vascular pathology (pulmonary hypertension, embolism) were statistically significant with adjusted residuals of 7.9, 7 and 4.1, respectively. The obtained results show how chest ultrasound is an effective complementary diagnostic tool for the pulmonologist. When performed, as a complement to the patient’s physical examination, it can restrict the diagnostic hypothesis in the case of pleural effusion, consolidation and diffuse fibrosing disease of the lung. Full article
(This article belongs to the Special Issue Lung Ultrasound: A Leading Diagnostic Tool)
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15 pages, 4443 KiB  
Article
Lung Ultrasound in Children with Cystic Fibrosis in Comparison with Chest Computed Tomography: A Feasibility Study
by Ioana Mihaiela Ciuca, Liviu Laurentiu Pop, Mihaela Dediu, Emil Robert Stoicescu, Monica Steluta Marc, Aniko Maria Manea and Diana Luminita Manolescu
Diagnostics 2022, 12(2), 376; https://doi.org/10.3390/diagnostics12020376 - 1 Feb 2022
Cited by 12 | Viewed by 2353
Abstract
Background: Cystic fibrosis (CF) lung disease determines the outcome of this condition. For lung evaluation processes, computed tomography (CT) is the gold standard, but also causes irradiation. Lately, lung ultrasound (LUS) has proven to be reliable for the diagnosis of consolidations, atelectasis, and/or [...] Read more.
Background: Cystic fibrosis (CF) lung disease determines the outcome of this condition. For lung evaluation processes, computed tomography (CT) is the gold standard, but also causes irradiation. Lately, lung ultrasound (LUS) has proven to be reliable for the diagnosis of consolidations, atelectasis, and/or bronchiectasis. The aim of our study was to evaluate the value of a newly conceived LUS score by comparing it to the modified Bhalla CT score. A further aim was to evaluate the correlation between the score and the lung clearance index (LCI). Methods: Patients with CF were screened by LUS, followed by a CT scan. Spearman’s test was used for correlations. Results: A total of 98 patients with CF were screened, and 57 were included in the study; their mean age was 11.8 ± 5.5 (mean ± SD) years. The mean LUS score was 5.88 ± 5.4 SD. The LUS CF score had a very strong correlation with the CT score of rs = 0.87 (p = 0.000). LUS showed a good sensibility for detecting atelectasis (Se = 83.7%) and consolidations (Se = 94.4%). A lower Se (77.7%) and Sp (9%) were found for cylindrical bronchiectasis. Conclusion: Our study shows that LUS and the lung CF score are parameters that can be used with a complementary role in the diagnosis and monitoring of CF lung disease in children. Full article
(This article belongs to the Special Issue Lung Ultrasound: A Leading Diagnostic Tool)
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13 pages, 3457 KiB  
Article
On the Replica of US Pulmonary Artifacts by Means of Physical Models
by Marcello Demi
Diagnostics 2021, 11(9), 1666; https://doi.org/10.3390/diagnostics11091666 - 12 Sep 2021
Cited by 8 | Viewed by 1362
Abstract
Currently, the diagnostic value of the artefactual information provided by lung ultrasound images is widely recognized by physicians. In particular, the existence of a correlation between the visual characteristics of the vertical artifacts, which arise from the pleura line, and the genesis (pneumogenic [...] Read more.
