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Evaluation of bedside lung ultrasonography in the diagnosis of alveolar-interstitial syndrome and pleural effusion in the ICU


The purpose of this study was to determine the efficacy of ultrasonography (US) in the detection of alveolar-interstitial syndrome and pleural effusion in critically ill patients, compared with the results of the gold standard computed tomography (CT).


Twenty-seven consecutive critically ill patients were enrolled in this study (age = 65 ± 17 years, male/female = 10/17, APACHE II score = 18.3 ± 6.2 and Lung Injury Score = 1.0 ± 0.7). Lung US was performed before or after CT within an interval of 20 hours by two independent physicians blinded to the results of the CT. Ultrasound scanning of the anterior and the lateral chest was obtained on the right and left hemithorax, from the second to the fourth–fifth intercostal space from parasternal to midaxillary line. The results of the US scanning in each intercostal space were grouped into the respective lobe (superior, mid and inferior for the right lung, and superior and inferior for the left lung) and were compared with the findings of the CT in each lobe respectively. Alveolar-interstitial syndrome was defined as the presence of more than two comet-tail artifacts perpendicular to the pleural line, and the pleural effusion was detected as a hypoechoic space above the diaphragm.


The diagnostic sensitivity and specificity of US for the alveolar-interstitial syndrome were 94.1% and 60% for the right superior lobe, 93.7% and 100% for the right mid lobe, 76.5% and 90% for the right inferior lobe, 93.3% and 72.7% for the left superior lobe, and 88.2% and 90% for the left inferior lobe, respectively. Finally the sensitivity and the specificity of US for pleural effusion were 94.7% and 100% for the right and 86.6% and 91.7% for the left pleural effusion, respectively.


The preliminary data of this study suggest that US may provide essential information about the respiratory condition of the critically ill patient. The fact that lung US is an imaging tool that can be easily performed at the bedside, that is free of radiation exposure and that is less costly makes it an attractive and promising alternative to CT.

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Stefanidis, K., Vitzilaios, K., Tripodakis, E. et al. Evaluation of bedside lung ultrasonography in the diagnosis of alveolar-interstitial syndrome and pleural effusion in the ICU. Crit Care 12 (Suppl 2), P86 (2008).

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