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Ultrasounds in the Diagnosis of Thoracic Diseases: Transthoracic and Endosonographic Approaches

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A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Medical Imaging and Theranostics".

Deadline for manuscript submissions: closed (31 January 2024) | Viewed by 4577

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Special Issue Editor

Dr. Sara Colella

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Guest Editor

Respiratory Disease Unit, “G. Mazzini” Hospital, Teramo, Italy
Interests: interventional pulmonology; thoracic malignancy; interstitial lung diseases; infectious diseases

Special Issue Information

Dear Colleagues,

The use of ultrasounds in respiratory medicine is well known and well documented; thus, it has progressively gained ground in the diagnostic work-up of endothoracic lesions.

There are two ultrasound-guided biopsy approaches: trans-thoracic ultrasound and endoscopic ultrasound. The first consists of performing a trans-thoracic biopsy under ultrasound visualization, and it is mainly dedicated for peripheral lesions very close to the pleura surface. Endoscopic ultrasound is a term that include EBUS-TBNA and EUS-(B)-FNA, depending, respectively, on whether the endoscope is inserted into the trachea or into the oesophagus. EBUS-TBNA is suitable for lesions located in the mediastinum, in the inner third of the thorax and, in selected cases, also located close to the segmentary bronchi; EUS-(B)-FNA is traditionally used for sampling lung and mediastinal lesions located near the oesophagus and for sub-diaphragmatic structures such as lymph nodes stations 8 and 9 and the left adrenal gland.

The above-mentioned techniques have been mainly employed when malignant diseases are suspected, such as in lung cancer diagnosis and staging, but also for the diagnosis of benign diseases such as granulomatous diseases or infections. The development of new technologies has led to the possibility to further optimize the diagnostic yield with new diagnostic tools such as, for example, mini-forceps or cryoprobe in EBUS-TBNA, thus opening the possibility to implement the use of ultrasound in respiratory medicine.

The aim of this Issue is to collect papers regarding the use of ultrasound in the diagnosis of lung diseases, using either trans-thoracic ultrasound or endosonography; particularly, case series on new technological or biopsy approaches are more than welcome, as well as meta-analyses.

Thank you for your interest and for you time,

My best wishes,

Dr. Sara Colella
Guest Editor

Manuscript Submission Information

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Keywords

trans-thoracic ultrasound
endosonography
EBUS-TBNA
EUS-B-TBNA
biopsy
endothoracic lesions
malignant diseases
benign diseases

Published Papers (5 papers)

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Research

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13 pages, 1945 KiB

Open AccessArticle

Lung Ultrasound Reproducibly Outperforms Computed Tomography in the Detection of Extravascular Lung Water in Patients Undergoing Haemodialysis

by John P. Corcoran, Mark Hew, Ben Attwood, Murali Shyamsundar, Sheera Sutherland, Kristine Ventura, Rachel Benamore, Victoria St. Noble, Hania E. Piotrowska, Christopher W. Pugh, Christian B. Laursen, Fergus V. Gleeson and Najib M. Rahman

Diagnostics 2024, 14(6), 589; https://doi.org/10.3390/diagnostics14060589 - 11 Mar 2024

Viewed by 690

Abstract

Background: Lung ultrasound (LUS) is increasingly used as an extension of physical examination, informing clinical diagnosis, and decision making. There is particular interest in the assessment of patients with pulmonary congestion and extravascular lung water, although gaps remain in the evidence base underpinning this practice as a result of the limited evaluation of its inter-rater reliability and comparison with more established radiologic tests. Methods: 30 patients undergoing haemodialysis were prospectively recruited to an observational cohort study (NCT01949402). Patients underwent standardised LUS assessment before, during and after haemodialysis; their total LUS B-line score was generated, alongside a binary label of whether appearances were consistent with an interstitial syndrome. LUS video clips were recorded and independently scored by two blinded expert clinician sonographers. Low-dose non-contrast thoracic CT, pre- and post dialysis, was used as a “gold standard” radiologic comparison. Results: LUS detected a progressive reduction in B-line scores in almost all patients undergoing haemodialysis, correlating with the volume of fluid removed once individuals with no or minimal B-lines upon pre-dialysis examination were discounted. When comparing CT scans pre- and post dialysis, radiologic evidence of the change in fluid status was only identified in a single patient. Conclusions: This is the first study to demonstrate that LUS detects changes in extravascular lung water caused by changing fluid status during haemodialysis using a blinded outcome assessment and that LUS appears to be more sensitive than CT for this purpose. Further research is needed to better understand the role of LUS in this and similar patient populations, with the aim of improving clinical care and outcomes. Full article

