Lung Ultrasound in Evaluationof Pneumonia
uring the last 20 years, ultrasound has been shown to behighly effective in evaluating a range of pathologic pul-monary conditions. One of the most widely studied andpracticed applications is the evaluation of pneumonia with ultra-sound. Ultrasound interrogation of the thorax for detection of pneu-monia has been explored most in critical care and emergency department settings. However, recently, the application has spreadto general practice and even prehospital settings. A number of scan-ning approaches exist, ranging from highly involved research scan-ning tools to rapid and focused surveillance scans. The most widely accepted protocol is performed rapidly and easily and has provedto be sensitive and specific in adult and pediatric patients. Multiplestudies have shown lung ultrasound imaging to be more accuratethan chest radiography and in some cases rivals the accuracy of com-puted tomography (CT), such as in the diagnosis of lung abscesses.This article reviews clinical scenarios in which the lung ultrasoundexamination is useful in suspected pneumonia, describes pathologicfindings, and presents a commonly accepted scanning protocol.
Overview and Clinical Problem
The diagnosis of pneumonia, once thought to be accomplished sim-ply by physical examination, history taking, and specific ausculta-tory findings, has recently become highly dependent on imaging.There is, in general, a method behind this apparent clinical mad-ness. Despite a long-held belief that physical examination findingsand proper auscultation are sufficient to rule in, or out, the presenceof pneumonia, multiple pressures in clinical practice have drivenincreased use of chest radiography and occasionally CT. The phys-ical examination has proved to be unreliable for detection of pneu-monia, even in expert hands.
Studies comparing examinations by expert physicians to chest radiography have verified the failure of auscultation as a diagnostic method in evaluation of pneumonia, yetphysicians are under an increasing burden to be more accurate, andmissing pneumonia is seen as a substantial liability. Additionally, thecommon approach in general private practice of prescribing antibi-otics to any patient presenting with a cough and fever contributes toincreasing antibiotic resistance and is actively combated by the USCenters for Disease Control and Prevention.
Michael Blaivas, MD
Received January 30, 2012, from the Depart-ment of Emergency Medicine, Northside HospitalForsyth, Cumming, Georgia USA. Revisionrequested February 14, 2012. Revised manuscript accepted for publication March 14, 2012. Address correspondence to Michael Blaivas, MD, Department of Emergency Medicine, North-side Hospital Forsyth, 1200 Northside Forsyth Dr, Cumming, GA 30040-1147 USA. E-mail: firstname.lastname@example.org
ARDS, acute respiratory distress syndrome;CT, computed tomography
©2012 by the American Institute of Ultrasound in Medicine|J Ultrasound Med 2012; 31:823–826|0278-4297|www.aium.org
SOUND JUDGMENT SERIES
Invited paperVideo online at jultrasoundmed.org
TheSoundJudgmentSeriesconsists of invitedarticleshighlightingtheclinical valueofusingultrasoundfirstinspecificclinicaldiagnoseswhere ultrasoundhas showncomparativeorsuperiorvalue. The seriesismeanttoserveasaneducational toolformedicalandsonographystudentsand clinical practitioners andmayhelpintegrateultrasoundintoclinicalpractice.