Assessment of thoracic ultrasound in complementary diagnosis and in follow up of community-acquired pneumonia (cap)
Assessment of thoracic ultrasound in complementary diagnosis and in follow up of community-acquired pneumonia (cap)
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DOI：
10.1186/s12880-017-0225-5
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发表时间：
2017-08-31
影响因子：
2.7
通讯作者：
Sperandeo, Marco
中科院分区：
文献类型：
--
作者：
D'Amato, Maria;Rea, Gaetano;Sperandeo, Marco
背景：胸部X线是社区获得性肺炎(CAP)的主要诊断工具。一些作者最近提出，在CAP的诊断和随访中，胸部超声(TUS)可以有价值地辅助甚至可靠地取代CXR。我们在大样本CAP患者中研究了TUS的临床应用价值，以挑战它可能替代CXR的假设。方法：连续645例经CXR证实的CAP患者中，510例随后进入我科内科。这些患者由一位训练有素的操作员进行TUS评估，但他对最初的诊断视而不见。入院时进行TUS扫描，并在入院后第4-6天和第9-14天重复扫描。结果：TUS发现了375/510(73.5%)经CXR证实的病变，大多位于肺的后基底区或中胸段。CXR和TUS分别检出26.9%和30.4%的患者胸腔积液。TUS记录的实变区大小分别为：0时6.3+/-3.4 cm，4-6 d时2.5+/-1.8 cm，9-14 d时0.9+/-1.4 cm。在12例延迟愈合的CAP患者中，7例为肺癌。结论：在CXR确诊的CAP患者中，TUS能检出超过70%的肺实变，但有26.5%的病例有假阴性结果。我们的纵向结果证实了TUS在可检测到的病变的随访中的作用。因此，TUS应该被视为肺炎的补充和监测工具，而不是主要的成像方式。
Background: Chest X-ray (CXR) is the primary diagnostic tool for community-acquired pneumonia (CAP). Some authors recently proposed that thoracic ultrasound (TUS) could valuably flank or even reliably substitute CXR in the diagnosis and follow-up of CAP. We investigated the clinical utility of TUS in a large sample of patients with CAP, to challenge the hypothesis that it may be a substitute for CXR.Methods: Out of 645 consecutive patients with a CXR-confirmed CAP diagnosed in the emergency room of our hospital over a three-years period, 510 were subsequently admitted to our department of Internal Medicine. These patients were evaluated by TUS by a well-trained operator who was blinded of the initial diagnosis. TUS scans were performed both at admission and repeated at day 4-6th and 9-14th during stay.Results: TUS identified 375/510 (73.5%) of CXR-confirmed lesions, mostly located in posterior-basal or mid-thoracic areas of the lungs. Pleural effusion was detected in 26.9% of patients by CXR and in 30.4% by TUS. TUS documented the change in size of the consolidated areas as follows: 6.3 +/- 3.4 cm at time 0, 2.5 +/- 1.8 at 4-6 d, 0.9 +/- 1.4 at 9-14 d. Out of the 12 patients with delayed CAP healing, 7 of them turned out to have lung cancer.Conclusions: TUS allowed to detect lung consolidations in over 70% of patients with CXR-confirmed CAP, but it gave false negative results in 26.5% of cases. Our longitudinal results confirm the role of TUS in the follow-up of detectable lesions. Thus, TUS should be regarded as a complementary and monitoring tool in pneumonia, instead of a primary imaging modality.