LUNG ULTRASONOGRAPHY IN PNEUMONIA

Aim. In order to optimize the diagnosis of pneumonia by including lung ultrasonography in the diagnostic algorithm for pneumonia, the main ultrasound signs of inflammatory infiltration of the lungs were identified, depending on the form of morphological substrate, and the capabilities of ultrasound examination in monitoring pneumonia were evaluated.

Material and Methods. A total of 96 patients were admitted to hospital by emergency to rule out/to confirm pneumonia based on X-ray diagnosis of this pathology in 81 persons. Ultrasonic examination was performed in all patients at a day of admission to hospital. Dynamics in inflammatory infiltrate was evaluated in 55 patients at days 3–4, 7, and 10–14 of hospital stay.

Results. The ultrasonic signs of inflammatory infiltrate were found in 55 of 96 patients with prevalent ultrasound pattern of pleuropneumonia (n=48; 50%) and bronchopneumonia in a smaller number of patients (n=7; 8.6%). The results of ultrasonography showed the low sensitivity (69.7%) and significantly high specificity (100%) rates of the method in detecting pneumonia. Positive dynamics in ultrasonic monitoring of pneumonia was detected in the overwhelming number of patients (n=45; 81.8%) at day 3 of hospitalization. Negative dynamics (n=3; 5.5%) was observed at days 3 and 7 of the study.

Conclusion. Ultrasonic study may be considered a useful step in the diagnostic algorithm for patients with pneumonia as this method provides additional information for an attending physician and does not involve adverse effects of ionizing radiation on patient’s body. Since the ultrasonic data on positive and negative dynamics of pneumonia were received ahead of the results of standard control radiography and were verified by further clinical and radiological observations, the role of ultrasonic monitoring of the inflammatory infiltrate was essential for evaluation of the efficacy of antibiotic therapy at earlier time.

1. Lichtenstein D.A. BLUE-protocol and FALLS-protocol: two applications of lung ultrasound in the critically ill. Chest. 2015;147:1659–1670.

2. Alzahrani S.A., Al-Salamah M.A., Al-Madani W.H., Elbarbary M.A. Systematic review and meta-analysis for the use of ultrasound versus radiology in diagnosing of pneumonia. Crit. Ultrasound J. 2017;9(1): 6.

3. Unluer E., Karagoz A., Senturk G., Karaman M., Olow K., Bayata S. Bedside lung ultrasonography for diagnosis of pneumonia. Hong Kong Am. J. Emerg. Med. 2013;20(2):98–104.

4. Cortellaro F., Ceriani E., Spinelli M., Campanella C., Bossi I., Coen D., et al. Lung ultrasound for monitoring cardiogenic pulmonary edema. Intern. Emerg. Med. 2017, Oct;12(7):1011–1017. DOI: 10.1007/s11739-016-1510-y.

5. Guyi W., Xiaoying J. Lung ultrasound: a promising tool to monitor ventilator-associated pneumonia in critically ill patients. Crit. care.2016;20:13054–13016. DOI: 10.1186/s13054-016-1487-y.

6. Blaivas M. Lung Ultrasound in Evaluation of Pneumonia. Ultrasound in medicine. 2012;6:823–826.

7. Dianova T.I., Safonov D.V. Ultrasonic monitoring and age-related echographic features of community-acquired pneumonia in children. Modern technologies in medicine. 2015;7(2):113–119 (In Russ.).

8. Ol’khova E.B., Khaspekov D.V., Buvaeva G.S. Diagnostic value of ultrasound examination of the lungs and pleural cavities in urgent conditions in children. Medical vizualization. 2004;4:95–101 (In Russ.).

9. Goran R. Lung ultrasound in the diagnosis of pediatric pneumonia. Acta Medica Academica. 2016;45(1):82–83.

10. Yilmaz H.L., Özkaya A.K., Sarı Gökay S., Tolu Kendir Ö., Senol H. Pointof-care lung ultrasound in children with community acquired pneumonia. Am. J. Emerg. Med. 2017, Jul;35(7):964–969. DOI: 10.1016/j.ajem.2017.01.065.

11. Interrigi M.C., Trovato F.M., Catalano D., Trovato G.M. Emergency thoracic ultrasound and clinical risk management. Ther. Clin. Risk Manag. 2017;13:151–160.

12. Chavez M.A., Shams N., Ellington L.E., Naithani N., Gilman R.H., Steinhoff M.C., et al. Lung ultrasound for the diagnosis of pneumonia in adults: a systematic review and meta-analysis. Respir. Res. 2014;15:50. DOI: 10.1186/1465-9921-15-50.

13. Reissig A., Copetti R., Mathis G., Mempel C., Schuler A., Zechner P., et al. Lung ultrasound in the diagnosis and follow-up of communityacquired pneumonia: a prospective, multicenter, diagnostic accuracy study. Chest. 2012;142 (4):965–972.

14. Boursiani C., Tsolia M., Koumanidou C., Malagari A., Vakaki M., Karapostolakis G., et al. Lung Ultrasound as First-Line Examination for the Diagnosis of Community-Acquired Pneumonia in Children. Pediatr. Emerg. Care. 2017;33(1):62–66.

15. Caiulo V.A., Gargani L., Caiulo S., Fisicaro A., Moramarco F., Latini G., et al. Lung ultrasound characteristics of communityacquired pneumonia in hospitalized children. Pediatr. Pulmonol. 2013;48(3):280–287.