Search Results (114)

Background: Patients with acute heart failure exhibit high rates of early rehospitalization accompanied by significant mortality. Therefore, identifying high-risk patients who are prone to disease exacerbation may enable early therapeutic interventions for improved disease management. Methods: This single-center, prospective observational study was conducted at a Brazilian hospital. Adult patients hospitalized for acute heart failure were enrolled. On the day of hospital discharge, NT-pro-BNP and body weight data were collected, and bedside lung and inferior vena cava ultrasound examinations were performed. The patients were followed up for up to 30 days after discharge. The primary outcome was rehospitalization for acute heart failure. Results: A total of 100 patients were included in the final analysis, of whom 10% were readmitted within 30 days owing to acute heart failure. The number of patients with total B-line scores >3 in the readmitted and non-readmitted groups was 6 and 19, respectively (60% and 21%, respectively; absolute risk difference: 39%; p = 0.014). The mean inferior vena cava collapsibility index was significantly lower in readmitted compared to that in non-readmitted patients (25.5% vs. 39.8%, standard deviation: 15.4% and 18.4%, respectively; p = 0.020). However, mean body weight and mean NT-pro-BNP levels at discharge did not differ between the groups. In a multivariate logistic regression model adjusted for sex, age, discharge body weight, and left ventricular ejection fraction, a total B-lines score >3 had an odds ratio of 4.72 (95% confidence interval (CI): 1.01–22.13; p = 0.049), while the inferior vena cava collapsibility index had an odds ratio of 0.96 (95% CI: 0.91–1.01; p = 0.091). Conclusions: A total B-line score >3 at discharge in patients hospitalized for acute heart failure was associated with 30-day rehospitalization. In contrast, inferior vena cava ultrasound, discharge body weight, and NT-pro-BNP at discharge were not significant predictors of rehospitalization. Full article

Since the COVID-19 pandemic, the utilization of transthoracic ultrasonography (TTU) in the evaluation of pulmonary field artefacts has become standard practice among clinicians. However, there is a considerable lack of knowledge regarding the assessment of diaphragm mobility in the context of various lung diseases. Although numerous conditions are known to affect diaphragm mobility, including neurological, cardiovascular, and infectious diseases, it appears that pulmonary diseases may also limit the mobility of this major respiratory muscle. Despite the evidence of diaphragm mobility disorders in patients diagnosed with lung cancer, there is a discrepancy in the literature regarding the function of the diaphragm in individuals with chronic obstructive pulmonary disease (COPD). A shared aetiological factor frequently results in the co-occurrence of the aforementioned diseases. It is, however, possible to detect patients whose obstructive airway disease is caused only by the compression of infiltrative and nodal lesions rather than COPD. Bilateral TTU of diaphragmatic mobility in correlation with other available pulmonary function tests and radiological imaging may prove to be a valuable approach to isolating lung cancer patients with COPD overdiagnosis. Conversely, the overdiagnosis of COPD has been implicated in the potentially unnecessary and harmful use of inhaled medications with their adverse effects (e.g., cardiac arrhythmias, limb tremor, cough, and pneumonia), the failure to decrease obstruction in cases of other lung disorders, and the potential to contribute to the delayed diagnosis of the underlying condition responsible for the respiratory symptoms. This paper aims to provide a comprehensive overview of the utilization of ultrasound in the evaluation of diaphragm movement impairments for the detection of obstructions while also delineating the underlying limitations of this technique. Moreover, we propose a diagnostic algorithm for the purpose of excluding unilateral obstruction resulting from infiltrative neoplastic masses based on the ultrasound assessment of diaphragmatic mobility. Full article