Currently, the diagnostic value of the artefactual information provided by lung ultrasound images is widely recognized by physicians. In particular, the existence of a correlation between the visual characteristics of the vertical artifacts, which arise from the pleura line, and the genesis (pneumogenic or cardiogenic) of a pulmonary disorder is commonly accepted. Physicians distinguish vertical artifacts from vertical artifacts which extend to the bottom of the screen (B-lines) and common vertical artifacts from well-structured artifacts (modulated B-lines). However, the link between these visual characteristics and the causes which determine them is still unclear. Moreover, the distinction between short and long artifacts and the distinction between common and structured artifacts are not on/off, and their classification can be critical. In order to derive further information from the visual inspection of the vertical artifacts, the mechanisms which control the artifact formation must be identified. In this paper, the link between the visual characteristics of the vertical artifacts (the observed effect) and the distribution of the aerated spaces at the pleural level (the cause) is addressed. Plausible mechanisms are suggested and illustrated through experimental results. Full article
(This article belongs to the Special Issue Lung Ultrasound: A Leading Diagnostic Tool)
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12 pages, 262 KiB  
Article
Hospitalist Perceptions of Barriers to Lung Ultrasound Adoption in Diverse Hospital Environments
by Anna M. Maw, P. Michael Ho, Megan A. Morris, Russell E. Glasgow, Amy G. Huebschmann, Juliana G. Barnard, Robert Metter, David M. Tierney, Benji K. Mathews, Edward P. Havranek, Mark Kissler, Michelle Fleshner, Barbara K. Burian, Elke Platz and Nilam J. Soni
Diagnostics 2021, 11(8), 1451; https://doi.org/10.3390/diagnostics11081451 - 11 Aug 2021
Cited by 5 | Viewed by 2527
Abstract
Despite the many advantages of lung ultrasound (LUS) in the diagnosis and management of patients with dyspnea, its adoption among hospitalists has been slow. We performed semi-structured interviews of hospitals from four diverse health systems in the United States to understand determinants of [...] Read more.
Despite the many advantages of lung ultrasound (LUS) in the diagnosis and management of patients with dyspnea, its adoption among hospitalists has been slow. We performed semi-structured interviews of hospitals from four diverse health systems in the United States to understand determinants of adoption within a range of clinical settings. We used the diffusion of innovation theory to guide a framework analysis of the data. Of the 27 hospitalists invited, we performed 22 interviews from four hospitals of diverse types. Median years post-residency of interviewees was 10.5 [IQR:5-15]. Four main themes emerged: (1) There are important clinical advantages to LUS despite operator dependence, (2) LUS enhances patient and clinician experience, (3) Investment of clinician time to learn and perform LUS is a barrier to adoption but yields improved efficiency for the health system and (4) Mandated training and use may be necessary to achieve broad adoption as monetary incentives are less effective. Despite the perceived benefits of LUS for patients, clinicians and health systems, a significant barrier to broad LUS adoption is the experience of time scarcity by hospitalists. Future implementation strategies should focus on changes to the clinical environment that address clinician barriers to learning and adoption of new skills. Full article
(This article belongs to the Special Issue Lung Ultrasound: A Leading Diagnostic Tool)
16 pages, 1021 KiB  
Article
Lung Ultrasound-Guided Fluid Management versus Standard Care in Surgical ICU Patients: A Randomised Controlled Trial
by Daniel-Mihai Rusu, Ioana Grigoraș, Mihaela Blaj, Ianis Siriopol, Adi-Ionut Ciumanghel, Gigel Sandu, Mihai Onofriescu, Olguta Lungu and Adrian Constantin Covic
Diagnostics 2021, 11(8), 1444; https://doi.org/10.3390/diagnostics11081444 - 10 Aug 2021
Cited by 4 | Viewed by 2573
Abstract
The value of lung ultrasound (LU) in assessing extravascular lung water (EVLW) was demonstrated by comparing LU with gold-standard methods for EVLW assessment. However, few studies have analysed the value of B-Line score (BLS) in guiding fluid management during critical illness. The purpose [...] Read more.
