Resident Journal Review: Bedside Ultrasound for the Diagnosis of Pneumonia

Authors: Ted Segarra, MD; Taylor Conrad, MD; Rithvik Balakrishnan, MD; Taylor M. Douglas, MD
Editors: Kami Hu, MD FAAEM and Kelly Maurelus, MD FAAEM
Originally published: Common Sense March/April 2019

Respiratory distress is a common presentation in both the pediatric and adult emergency department (ED). Community acquired pneumonia (CAP) is a common cause for this distress, and carries the potential for high morbidity and mortality if inadequately treated. In a fast-moving and potentially resource-limited ED, however, it can sometimes be difficult to decide which patients require further imaging to differentiate CAP from the myriad of other potential etiologies for respiratory distress such as bronchiolitis, asthma, chronic obstructive pulmonary disease (COPD), heart failure, and pulmonary embolism. Although both the British Thoracic Society (BTS) and Infectious Disease Society of America (IDSA) state that bacterial CAP is a clinical diagnosis based on persistent fever, retractions, and tachypnea, they agree that radiographic imaging should be obtained in any patient requiring hospital admission or with significant clinical uncertainty.[1,2] Unfortunately, even if the ED provider decides to pursue chest X-ray (CXR) imaging, he or she may still miss the diagnosis, as CXR has been shown in several studies to have a notable false negative rate (FNR) and high inter-observer variability in the diagnosis of CAP.[3,4,5,6] The limitations and inherent radiation exposure of CXR, in combination with the increasing availability of and familiarity with bedside lung ultrasound (LUS) imaging, have prompted many ED physicians to begin looking to LUS as a potential alternative in the evaluation of patients with suspected CAP.

1. What is the level of sensitivity and specificity of LUS compared to traditional CXR and clinical findings in the diagnosis of CAP?
2. Do other aspects of bedside LUS (i.e. lack of ionizing radiation, speed of assessment, easy repeatability, ability to monitor progression of disease, cost) make LUS a more feasible alternative in resource-limited environments?

Literature Update in Pneumonia

Image Credit: Flickr

Authors: David Bostick, MD MPH; Phil Magidson, MD MPH; Carina Sorenson, MD; Neil Christopher, MD; Kami M. Hu, MD; David Wacker, MD PhD
Editors: Michael C. Bond, MD FAAEM; Jay Khadpe, MD FAAEM
Originally Published: Common Sense March/April 2015

Patients with community-acquired pneumonia (CAP) are frequently seen in the emergency department (ED). According to the National Hospital Ambulatory Medical Care Survey (NHAMCS), pneumonia is the third most common principal ED discharge diagnosis in the United States.[1] In this literature update, we examine: use of point-of-care ultrasound to diagnose pneumonia, obtaining routine blood cultures, risk factors for multi-drug resistant organisms and the efficacy of antibiotic monotherapy versus combination therapy in moderately severe pneumonia.