Background: The distinction between N2a and N2b in the lung cancer TNM 9th edition staging system has reduced the heterogeneity of prognosis using the previous staging system. Moreover, this distinction may enable new treatment approaches in non-small-cell lung cancer (NSCLC). We aimed to evaluate the differences in survival between 8th- and 9th-edition staging and the mortality prediction of the TNM 9th edition in NSCLC patients who did not undergo surgical staging and who were “N”-staged with solely endobronchial ultrasound–transbronchial needle aspiration (EBUS–TBNA) without endoscopic ultrasonography (EUS). Methods: Lung cancer patients who were newly diagnosed and staged with EBUS between May 2016 and January 2023 were retrospectively reviewed. Patients were divided into two groups, “All M0 = Model 1” and “T1–2 N1–2–3 M0 = Model 2”, and compared according to their survival for both the 8th and 9th edition TNM staging systems. Cox regression analyses were performed for independent predictors of 2-year mortality. Results: In this retrospective study, a total of 90 patients were included. Most of the patients were male (84.4%), and the mean age of the study group was 64.0 ± 9.6; deceased patients were older (p = 0.024). There were no differences between groups in terms of smoking habit, comorbidities, tumor PET/CT localization, or 8th and 9th N-staging results with EBUS. The median follow-up period was 26 (0–100) months and longer for living patients than deceased patients in both groups (42 (23–100) vs. 18 (0–74), p = 0.03; 36 (24–100) vs. 20 (1–74), p < 0.001). According to the 8th edition of TNM staging, N2 stage (HR 2.26, 95% CI 1.01–5.05, p = 0.045) and N3 disease (HR 3.31, 95% CI 1.43–7.67, p = 0.005) are independent predictors of two-year mortality for Model 1 patients. When patients were staged according to the 9th edition TNM with EBUS, the relationship between N2a and mortality was not significant, while N2B disease increased the 2-year mortality risk by 2.78-fold (95% 1.07–7.22, p = 0.035), and N3 disease increased it by 3.31-fold (95% 1.43–7.67, p = 0.005). Conclusions: According to the TNM 9th edition staging system, we demonstrated that N2b disease significantly increases the risk of mortality in NSCLC cases using systematic mediastinal staging with EBUS–TBNA alone. Full article

Diffuse alveolar hemorrhage (DAH), a catastrophic complication of connective tissue disorders (CTDs), manifests as rapid-onset hypoxemia, alveolar infiltrates, and progressive bleeding into the airways. While immune-mediated alveolar–endothelial injury primarily drives its pathophysiology, diagnosis is based on bronchoscopy and chest imaging. The clinical urgency lies in securing the compromised airway and stabilizing respiratory failure, a challenge increased by CTD-specific anatomical alterations such as cervical spine instability, cricoarytenoid arthritis, and subglottic stenosis. High-dose corticosteroids and immunosuppression are essential, while severe cases require extracorporeal membrane oxygenation or plasmapheresis. This comprehensive review introduces two novel approaches to address fundamental gaps in the management of CTD-induced DAH: a structured algorithm for a CTD-specific airway risk stratification tool, integrating anatomical screening and the application of lung ultrasounds (LUSs) for post-intubation CTD-induced DAH ventilation management. The need for a multidisciplinary team approach is also discussed. Despite aggressive care, mortality remains high (25–50%), underscoring the necessity for improved early recognition and intervention strategies for these high-risk patients. Full article

The hospital-at-home (HaH) model offers hospital-level care within patients’ homes and has proven effective for managing conditions such as pneumonia. The point-of-care ultrasonography (PoCUS) is a key diagnostic tool in this model, especially when traditional imaging modalities are unavailable. This review explores how PoCUS can be optimized to manage pneumonia in HaH settings, focusing on its diagnostic accuracy in patients with comorbidities, differentiation from mimickers, and role in assessing disease severity. Pulmonary comorbidities, such as heart failure and interstitial lung disease (ILD), can complicate lung ultrasound (LUS) interpretation. In heart failure, combining lung, cardiac, and venous assessments (e.g., IVC collapsibility, VExUS score) improves diagnostic clarity. In ILD, distinguishing chronic changes from acute infections requires attention to B-line patterns and pleural abnormalities. PoCUS must differentiate pneumonia from conditions such as atelectasis, lung contusion, cryptogenic organizing pneumonia, eosinophilic pneumonia, and neoplastic lesions—many of which present with similar sonographic features. Serial LUS scoring provides useful information on pneumonia severity and disease progression. Studies, particularly during the COVID-19 pandemic, show correlations between worsening LUS scores and poor outcomes, including increased ventilator dependency and mortality. Furthermore, LUS scores correlate with inflammatory markers and gas exchange metrics, supporting their prognostic value. In conclusion, PoCUS in HaH care requires clinicians to integrate multi-organ ultrasound findings, clinical context, and serial monitoring to enhance diagnostic accuracy and patient outcomes. Mastery of LUS interpretation in complex scenarios is crucial to delivering personalized, high-quality care in the home setting. Full article