The value of lung ultrasound (LU) in assessing extravascular lung water (EVLW) was demonstrated by comparing LU with gold-standard methods for EVLW assessment. However, few studies have analysed the value of B-Line score (BLS) in guiding fluid management during critical illness. The purpose of this trial was to evaluate if a BLS-guided fluid management strategy could improve fluid balance and short-term mortality in surgical intensive care unit (ICU) patients. We conducted a randomised, controlled trial within the ICUs of two university hospitals. Critically ill patients were randomised upon ICU admission in a 1:1 ratio to BLS-guided fluid management (active group) or standard care (control group). In the active group, BLS was monitored daily until ICU discharge or day 28 (whichever came first). On the basis of BLS, different targets for daily fluid balance were set with the aim of avoiding or correcting moderate/severe EVLW increase. The primary outcome was 28-day mortality. Over 24 months, 166 ICU patients were enrolled in the trial and included in the final analysis. Trial results showed that daily BLS monitoring did not lead to a different cumulative fluid balance in surgical ICU patients as compared to standard care. Consecutively, no difference in 28-day mortality between groups was found (10.5% vs. 15.6%, p = 0.34). However, at least 400 patients would have been necessary for conclusive results. Full article
(This article belongs to the Special Issue Lung Ultrasound: A Leading Diagnostic Tool)
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12 pages, 3883 KiB  
Article
Clinical Impact of Vertical Artifacts Changing with Frequency in Lung Ultrasound
by Natalia Buda, Agnieszka Skoczylas, Marcello Demi, Anna Wojteczek, Jolanta Cylwik and Gino Soldati
Diagnostics 2021, 11(3), 401; https://doi.org/10.3390/diagnostics11030401 - 26 Feb 2021
Cited by 18 | Viewed by 2591
Abstract
Background: This study concerns the application of lung ultrasound (LUS) for the evaluation of the significance of vertical artifact changes with frequency and pleural line abnormalities in differentiating pulmonary edema from pulmonary fibrosis. Study Design and Methods: The study was designed as a [...] Read more.
Background: This study concerns the application of lung ultrasound (LUS) for the evaluation of the significance of vertical artifact changes with frequency and pleural line abnormalities in differentiating pulmonary edema from pulmonary fibrosis. Study Design and Methods: The study was designed as a diagnostic test. Having qualified patients for the study, an ultrasound examination was performed, consistent with a predetermined protocol, and employing convex and linear transducers. We investigated the possibility of B-line artifact conversion depending on the set frequency (2 MHz and 6 MHz), and examined pleural line abnormalities. Results: The study group comprised 32 patients with interstitial lung disease (ILD) (and fibrosis) and 30 patients with pulmonary edema. In total, 1941 cineloops were obtained from both groups and analyzed. The employment of both types of transducers (linear and convex) was most effective (specificity 91%, specificity 97%, positive predictive value (PPV) 97%, negative predictive value (NPV) 91%, LR(+) 27,19, LR(−) 0.097, area under curve (AUC) = 0.936, p = 7 × 10−6). Interpretation: The best accuracy in differentiating the etiology of B-line artifacts was obtained with the use of both types of transducers (linear and convex), complemented with the observation of the conversion of B-line artifacts to Z-line. Full article
(This article belongs to the Special Issue Lung Ultrasound: A Leading Diagnostic Tool)
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20 pages, 16491 KiB  
Review
The Role of Ultrasound in the Diagnosis of Pulmonary Infection Caused by Intracellular, Fungal Pathogens and Mycobacteria: A Systematic Review
by Mariaclaudia Meli, Lucia Spicuzza, Mattia Comella, Milena La Spina, Gian Luca Trobia, Giuseppe Fabio Parisi, Andrea Di Cataldo and Giovanna Russo
Diagnostics 2023, 13(9), 1612; https://doi.org/10.3390/diagnostics13091612 - 2 May 2023
Cited by 5 | Viewed by 2119
Abstract
Background: Lung ultrasound (LUS) is a widely available technique allowing rapid bedside detection of different respiratory disorders. Its reliability in the diagnosis of community-acquired lung infection has been confirmed. However, its usefulness in identifying infections caused by specific and less common pathogens (e.g., [...] Read more.
