In a paper recently published in Chest, Llamas-Álvarez et al have undertaken a systematic review and meta-analysis of lung ultrasound for the diagnosis of pneumonia in adults. Studies examining patients over the age of 18 with either community acquired or nosocomial pneumonia were included. The reference standard was plain radiography, CT scanning or both.
The authors identified 16 studies involving 2359 patients. Six studies were performed in an ICU setting, 7 in emergency departments, with remainder in wards or a combined ward /ED. The reported sensitivities and specificities of the individual studies ranged from 0.57 - 1.00 and 0.54-0.99 respectively.
The meta-analysis showed a pooled sensitivity of 80-90% and specificity of 70-90%, with an area under the SROC curve of 0.93, leading the authors to conclude that "bedside lung ultrasonography has excellent accuracy for the diagnosis of pneumonia in adults".
Llamas-Alvarez AM, Tenza-Lozano EM, Latour-Perez J. Accuracy of Lung Ultrasonography in the Diagnosis of Pneumonia in Adults: Systematic Review and Meta-Analysis. Chest. 2017 Feb;151(2):374-382.
Another excellent lung ultrasound tutorial. This one focus on image interpretation. There is a preceding talk on image acquisition which can be found here
These two videos by Liz Turner cover both the basic of chest ultrasound and more advanced techniques. The first video covers the detection of pneumothorax and pleural effusions. The second builds on this to cover other pathologies and discusses the BLUE protocol.
In the words of the authors, FAST & RELIABLE is "a comprehensive ultrasound protocol aimed to quickly differentiate between the major causes of hypotension". Some of the components of the protocol may be slightly beyond the skills of a beginner POCUS practitioner. Those skills, e.g.
Sagittal and transverse views of the uterus and adnexae in the suprapubic area , DVT scanning at femoral and popliteal veins, are not unachievable skills.
1. Click here for a pictorial summary of the FAST & RELIABLE protocol.
2. Diagram from the article: the causes of hypotension and how the FAST & RELIABLE protocol is relevant.
This is an entertaining 3 minute rap from The EMC summarising echo findings of right heart strain like what you might see in pulmonary embolism. "Right heart strain pushed the septum to the left to the left!". Enjoy.