The ovine respiratory complex significantly affects lamb welfare and production efficiency, necessitating accurate diagnostic methods for pulmonary lesions. This study explores the relationship between clinical scoring, auscultation, ultrasonography, and macroscopic post-mortem evaluation to assess respiratory disease in 111 lambs. A standardized clinical scoring system, adapted from bovine models, evaluated ocular and nasal discharge, head tilt, cough, and rectal temperature. Auscultation categorized pulmonary sounds, while ultrasonography identified lung abnormalities, including B-lines, consolidations, pleural effusion, and abscesses. Macroscopic post-mortem examinations confirmed lesion extent. Kendall–Tau-B correlation coefficient analysis revealed significant associations between the methods (p < 0.01), with a high correlation between auscultation and clinical scoring τ of 0.634 (95% CI: 0.489 to 0.765), auscultation and ultrasonography τ of 0.611 (95% CI: 0.500 to 0.710), and ultrasonography and post-mortem findings τ 0.608 (95% CI: 0.460 to 0.731). While auscultation and clinical scoring provided useful insights, ultrasonography exhibited superior sensitivity in detecting subclinical and early-stage lesions, aligning closely with post-mortem evaluations. These findings emphasize ultrasonography as an effective tool for diagnosing respiratory disease in lambs, improving diagnostic accuracy and enabling timely interventions to mitigate disease impact and reduce antimicrobial use. Full article

Background: Diaphragmatic ultrasound emerges as a valuable non-invasive method for assessing diaphragm functionality in patients with amyotrophic lateral sclerosis (ALS). This study aimed to evaluate diaphragmatic ultrasound parameters in ALS, compare them with respiratory function tests, and determine whether they are associated with the need for non-invasive ventilation (NIV). Methods: This was a prospective, descriptive, and multicenter study across five centers, enrolling patients with recent diagnoses of ALS. At three-monthly visits, participants underwent both diaphragmatic ultrasound and pulmonary function testing. The following variables were analyzed: withdrawal from this study due to NIV or death, excursion, velocity, thickness, thickening fraction, and spirometric and respiratory muscle function values. Results: A total of 41 patients were included. A total of 24 (61.5%) patients left this study before the final year: 17 due to initiation of NIV, 4 due to clinical deterioration without NIV, and 3 due to death. Statistically significant moderate correlations were observed between diaphragmatic excursion and velocity and FVC and supine FVC (p < 0.001) and with MIP and the SNIP test (p < 0.05). No correlation was observed with thickening fraction. Additionally, lower baseline values in excursion were significantly associated with study withdrawal, along with reduced lung function (FVC, supine FVC, and MEP (p < 0.001). Conclusions: assessing diaphragmatic excursion by ultrasonography may serve as a useful tool for monitoring patients with ALS. Full article

Lung cancer is the leading cause of cancer-related deaths globally and ranks among the most common cancer types. Given its low overall five-year survival rate, early diagnosis and timely treatment are essential to improving patient outcomes. In recent years, advances in computer technology have enabled artificial intelligence to make groundbreaking progress in imaging-based lung cancer diagnosis. The primary aim of this study is to develop a computer-aided diagnosis (CAD) system for lung cancer using endobronchial ultrasonography (EBUS) images and deep learning algorithms to facilitate early detection and improve patient survival rates. We propose ${\mathrm{M}}^3\text{-}\mathrm{Net}$, which is a multi-branch framework that integrates multiple features through an attention-based mechanism, enhancing diagnostic performance by providing more comprehensive information for lung cancer assessment. The framework was validated on a dataset of 95 patient cases, including 13 benign and 82 malignant cases. The dataset comprises 1140 EBUS images, with 540 images used for training, and 300 images each for the validation and test sets. The evaluation yielded the following results: accuracy of 0.76, F1-score of 0.75, AUC of 0.83, PPV of 0.80, NPV of 0.75, sensitivity of 0.72, and specificity of 0.80. These findings indicate that the proposed attention-based multi-feature fusion framework holds significant potential in assisting with lung cancer diagnosis. Full article