Background: Lung ultrasound (LUS) is a widely available technique allowing rapid bedside detection of different respiratory disorders. Its reliability in the diagnosis of community-acquired lung infection has been confirmed. However, its usefulness in identifying infections caused by specific and less common pathogens (e.g., in immunocompromised patients) is still uncertain. Methods: This systematic review aimed to explore the most common LUS patterns in infections caused by intracellular, fungal pathogens or mycobacteria. Results: We included 17 studies, reporting a total of 274 patients with M. pneumoniae, 30 with fungal infection and 213 with pulmonary tuberculosis (TB). Most of the studies on M. pneumoniae in children found a specific LUS pattern, mainly consolidated areas associated with diffuse B lines. The typical LUS pattern in TB consisted of consolidation and small subpleural nodes. Only one study on fungal disease reported LUS specific patterns (e.g., indicating “halo sign” or “reverse halo sign”). Conclusions: Considering the preliminary data, LUS appears to be a promising point-of-care tool, showing patterns of atypical pneumonia and TB which seem different from patterns characterizing common bacterial infection. The role of LUS in the diagnosis of fungal disease is still at an early stage of exploration. Large trials to investigate sonography in these lung infections are granted. Full article
(This article belongs to the Special Issue Lung Ultrasound: A Leading Diagnostic Tool)
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11 pages, 1556 KiB  
Review
Patient Self-Performed Point-of-Care Ultrasound: Using Communication Technologies to Empower Patient Self-Care
by Andrew W. Kirkpatrick, Jessica L. McKee, Kyle Couperus and Christopher J. Colombo
Diagnostics 2022, 12(11), 2884; https://doi.org/10.3390/diagnostics12112884 - 21 Nov 2022
Cited by 3 | Viewed by 1955
Abstract
Point-of-Care ultrasound (POCUS) is an invaluable tool permitting the understanding of critical physiologic and anatomic details wherever and whenever a patient has a medical need. Thus the application of POCUS has dramatically expanded beyond hospitals to become a portable user-friendly technology in a [...] Read more.
Point-of-Care ultrasound (POCUS) is an invaluable tool permitting the understanding of critical physiologic and anatomic details wherever and whenever a patient has a medical need. Thus the application of POCUS has dramatically expanded beyond hospitals to become a portable user-friendly technology in a variety of prehospital settings. Traditional thinking holds that a trained user is required to obtain images, greatly handicapping the scale of potential improvements in individual health assessments. However, as the interpretation of ultrasound images can be accomplished remotely by experts, the paradigm wherein experts guide novices to obtain meaningful images that facilitate remote care is being embraced worldwide. The ultimate extension of this concept is for experts to guide patients to image themselves, enabling secondary disease prevention, home-focused care, and self-empowerment of the individual to manage their own health. This paradigm of remotely telementored self-performed ultrasound (RTMSPUS) was first described for supporting health care on the International Space Station. The TeleMentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group has been investigating the utility of this paradigm for terrestrial use. The technique has particular attractiveness in enabling surveillance of lung health during pandemic scenarios. However, the paradigm has tremendous potential to empower and support nearly any medical question poised in a conscious individual with internet connectivity able to follow the directions of a remote expert. Further studies and development are recommended in all areas of acute and chronic health care. Full article
(This article belongs to the Special Issue Lung Ultrasound: A Leading Diagnostic Tool)
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16 pages, 1749 KiB  
Review
What Is COVID 19 Teaching Us about Pulmonary Ultrasound?
by Gino Soldati and Marcello Demi
Diagnostics 2022, 12(4), 838; https://doi.org/10.3390/diagnostics12040838 - 29 Mar 2022
Cited by 8 | Viewed by 3320
Abstract
In lung ultrasound (LUS), the interactions between the acoustic pulse and the lung surface (including the pleura and a small subpleural layer of tissue) are crucial. Variations of the peripheral lung density and the subpleural alveolar shape and its configuration are typically connected [...] Read more.
