SHORT COMMUNICATION - Accuracy of lung ultrasound and chest X-rays in diagnosing acute pulmonary oedema in patients presenting with acute dyspnoea in emergency department.

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From: Journal of Pakistan Medical Association(Vol. 71, Issue 10)
Publisher: Knowledge Bylanes
Document Type: Report
Length: 1,641 words
Lexile Measure: 1720L

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Byline: Sanniya Khan Ghauri, Khawaja Junaid Mustafa, Arslaan Javaeed and Abdus Salam Khan

Keywords: Pulmonary oedema, diagnostic accuracy, lung ultrasound, chest x-ray

Introduction

Acute shortness of breath is one of the top 10 causes for which adults present to the emergency department; it has a prevalence of 3-9% of all presentations.1 History, clinical findings, laboratory workup and chest X-ray are the usual baseline investigations to differentiate between the different causes of dyspnoea but these are not very specific and there is a significant delay in the availability of results which leads to misdiagnosis in 20% of the cases.2,3 In an earlier study, the prevalence rate for acute pulmonary oedema in patients presenting with dyspnoea was found out to be 45-55%.4 Lung ultrasound (LUS) is an innovative bedside technique which can be performed easily by the emergency physician and can differentiate acute pulmonary oedema from other causes of dyspnoea, thereby helping in early identification and initiation of specific treatment.5-7

LUS is gaining importance worldwide due to its easy applicability as a bedside procedure, cost effectivity, no exposure to radiation, no effect by positioning and it can be easily performed with minimal training.8-10 Pulmonary oedema, identified as diffuse alveolar interstitial syndrome, is characterised by a cone-shaped vertical artefact on ultrasound known as the 'comet-tail' sign or 'B-lines'.2,6-8 The presence of three of these comet tails in any two quadrants of both the lungs is diagnostic with 100% sensitivity and 92% specificity.8 In contrast, no comet tails will be present in acute COPD exacerbation.2 In another study, the ultrasound examination and NT-proBNP, when combined together, interestingly had a sensitivity and specificity of 100% each, along with PPV and NPV of 100% each for distinguishing heart failure as compared to pulmonary causes in patients presenting with dyspnoea.7

Currently, the utility of ultrasound examination is mainly limited to abdominal, obstetric, vascular and urological problems. Lung ultrasound performed by an emergency physician can expedite the diagnosis and treatment of acute pulmonary oedema in a patient presenting with undifferentiated dyspnoea. It can also reduce the exposure to X-ray radiation and the inconvenience of shifting a critical patient to the radiology unit. Moreover, it can assess the lung in a better way as compared to a 2-D X-ray and can also demonstrate improvement or failure in improvement, after appropriate management. Although published data exists, this is the first study to be conducted in an emergency department in Pakistan. This study aims to investigate the ability of LUS to...

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