Background: Endotracheal tube (ETT) placement is crucial for neonates with respiratory failure. Ultrasonography (US) has emerged as a valuable tool to detect ETT positioning, competing with traditional methods. Nurses, being front-line caregivers, can perform basic ultrasound examinations. This study aimed to assess whether a nurse inexperienced in US could identify the correct ETT position in neonates after a brief ultrasound training. Methods: This study included intubated neonates hospitalized in a NICU with a postmenstrual age of under 45 weeks. A NICU nurse, following a short ultrasound training, measured the distance of the ETT tip to the right pulmonary artery and aortic arch. Chest X-rays (CXRs) confirmed the ETT position. The neonates’ ages, genders, weights, and examination times were recorded. Results: This study involved 67 neonates, including 40 (59.7%) males, with 39 (58.2%) weighing below 1500 g. The median time for correct ETT placement confirmation by CXR was 12.6 min, while US-assisted ETT recognition took 6 min initially and 5.1 min at the end of the training, which was a significant difference. No major differences were found in US distance based on the neonate’s weight and age. Gender marginally influenced US distance (β = −0.089, p = 0.056). Conclusions: The NICU nurse responded well to ultrasound training, showing results comparable with CXR. Further studies with more patients and additional studied factors are needed to fully assess US’s reliability in determining ETT positioning. Full article

Thoracic point-of-care ultrasound (T-POCUS) has grown in popularity and usage in small animal emergencies and critical care settings due to its non-invasive nature, mobility, and ability to acquire images in real time. This review summarizes current understanding about T-POCUS in dogs and cats with respiratory illnesses, including normal thoracic ultrasonography appearance and numerous pathological situations. The basics of T-POCUS are covered, including equipment, scanning procedures, and picture settings. Practical applications in patients with respiratory distress are discussed, with an emphasis on pleural space abnormalities and lung diseases. Ultrasound results define pulmonary disorders such as pneumonia, atelectasis, cardiogenic and non-cardiogenic pulmonary edema, lung lobe torsion, pulmonary fibrosis, pulmonary thromboembolism, pulmonary neoplasms, and pulmonary bleeding. The evaluation focuses on T-POCUS diagnostic skills in a variety of clinical settings. Limitations and the need for more study to standardize techniques, establish agreed terminology, and create specialized educational routes are highlighted. Full article

Background/Objectives: Point-of-care lung ultrasonography (LUS) represents an accurate diagnostic tool in older patients with respiratory failure. The integration of LUS with ultrasonographic assessment of diaphragm thickness and excursion, right vastus lateralis (RVL) muscle thickness and cross-sectional area (CSA) could provide real-time information on frailty and sarcopenia. The primary aim of this proof-of-concept prospective study was to evaluate clinical correlates of thoracic, diaphragmatic, and muscular ultrasound to characterize the associations between frailty, respiratory failure, and sarcopenia in older patients hospitalized for acute respiratory complaints. Methods: Each of 52 participants (age median 84, IQR 80–89 years old) underwent integrated LUS, diaphragm and RVL ultrasound examination upon admission (T0) and after 72 h of hospitalization (T1). LUS score was used to estimate lung interstitial syndrome severity. Diaphragm excursion, thickness, RVL thickness and CSA were measured following a standardized protocol. Frailty was assessed with the PC-FI (Primary Care-Frailty Index). Results: All patients exhibited multifactorial causes of respiratory symptoms. The LUS score on T0 predicted 3-month rehospitalization. Frail patients exhibited higher LUS scores on T1. Diaphragm excursion on T0 was reduced in patients with COPD and heart failure and in those developing delirium during hospitalization. Diaphragm excursion on T1 was negatively associated with PC-FI. Diaphragm thickness, RVL thickness, and CSA exhibited a positive association with obesity. Right vastus lateralis CSA on T1, however, was also negatively associated with PC-FI. Conclusions: Integrated lung, diaphragm, and RVL ultrasound shows clinical correlations with several aspects of frailty that may help to improve the management of geriatric patients with respiratory illness. Full article

Thoracic ultrasonography (TUS) has emerged as a critical tool in the diagnosis and management of respiratory diseases in cattle, particularly bovine respiratory disease (BRD), which is one of the most economically significant health issues in feedyard operations. The objective of this review is to explore TUS in veterinary medicine, including the historical development, methodologies, and clinical applications for diagnosing and prognosing respiratory diseases. This review also emphasizes the importance of operator training, noting that even novice operators can achieve diagnostic consistency with proper instructions. Ultrasound was introduced in the mid-20th century for back-fat thickness measurements; TUS has evolved to offer a non-invasive, real-time imaging modality that allows for the detection of lung and pleural abnormalities such as consolidations, pleural effusions, and B-lines. These features are vital indicators of respiratory disease, and their early identification through TUS can significantly improve clinical outcomes. Compared to traditional diagnostic methods like auscultation or radiography, TUS provides superior accuracy in detecting both subclinical and advanced respiratory conditions, particularly in high-risk populations. Furthermore, TUS has demonstrated strong prognostic value, with studies showing that the extent of lung consolidation correlates with higher relapse risk, reduced growth performance, and increased mortality. Full article