In lung ultrasound (LUS), the interactions between the acoustic pulse and the lung surface (including the pleura and a small subpleural layer of tissue) are crucial. Variations of the peripheral lung density and the subpleural alveolar shape and its configuration are typically connected to the presence of ultrasound artifacts and consolidations. COVID-19 pneumonia can give rise to a variety of pathological pulmonary changes ranging from mild diffuse alveolar damage (DAD) to severe acute respiratory distress syndrome (ARDS), characterized by peripheral bilateral patchy lung involvement. These findings are well described in CT imaging and in anatomopathological cases. Ultrasound artifacts and consolidations are therefore expected signs in COVID-19 pneumonia because edema, DAD, lung hemorrhage, interstitial thickening, hyaline membranes, and infiltrative lung diseases when they arise in a subpleural position, generate ultrasound findings. This review analyzes the structure of the ultrasound images in the normal and pathological lung given our current knowledge, and the role of LUS in the diagnosis and monitoring of patients with COVID-19 lung involvement. Full article
(This article belongs to the Special Issue Lung Ultrasound: A Leading Diagnostic Tool)
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12 pages, 4771 KiB  
Review
Overview of Lung Ultrasound in Pediatric Cardiology
by Massimiliano Cantinotti, Pietro Marchese, Raffaele Giordano, Eliana Franchi, Nadia Assanta, Vivek Jani, Shelby Kutty and Luna Gargani
Diagnostics 2022, 12(3), 763; https://doi.org/10.3390/diagnostics12030763 - 21 Mar 2022
Cited by 7 | Viewed by 3975
Abstract
Lung ultrasound (LUS) is increasing in its popularity for the diagnosis of pulmonary complications in acute pediatric care settings. Despite the high incidence of pulmonary complications for patients with pediatric cardiovascular and congenital heart disease, especially in children undergoing cardiac surgery, the use [...] Read more.
Lung ultrasound (LUS) is increasing in its popularity for the diagnosis of pulmonary complications in acute pediatric care settings. Despite the high incidence of pulmonary complications for patients with pediatric cardiovascular and congenital heart disease, especially in children undergoing cardiac surgery, the use of LUS remains quite limited in these patients. The aim of this review is to provide a comprehensive overview and list of current potential applications for LUS in children with congenital heart disease, post-surgery. We herein describe protocols for LUS examinations in children, discuss diagnostic criteria, and introduce methods for the diagnosis and classification of pulmonary disease commonly encountered in pediatric cardiology (e.g., pleural effusion, atelectasis, interstitial edema, pneumothorax, pneumonia, and diaphragmatic motion analysis). Furthermore, applications of chest ultrasounds for the evaluation of the retrosternal area, and in particular, systematic search criteria for retrosternal clots, are illustrated. We also discussed the potential applications of LUS, including the guidance of interventional procedures, namely lung recruitment and drainage insertion. Lastly, we analyzed current gaps in knowledge, including the difficulty of the quantification of pleural effusion and atelectasis, and the need to differentiate different etiologies of B-lines. We concluded with future applications of LUS, including strain analysis and advanced analysis of diaphragmatic mechanics. In summary, US is an easy, accurate, fast, cheap, and radiation-free tool for the diagnosis and follow-up of major pulmonary complications in pediatric cardiac surgery, and we strongly encourage its use in routine practice. Full article
(This article belongs to the Special Issue Lung Ultrasound: A Leading Diagnostic Tool)
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14 pages, 10285 KiB  
Review
The Mechanisms Underlying Vertical Artifacts in Lung Ultrasound and Their Proper Utilization for the Evaluation of Cardiogenic Pulmonary Edema
by Toru Kameda, Naohisa Kamiyama and Nobuyuki Taniguchi
Diagnostics 2022, 12(2), 252; https://doi.org/10.3390/diagnostics12020252 - 20 Jan 2022
Cited by 12 | Viewed by 3196
Abstract
The recent advances in lung ultrasound for the diagnosis of cardiogenic pulmonary edema are outstanding; however, the mechanism of vertical artifacts known as B-lines used for the diagnosis has not yet been fully elucidated. The theory of “acoustic trap” is useful when considering [...] Read more.
