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Lung ultrasonographic protocol and findings in patients with acute pulmonary infection presenting to Teaching Hospital Karapitiya

Authors:
  • University of Ruhuna, Faculty of Medicine
Lung ultrasonographic protocol and findings in patients with acute pulmonary infection
presenting to Teaching Hospital Karapitiya
I. Kodikara1, S. Vanderburg2, M. Sellathurai3, C. K. Bodinayake1, A. Nagahawatte1, E.
Riviello4, L. G. Tillekeratne5,6.
1. Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.
2. Hubert-Yeargan Center for Global Health, Duke University School of Medicine, Durham, NC, USA.
3. Teaching Hospital Karapitiya, Galle, Sri Lanka.
4. Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
5. Duke Global Health Institute, Durham, NC, USA.
6. Department of Medicine, Duke University, Durham, NC, USA.
Introduction
Lung ultrasonography (USS) has high sensitivity in detecting lung interstitial abnormalities
and has become a point of care diagnostic tool. The use USS in acute lower respiratory tract
infections (LRTI) is yet to be understood. We aimed to describe an USS protocol and USS
findings in acute lung infections.
Methods
Patients aged >1year, admitted to Teaching Hospital Karapitiya with signs and symptoms of
LRTI were recruited from 2018 November to 2019 June. Patients with LRTI for >14 days,
diagnosis other than LRTI, or unwilling subjects were excluded. USS was performed within
24 hours of admission using curvilinear probe and lung settings. The sonographers were blind
to clinical or investigation findings. Twelve-zone protocol (Blue protocol) was performed:
upper and lower zones of anterior, posterior and lateral aspects of both lungs were examined.
Severity of lung involvement was assessed by lung aeration pattern; a quantitative lung
ultrasound score (LUS) was allocated for each zone, according to the worst ultrasound pattern:
normal aeration=0, moderate loss of aeration =1, severe loss of aeration =2, consolidation=3.
Total LUS was calculated for each lung (ranged from 0-36).
Results
From a total of 50 patients, 28 were females. Mean age was 56 (SD±21) years. LUS ranged
from 0/36 31/36. LUS was 0/36 in 32% of subjects with LRTI. Highest LUS score (31/36)
was reported by a patient with reactivation of pulmonary tuberculosis. LUS score was not
correlated with the age (r=0.22, p=0.12) or the gender (r=0.098, p=0.45) of the subject.
Conclusion
In this preliminary analysis of LRTI patient exhibit a wide range of LUS scores, independent
of gender, age, and LRTI etiology.
Key words: lung ultrasonography, acute lung infection, lung ultrasound score
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