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Evaluation of lung ultrasound for differential diagnosis of pneumonia and heart failure decompensation
Z D Kobalava1
1Peoples Friendship University of Russia (PFUR) - Moscow - Russian Federation
Background: challenges of pneumonia (PN) diagnosis in presence of concomitant chronic heart failure (CHF) can be attributed to difficulties of assessment of symptoms as well as presence of pitfalls in adopted clinical diagnostic algorithms. Purpose: study aimed to evaluate the utility of lung ultrasound (LUS) in differential diagnosis of PN and CHF decompensation. Methods: prospective case-control study enrolled adults with CHF and suspicion for PN. All participants underwent conventional procedures including lab tests and instrumental investigations. Infiltration consistent with PN was confirmed using chest computed tomography (CT) or X-ray in case of unilateral lesions; films were reviewed by 2 radiologists. Each PN case was matched in 1:1 ratio with CHF decompensation control on the basis of age, sex, etiology, course of CHF and comorbidities. LUS was performed using Bedside Lung Ultrasound in Emergency (BLUE) protocol blindly from the result of radiographical findings. Standard statistical tools were applied, p-value <0.05 was considered statistically significant. Results: A total of 60 patients, median age 76 years old, 57% males, were enrolled. Groups were comparable regarding the main characteristics with exception of body temperature (table). LUS patterns of PN were identified in 27/30 (90%) of cases vs 0/30 of controls, patterns of pulmonary congestion were revealed in 14/30 (47%) and 30/30 (100%) patients with PN and CHF decompensation, respectively. Diagnostic performance of LUS in PN verification was as follows: sensitivity of 90%, specificity, positive predictive value and negative predictive value of 100% for each parameter, respectively. Conclusion: BLUE protocol is sensitive and specific method of PN verification in patients with concomitant CHF. Being rapid and noninvasive, it could have significant role in diagnostic workup of pneumonia and CHF worsening particularly in settings with limited CT access.
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