The recent advances in lung ultrasound for the diagnosis of cardiogenic pulmonary edema are outstanding; however, the mechanism of vertical artifacts known as B-lines used for the diagnosis has not yet been fully elucidated. The theory of “acoustic trap” is useful when considering the generation of vertical artifacts. Basic research in several studies supports the theory. Published studies with pilot experiments indicate that clarification of the relationship between the length and intensity of vertical artifacts and physical or acoustic composition of sources may be useful for differentiating cardiogenic pulmonary edema from lung diseases. There is no international consensus with regard to the optimal settings of ultrasound machines even though their contribution to the configuration of vertical artifacts is evident. In the clinical setting, the configuration is detrimentally affected by the use of spatial compound imaging, the placement of the focal point at a deep level, and the use of multiple focus. Simple educational materials using a glass microscope slide also show the non-negligible impact of the ultrasound machine settings on the morphology of vertical artifacts. Full article
(This article belongs to the Special Issue Lung Ultrasound: A Leading Diagnostic Tool)
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14 pages, 2010 KiB  
Review
Vertical Artifacts in Lung Ultrasonography: Some Common Clinician Questions and the Related Engineer Answers
by Marcello Demi, Natalia Buda and Gino Soldati
Diagnostics 2022, 12(1), 215; https://doi.org/10.3390/diagnostics12010215 - 16 Jan 2022
Cited by 14 | Viewed by 2241
Abstract
Introduction: Vertical artifacts, including B lines, are frequently seen in a variety of lung diseases. Their sonomorphology varies in length, width, shape, and internal reverberations. The reason for this diversity is still unknown and is the cause of discussion between clinicians and ultrasound [...] Read more.
Introduction: Vertical artifacts, including B lines, are frequently seen in a variety of lung diseases. Their sonomorphology varies in length, width, shape, and internal reverberations. The reason for this diversity is still unknown and is the cause of discussion between clinicians and ultrasound physics engineers. Aim: The aim of this work is to sum up the most common clinician observations and provide an explanation to each of them derived from ultrasound physics. Materials and Methods: Based on clinical and engineering experiences as well as data collected from relevant literature, the sonomorphology of vertical artifacts was analyzed. Thirteen questions and answers were prepared on the common sonomorphology of vertical artifacts, current nomenclature, and clinical observations. Conclusions: From a clinical standpoint, the analysis of vertical artifacts is very important and requires that further clinical studies be conducted in cooperation with engineers who specialize in physics. Full article
(This article belongs to the Special Issue Lung Ultrasound: A Leading Diagnostic Tool)
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13 pages, 63858 KiB  
Review
Lung Ultrasound: A Diagnostic Leading Tool for SARS-CoV-2 Pneumonia: A Narrative Review
by Luigi Maggi, Anna Maria Biava, Silvia Fiorelli, Flaminia Coluzzi, Alberto Ricci and Monica Rocco
Diagnostics 2021, 11(12), 2381; https://doi.org/10.3390/diagnostics11122381 - 17 Dec 2021
Cited by 11 | Viewed by 2915
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread worldwide causing a global pandemic. In this context, lung ultrasound (LUS) has played an important role due to its high diagnostic sensitivity, low costs, simplicity of execution and radiation safeness. Despite computed tomography (CT) [...] Read more.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread worldwide causing a global pandemic. In this context, lung ultrasound (LUS) has played an important role due to its high diagnostic sensitivity, low costs, simplicity of execution and radiation safeness. Despite computed tomography (CT) being the imaging gold standard, lung ultrasound point of care exam is essential in every situation where CT is not readily available nor applicable. The aim of our review is to highlight the considerable versatility of LUS in diagnosis, framing the therapeutic route and follow-up for SARS-CoV-2 interstitial syndrome. Full article
(This article belongs to the Special Issue Lung Ultrasound: A Leading Diagnostic Tool)
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12 pages, 434 KiB  
Review
Is Lung Ultrasound Helpful in COVID-19 Neonates?—A Systematic Review
by Emil Robert Stoicescu, Ioana Mihaiela Ciuca, Roxana Iacob, Emil Radu Iacob, Monica Steluta Marc, Florica Birsasteanu, Diana Luminita Manolescu and Daniela Iacob
Diagnostics 2021, 11(12), 2296; https://doi.org/10.3390/diagnostics11122296 - 8 Dec 2021
Cited by 11 | Viewed by 2651
Abstract
Background: The SARS-CoV-2 infection has occurred in neonates, but it is a fact that radiation exposure is not recommended given their age. The aim of this review is to assess the evidence on the utility of lung ultrasound (LUS) in neonates diagnosed with [...] Read more.
