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domingo, 1 de mayo de 2016

Pneumonia US Diagnostic Strategy

BroomeDocs - Posted on MARCH 30, 2016 
"In June I will be travelling to the Emerald Isle to attend and learn at the SMACC Conference in Dublin. One of my jobs whilst I am there is to help out on the SMACC Mini workshop – I will be talking about using lung US to diagnose paediatric pneumonia. Clearly, I am a self-confessed sonophile. I think that we can get a lot of information in quick time by using the bedside scanner to interrogate the lungs. BUT, there is always a BUT… what we do with this information is most important. Lung ultrasound is really very simple, technically easy and there are not many subtle anatomical findings to keep you guessing...
Dr Rory Spiegel posted a great critique of the recent evidence around lung US for pneumonia at EMNerd this week. “A Case of Shadows II” His post has prompted me to respond by explaining how I think we should use this tool in the light of our current evidence...
If you have done any lung scanning you will know that there exists a spectrum of findings -ranging from hard to soft. So where on this spectrum can we “call it”?
  • Hepatisation with dynamic air bronchograms
  • Hepatisation with static air bronchograms
  • Large subpleural consolidations
  • Sub centimetre sub pleural consolidations
  • Unilateral B-lines
  • Unilateral effusion
The diagnostic characteristics of these signs are not all equivalent – as you go down the 
spectrum they become less specific [and more sensitive]. This does not make them useless – just less potent as far as diagnosis goes..."