(This article belongs to the Special Issue Ultrasounds in the Diagnosis of Thoracic Diseases: Transthoracic and Endosonographic Approaches)

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14 pages, 2695 KiB

Open AccessArticle

Differentiating Viral from Bacterial Pneumonia in Children: The Diagnostic Role of Lung Ultrasound—A Prospective Observational Study

by Emil Robert Stoicescu, Roxana Iacob, Adrian Cosmin Ilie, Emil Radu Iacob, Septimiu Radu Susa, Laura Andreea Ghenciu, Amalia Constantinescu, Daiana Marina Cocolea, Cristian Oancea and Diana Luminita Manolescu

Diagnostics 2024, 14(5), 480; https://doi.org/10.3390/diagnostics14050480 - 23 Feb 2024

Viewed by 852

Abstract

This prospective observational study aimed to investigate the utility of lung ultrasound (LUS) in diagnosing and managing pediatric respiratory infections, specifically focusing on viral, bacterial, and SARS-CoV-2 infections. Conducted over a period of 1 year and 8 months, this research involved 85 pediatric patients (showcasing a median age of 14 months) recruited based on specific criteria, including age, confirmed infection through multiplex PCR tests, and willingness to undergo LUS imaging. This study employed a 12-area scoring system for LUS examinations, utilizing the lung ultrasound score (LUSS) to evaluate lung abnormalities. The PCR examination results reveal diverse respiratory pathogens, with SARS-CoV-2, influenza, and bacterial co-infections being prominent among the cases. As an observational study, this study was not registered in the registry. Distinct LUS patterns associated with different pathogens were identified, showcasing the discriminatory potential of LUS in differentiating between viral and bacterial etiologies. Bacterial infections demonstrated more severe lung involvement, evident in significantly higher LUSS values compared with viral cases (p < 0.0001). The specific abnormalities found in bacterial superinfection can be integrated into diagnostic and management protocols for pediatric respiratory infections. Overall, this research contributes valuable insights into optimizing LUS as a diagnostic tool in pediatric pneumonia, facilitating more informed and tailored healthcare decisions. Full article

(This article belongs to the Special Issue Ultrasounds in the Diagnosis of Thoracic Diseases: Transthoracic and Endosonographic Approaches)

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15 pages, 3974 KiB

Open AccessArticle

Stratifying Disease Severity in Pediatric COVID-19: A Correlative Study of Serum Biomarkers and Lung Ultrasound—A Retrospective Observational Dual-Center Study

Diagnostics 2024, 14(4), 440; https://doi.org/10.3390/diagnostics14040440 - 17 Feb 2024

Viewed by 740

Abstract

The COVID-19 pandemic, caused by SARS-CoV-2, has manifested distinct impacts on infants and children. This study delves into the intricate connection between lung ultrasound (LUS) findings and serum biomarkers in neonates and infants with COVID-19. Exploring factors contributing to the mild symptoms in this demographic, including immune responses and pre-existing immunity, the study spans 3 years and 9 months, involving 42 patients. Respiratory and gastrointestinal symptoms predominate, and LUS emerges as a vital, non-irradiating tool for evaluating pulmonary abnormalities. Serum biomarkers like CRP, procalcitonin, and cytokines provide key insights into the pathophysiology. Correlations reveal nuanced links between LUS score and clinical parameters, unveiling associations with hospitalization duration (rho = 0.49), oxygen saturation (rho = −0.88), and inflammatory markers, like ferritin (rho = 0.62), LDH (rho = 0.73), and D-dimer (rho = 0.73) with significance level (p < 0.05). The absence of large consolidations in LUS suggests unique pulmonary characteristics. The novelty of these findings lies in the comprehensive integration of LUS with serum biomarkers to assess and monitor the severity of lung involvement in neonates and infants affected by SARS-CoV-2. This approach offers valuable insights into disease severity, biomarker levels, the duration of hospitalization, and oxygen saturation, providing a multifaceted understanding of COVID-19’s impact on this vulnerable population. Full article

