Value of chest sonography in the diagnosis and management of acute chest disease.
ABSTRACT The aim of this study was to investigate the value of chest sonography in the diagnosis and management of patients with chest radiograph opacities in an emergency department.
Seventy-eight patients with acute chest complaints whose chest radiographs showed opacities underwent chest sonography. The initial diagnosis (based on clinical manifestations and the chest radiograph), the sonographic diagnosis (before any invasive procedures), and the final diagnosis were compared. The impact of chest sonography on the management of patients with chest opacities was also analyzed.
The initial diagnosis was in concordance with the final diagnosis in 60 (77%) of the 78 patients, while the sonographic diagnosis was in concordance with the final diagnosis in 75 (96%) of the patients. Chest sonography therefore significantly increased the rate of correct diagnoses from 77% (95% confidence interval, 67-87%) to 96% (95% confidence interval, 92-100%; p < 0.0001). Sonography provided new information in 52 patients (67%): a different diagnosis from the initial diagnosis in 18 patients and additional diagnostic information in 34 patients. New information gained from sonography affected the management of 35 patients. Sonography also provided help in guiding 42 (70%) of 60 invasive diagnostic procedures and 22 (73%) of 30 invasive therapeutic procedures for which chest radiography and physical examination had failed to or were unsuitable to provide guidance. Overall, sonography assisted in the management of 64 (82%) of 78 patients. Sonography was of no benefit in 14 patients (18%).
We conclude that chest sonography can complement chest radiography and is of value in the diagnosis and management of emergency department patients with acute chest diseases presenting as opacities on chest radiographs.
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ABSTRACT: We report an analysis of computed tomography (CT) of the thorax in 75 patients with combinations of pleural and parenchymal disease or complex pleural shadows. These patients were among more than 300 with pulmonary disease examined by this method. Twenty-eight percent of the 75 scans within this group were classified as high value, contributing information which was not available from other clinical or roentgenographic data, and which directly altered the management, diagnosis, or prognosis of these patients. Forty percent of the scans were classified as of intermediate value, contributing to better understanding of the case but with no major influence on patient management or prognosis. Thirty-two percent of the scans added no additional information to the chest roentgenograms. Thirty-seven percent of the 46 scans done specifically to differentiate pleural from parenchymal disease were classified as of high value, but only 14% of the scans in patients with pleural fluid loculations or pleural masses were placed in this category. We conclude that thoracic CT provided information not otherwise available in one third of the patients with complex combined pleural and parenchymal disease examined in our series.Journal of Computer Assisted Tomography 12/1978; 2(5):601-6. · 1.58 Impact Factor
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ABSTRACT: Real-time ultrasound scanning is a rapid and readily available way of detecting pericardial fluid. We have successfully and safely used real-time ultrasound scanning to plan and guide pericardiocentesis on 24 occasions in the last 2 years, in each case for therapeutic purposes in patients with malignant pericardial effusions. The procedure may be readily performed in the ultrasound department or on the ward. We advise the use of real-time ultrasound guidance in all instances of pericardiocentesis.Clinical Radiology 04/1987; 38(2):119-22. · 1.82 Impact Factor
Article: Thoracentesis in clinical practice.[show abstract] [hide abstract]
ABSTRACT: Thoracentesis is a commonly performed procedure indicated for diagnostic and therapeutic purposes. Removal of pleural fluid should be performed by experienced operators and, when attempted by physicians-in-training, close supervision by credentialed individuals is necessary. Diagnostic thoracentesis is most valuable in separating exudates from transudates. Analysis of the exudative fluid has the highest yield when infection and malignancy is likely. Pneumothorax is the most common major complication and can be minimized by the use of small-gauge needles (no. 21 or no. 22) when a small amount of fluid is removed (35 to 50 ml). Patients who may pose difficulties (e.g., those receiving ventilator support) appear to have no greater morbidity with thoracentesis than those patients not ventilator dependent. Ultrasound may be of value to decrease morbidity when small or loculated volumes of fluid are present. Therapeutic thoracentesis offers relief of symptoms of dyspnea, but caution is particularly needed because large needles and large volumes of fluid removed may increase morbidity.Heart and Lung The Journal of Acute and Critical Care 23(5):376-83. · 1.40 Impact Factor