Background: The SARS-CoV-2 infection has occurred in neonates, but it is a fact that radiation exposure is not recommended given their age. The aim of this review is to assess the evidence on the utility of lung ultrasound (LUS) in neonates diagnosed with COVID-19. Methods: A systematic literature review was performed so as to find a number of published studies assessing the benefits of lung ultrasound for newborns diagnosed with COVID and, in the end, to make a comparison between LUS and the other two more conventional procedures of chest X-rays or CT exam. The key terms used in the search of several databases were: “lung ultrasound”, “sonography”, “newborn”, “neonate”, and “COVID-19′. Results: In total, 447 studies were eligible for this review, and after removing the duplicates, 123 studies referring to LU were further examined, but only 7 included cases of neonates. These studies were considered for the present research paper. Conclusions: As a non-invasive, easy-to-use, and reliable method for lung lesion detection in neonates with COVID-19, lung ultrasound can be used as a useful diagnosis tool for the evaluation of COVID-19-associated lung lesions. The benefits of this method in this pandemic period are likely to arouse interest in opening new research horizons, with immediate practical applicability. Full article
(This article belongs to the Special Issue Lung Ultrasound: A Leading Diagnostic Tool)
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13 pages, 733 KiB  
Review
Hand-Held Ultrasound of the Lung: A Systematic Review
by Mariam Haji-Hassan, Lavinia Manuela Lenghel and Sorana D. Bolboacă
Diagnostics 2021, 11(8), 1381; https://doi.org/10.3390/diagnostics11081381 - 31 Jul 2021
Cited by 14 | Viewed by 2796
Abstract
Background: The ultrasound examination is a surface technique with an accurate diagnosis of pathological processes adjacent to the pleural line. The purpose of the study was to evaluate the role of hand-held ultrasound devices (visual stethoscopes) in the diagnosis of peripheral lung disease. [...] Read more.
Background: The ultrasound examination is a surface technique with an accurate diagnosis of pathological processes adjacent to the pleural line. The purpose of the study was to evaluate the role of hand-held ultrasound devices (visual stethoscopes) in the diagnosis of peripheral lung disease. Methods: We conducted a systematic search of literature comparing the diagnostic accuracy of truly hand-held ultrasound devices compared to conventional high-end ultrasound devices, chest X-rays, thoracic CT (computer tomography), or physical examinations to diagnose peripheral lung lesions. ScienceDirect, PubMed, and PubMed Central bibliographic databases were searched within a time limit of 15 years. Results: The applied search strategy retrieved 439 studies after removing duplicates; 34 were selected for full-text review, and 15 articles met all inclusion criteria and were included in the analysis. When comparing hand-held ultrasound devices to chest X-rays, negative predictive values were above 90%, while positive predictive values tended to be lower (from 35% to 75.8%). Hand-held ultrasound reached a correlation of 0.99 as associated with conventional ultrasound with a Bland–Altman bias close to zero. Conclusions: Being accessible, radiation-free, and comparatively easy to decontaminate, hand-held ultrasound devices could represent a reliable tool for evaluating peripheral lung diseases. This method can be successfully employed as an alternative to repeated X-ray examinations for peripheral lung disease monitoring. Full article
(This article belongs to the Special Issue Lung Ultrasound: A Leading Diagnostic Tool)
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