(This article belongs to the Special Issue Ultrasounds in the Diagnosis of Thoracic Diseases: Transthoracic and Endosonographic Approaches)

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Other

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19 pages, 3567 KiB

Open AccessSystematic Review

Accuracy of Thoracic Ultrasonography for the Diagnosis of Pediatric Pneumonia: A Systematic Review and Meta-Analysis

by Zhenghao Dong, Cheng Shen, Jinhai Tang, Beinuo Wang and Hu Liao

Diagnostics 2023, 13(22), 3457; https://doi.org/10.3390/diagnostics13223457 - 16 Nov 2023

Cited by 2 | Viewed by 871

Abstract

As an emerging imaging technique, thoracic ultrasonography (TUS) is increasingly utilized in the diagnosis of lung diseases in children and newborns, especially in emergency and critical settings. This systematic review aimed to estimate the diagnostic accuracy of TUS in childhood pneumonia. We searched Embase, PubMed, and Web of Science for studies until July 2023 using both TUS and chest radiography (CR) for the diagnosis of pediatric pneumonia. Two researchers independently screened the literature based on the inclusion and exclusion criteria, collected the results, and assessed the risk of bias using the Diagnostic Accuracy Study Quality Assessment (QUADAS) tool. A total of 26 articles met our inclusion criteria and were included in the final analysis, including 22 prospective studies and four retrospective studies. The StataMP 14.0 software was used for the analysis of the study. The overall pooled sensitivity was 0.95 [95% confidence intervals (CI), 0.92–0.97] and the specificity was 0.94 [95% CI, 0.88–0.97], depicting a good diagnostic accuracy. Our results indicated that TUS was an effective imaging modality for detecting pediatric pneumonia. It is a potential alternative to CXR and a follow-up for pediatric pneumonia due to its simplicity, versatility, low cost, and lack of radiation hazards. Full article

(This article belongs to the Special Issue Ultrasounds in the Diagnosis of Thoracic Diseases: Transthoracic and Endosonographic Approaches)

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11 pages, 3466 KiB

Open AccessBrief Report

Sonographic Aeration Scoring Indicates Disease Severity in Critically Ill Patients with COVID-19

by Daniel T. Marggrander, Philippe Simon, Tobias Schröder, Daniel Gill-Schuster and Haitham Mutlak

Diagnostics 2023, 13(22), 3446; https://doi.org/10.3390/diagnostics13223446 - 15 Nov 2023

Viewed by 936

Abstract

Aims and Methods: We evaluated an ultrasound score from 0 to 32 points in eight pulmonary regions to monitor critically ill COVID-19 patients. The score was correlated to surrogate parameters of disease severity, i.e., the oxygenation index, respiratory support, mortality, plasma interleukin-6, and WHO and ARDS classifications. Results: A total of 27 patients were repeatedly examined, and 71 examinations were evaluated. Patients with severe COVID-19 scored higher (median 17) than those with moderate disease (median 11, p < 0.01). The score did not differentiate between stages of ARDS as defined by the Berlin criteria (p = 0.1) but could discern ARDS according to the revised ESICM definition (p = 0.002). Non-survivors had higher ultrasound scores than survivors (median 18.5 vs. 14, p = 0.04). The score correlated to the oxygenation index (ρ = −0.56, p = 0.03), and changes in the score between examinations correlated to changes in oxygenation (ρ = −0.41, p = 0.16). The correlation between the score and interleukin-6 was ρ = 0.35 (p < 0.001). The interrater reliability for the score was ICC = 0.87 (p < 0.001). Conclusions: The ultrasound score is a reliable tool that might help monitor disease severity and may help stratify the risk of mortality. Full article

(This article belongs to the Special Issue Ultrasounds in the Diagnosis of Thoracic Diseases: Transthoracic and Endosonographic Approaches)

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