Thoracic ultrasound: An adjunctive and valuable imaging tool in emergency, resource-limited settings and for a sustainable monitoring of patients

Abstract

Imaging workup of patients referred for elective assessment of chest disease requires an articulated approach: Imaging is asked for achieving timely diagnosis. The concurrent or subsequent use of thoracic ultrasound (TUS) with conventional (chest X-rays-) and more advanced imaging procedures (computed tomography and magnetic resonance imaging) implies advantages, limitations and actual problems. Indeed, despite TUS may provide useful imaging of pleura, lung and heart disease, emergency scenarios are currently the most warranted field of application of TUS: Pleural effusion, pneumothorax, lung consolidation. This stems from its role in limited resources subsets; actually, ultrasound is an excellent risk reducing tool, which acts by: (1) increasing diagnostic certainty; (2) shortening time to definitive therapy; and (3) decreasing problems from blind procedures that carry an inherent level of complications. In addition, paediatric and newborn disease are particularly suitable for TUS investigation, aimed at the detection of congenital or acquired chest disease avoiding, limiting or postponing radiological exposure. TUS improves the effectiveness of elective medical practice, in resource-limited settings, in small point of care facilities and particularly in poorer countries. Quality and information provided by the procedure are increased avoiding whenever possible artefacts that can prevent or mislead the achievement of the correct diagnosis. Reliable monitoring of patients is possible, taking into consideration that appropriate expertise, knowledge, skills, training, and even adequate equipment’s suitability are not always and everywhere affordable or accessible. TUS is complementary imaging procedure for the radiologist and an excellent basic diagnostic tool suitable to be shared with pneumologists, cardiologists and emergency physicians.

Keywords: Thoracic ultrasound, Pneumonia, Pleural effusion, Pneumothorax, Clinical risk management, Overdiagnosis, Wastebasket diagnosis

Core tip: Thoracic ultrasound (TUS), with some technical limitations, may provide useful imaging of pleura, lung and heart disease. The field of application of TUS are pleural effusion, pneumothorax, and lung consolidation. Paediatric and newborn disease are suitable for TUS investigation aimed at the detection of congenital or acquired chest disease avoiding or limiting radiological exposure. TUS improves the effectiveness of medical practice in resource-limited settings, in small point-of-care facilities, in hostile environment and in poorer countries. Monitoring of patients is possible, depending on disease and context, not asking to the procedure more than it can give.