The hospital-at-home (HaH) model delivers hospital-level acute care, including diagnostics, monitoring, and treatments, in a patient’s home. It is particularly effective for managing conditions such as pneumonia. Point-of-care ultrasonography (PoCUS) is a key diagnostic tool in the HaH model, and it often serves as a substitute for imaging-based diagnosis in the HaH setting. Both standard and handheld ultrasound equipment are suitable for lung ultrasound (LUS) evaluation. Curvelinear and linear probes are typically used. Patient positioning depends on their clinical condition and specific diagnostic protocols. To enhance sensitivity, we recommend using at least 10-point protocols supported by studies for pneumonia. Five essential LUS patterns should be identified, including A-line, multiple B-lines (alveolar-interstitial syndrome), confluent B-lines, subpleural consolidation, and consolidation with air bronchogram. Pleural effusion is common, and its internal echogenicity can indicate severity and the need for invasive procedures. The current evidence on various etiologies and types of pneumonia is limited, but LUS demonstrates good sensitivity in detecting abnormal sonographic patterns in atypical pneumonia, tuberculosis, and ventilator-associated pneumonia. Further LUS studies in the HaH setting are required to validate and generalize the findings. Full article

Lung ultrasonography can facilitate bovine respiratory disease (BRD) detection and can potentially improve treatment outcomes. In this study, ninety-six veal calves were followed weekly with clinical and lung ultrasound examinations during the production cycle. Thirty-six calves had clinical signs and abnormal lung ultrasound scans (TRT, n = 36) and were promptly treated with florfenicol and meloxicam. Healthy veal calves without clinical signs and lung lesions were enrolled in the control group (CTR, n = 48), while 12 calves were excluded by the study. The clinical (Wisconsin and California scores), ultrasound and lung lesion scores, total lung consolidation area, treatment rates (success, relapse, mortality), average daily gain (ADG), carcass quality, and gross lesions of lungs at slaughterhouse were monitored. Results showed 91.7% of treatments were performed 3–28 days after arrival. Lung lesions occurred five days before the peak of clinical scores. Following treatment, lungs healed within 5 days with high treatment success rates (97.1% success rate in 45 days and 94.9% overall success rate without relapse). Finally, TRT had similar gross lung lesion prevalence, ADG, and carcass quality to CTR. These results suggest that early detection of BRD followed by a prompt treatment can lead to several key benefits for the health and the growth performances of veal calves. Full article

Background: For patients undergoing abdominal surgery, postoperative pulmonary complications (PPCs) are a major source of morbidity and mortality. The use of point-of-care ultrasonography (POCUS), and specifically POCUS of the lungs, has seen many advancements in recent years. Objectives: We hypothesize that perioperative lung ultrasonography can be used as a predictor for PPCs. Methods: In a Single, 1000 beds, trauma level I medical center, patients presenting for elective intra-abdominal surgery with no severe pulmonary or cardiac diseases were evaluated preoperatively with a standardized 12-point lung ultrasound exam. A second identical exam was performed after surgery in the post-anesthesia care unit. PPCs were also documented. All lung ultrasound exams were presented to a blinded researcher and a lung ultrasound score (LUS) was calculated. Statistical analysis comparing pre- and postoperative LUS and PPC scores were performed. Results: A total of 61 patients were evaluated. The pre-surgery median LUS was 0 (in the range of 0–6) and the post-surgery median LUS was 3 (in the range of 0–14). The pre- to postsurgical LUS delta was 3.4 (standard deviation of 3.3). A postoperative LUS of 6 or more was defined as “high.” A High LUS did not correlate with prolonged post-anesthesia care unit or hospital stay, prolonged oxygen support, or number of desaturation events. Conclusion: For elective abdominal surgery in relatively healthy patients, preoperative LUS usually begins at a normal level and becomes worse after general anesthesia. However, this difference in LUS is not significantly associated with clinically relevant postoperative pulmonary complications such as prolonged oxygen therapy, pneumonia, and noninvasive or invasive mechanical ventilation. Trial registration: Clinicaltrials.gov identifier: NCT05502926. Summary: This paper explores the use of point-of-care ultrasonography as a predictor for postoperative pulmonary complications. The findings suggest that while the lung ultrasound score worsens with general anesthesia, the differences are not significantly associated with postoperative pulmonary complications. Full article