Department of Graduate Medical Education, Mount Carmel Health System, Columbus, Ohio, USA.
Office of Research Affairs, Mount Carmel Health System, Columbus, Ohio, USA.
J Ultrasound Med. 2019 Apr;38(4):967-973. doi: 10.1002/jum.14781. Epub 2018 Oct 2.
Chest radiography has been the preferred imaging study to assess pulmonary congestion. However, chest radiography interpretation is influenced by the level of expertise and high interobserver variability. Lung ultrasound (US) may produce more objective findings through evaluation of vertical comet tail artifacts known as B-lines, which are created by a decrease in the ratio of alveolar air to fluid pulmonary content. Few studies have directly compared chest radiography to bedside US against a reference standard for the diagnosis of pulmonary edema. This study compared the sensitivity and specificity of bedside US and chest radiography in diagnosing pulmonary edema.
This prospective observational cohort study involved adult patients presenting to the emergency department of an urban tertiary hospital with dyspnea. The primary outcome was the presence or absence of pulmonary edema, as indicated by B-lines on a bedside lung US examination or radiologist-interpreted chest radiography. Patients underwent a US examination within about 1 hour of chest radiography. The final diagnosis from the discharge summary served as the reference standard.
Ninety-nine patients were enrolled; 32.3% had congestive heart failure, and 40.4% had chronic obstructive pulmonary disease. Bedside US showed significantly higher sensitivity (96%) compared to chest radiography (65%; P < .001). Of 18 patients with negative radiographic findings and a discharge diagnosis of pulmonary edema, 16 (89%) had positive US findings (P < .001).
Bedside US has the potential to identify pulmonary edema more accurately than chest radiography. As current practice within the United States uses chest radiography, reflecting American College of Cardiology Foundation/American Heart Association guidelines for management of heart failure, the results of this study warrant further evaluation.
胸部 X 线摄影已成为评估肺充血的首选影像学研究。然而，胸部 X 线摄影的解释受专业水平和观察者间差异的影响。肺部超声（US）通过评估称为 B 线的垂直彗尾伪影可能产生更客观的结果，B 线是由肺泡空气与肺内液体比例降低引起的。很少有研究直接比较胸部 X 线摄影和床边 US 与肺水肿的参考标准对诊断的敏感性和特异性。本研究比较了床边 US 和胸部 X 线摄影诊断肺水肿的敏感性和特异性。
这项前瞻性观察性队列研究纳入了因呼吸困难就诊于城市三级医院急诊科的成年患者。主要结局是根据床边肺部 US 检查或放射科医生解读的胸部 X 线摄影是否存在 B 线来判断是否存在肺水肿。患者在接受胸部 X 线摄影后约 1 小时内接受 US 检查。出院小结中的最终诊断作为参考标准。
共纳入 99 例患者；32.3%患有充血性心力衰竭，40.4%患有慢性阻塞性肺疾病。床边 US 的敏感性明显高于胸部 X 线摄影（96%对 65%；P<0.001）。在 18 例放射检查结果阴性且出院诊断为肺水肿的患者中，16 例（89%）US 检查结果阳性（P<0.001）。
床边 US 比胸部 X 线摄影更能准确地识别肺水肿。由于美国目前的实践使用胸部 X 线摄影，反映了美国心脏病学会基金会/美国心脏协会关于心力衰竭管理的指南，因此这项研究的结果需要进一步评估。
