Bedside lung ultrasound in the critically ill patient with pulmonary pathology: different diagnoses with comparable chest X-ray opacification
© Koeze et al; licensee Springer. 2012
Received: 10 June 2011
Accepted: 6 March 2012
Published: 6 March 2012
The differential diagnosis and treatment of opacifications on the chest X-ray in critically ill patients may be challenging. This holds in particular the patient that suffers from respiratory failure with hemodynamic instability. Opacification in the chest X-ray could be the result of hematothorax, pleural effusion, atelectasis, or consolidation. Physical examination of such patients may not always indicate what the cause of the opacification is and thus may not always help indicate the correct therapeutic approach. In such cases, bedside ultrasound may be very helpful. We present two cases with similar chest X-ray opacifications but different diagnoses established with the help of a bedside lung ultrasound. There is documented accuracy of ultrasound in differentiating pleural effusions from consolidation. Ultrasound is safe and may be an alternative for computed tomography scan in a hemodynamically or respiratory unstable intensive care patient.
The chest X-ray with opacification of a partial or whole lung field in critically ill patients is not uncommon. It may introduce a challenge in the differential diagnosis and may delay treatment of acute pulmonary pathology in acute respiratory failure patients. Usually, further evaluation must be performed, for example with a computed tomography (CT) scan, which can also be used to guide therapeutic interventions. A considerable number of critically ill patients are unstable to such an extent that transport to a CT scanner poses additional risks. Acting on the wrong diagnosis poses another risk. Trying to drain a pleural effusion in the absence of fluid induces the risk of pneumothorax or the risk of loss of positive end-expiratory pressure during and after pulmonary suction which leads to shearing alveolar injury and hypoxemia. An alternative reliable tool in the differential diagnosis of pulmonary pathology may be bedside lung ultrasonography.
Lung ultrasound is a safe and reliable tool in differentiating pulmonal pathology in unstable critical care patients.
Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
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