Ultra-Sensitive Ultrasound

Abstract

Lung ultrasound (LUS) is a dynamic, real-time, non-invasive bedside tool that offers increased sensitivity over standard imaging modalities in identifying pulmonary edema. This case highlights acute post-operative hypoxia secondary to pulmonary edema that was initially missed by chest radiography (CXR) and chest computed tomography (CT). The edema was diagnosed first on same day by bedside LUS, later seen on next day follow-up CXR and resolved with diuresis. LUS has demonstrated superior accuracy compared to CXR, but scant evidence compares it to CT. This case presentation serves to increase awareness of LUS as a highly sensitive and easy-to-use diagnostic tool for hospital providers in the evaluation of acute hypoxia.

Keywords: diagnostic accuracy; lung ultrasound; point-of-care-ultrasound; pulmonary edema.

Figure 1. Initial Chest Radiography (CXR), with no evidence of pulmonary edema

Figure 2. Lung Ultrasound, with multiple comet tails (also known as B-lines)

One vertical comet tail (B-line) is indicated by the three white arrows.

Figure 3. One Day Later, Repeat Chest Radiography (CXR)

Black arrows identify bilateral pleural effusions.  CXR also notable for diffuse vascular congestion with pulmonary edema.