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Guideline
. 2020 Aug 16;10(8):597.
doi: 10.3390/diagnostics10080597.

Recommendations for Lung Ultrasound in Internal Medicine

Natalia Buda  1 , Wojciech Kosiak  2 , Marcin Wełnicki  3 , Agnieszka Skoczylas  4 , Robert Olszewski  5   6 , Jakub Piotrkowski  7 , Szymon Skoczyński  8 , Elżbieta Radzikowska  9 , Ewa Jassem  10 , Elżbieta Magdalena Grabczak  11 , Piotr Kwaśniewicz  12 , Gebhard Mathis  13 , Tudor P Toma  14
Affiliations
Guideline

Recommendations for Lung Ultrasound in Internal Medicine

Natalia Buda et al. Diagnostics (Basel). .

Abstract

A growing amount of evidence prompts us to update the first version of recommendations for lung ultrasound in internal medicine (POLLUS-IM) that was published in 2018. The recommendations were established in several stages, consisting of: literature review, assessment of literature data quality (with the application of QUADAS, QUADAS-2 and GRADE criteria) and expert evaluation carried out consistently with the modified Delphi method (three rounds of on-line discussions, followed by a secret ballot by the panel of experts after each completed discussion). Publications to be analyzed were selected from the following databases: Pubmed, Medline, OVID, and Embase. New reports published as of October 2019 were added to the existing POLLUS-IM database used for the original publication of 2018. Altogether, 528 publications were systematically reviewed, including 253 new reports published between September 2017 and October 2019. The new recommendations concern the following conditions and issues: pneumonia, heart failure, monitoring dialyzed patients' hydration status, assessment of pleural effusion, pulmonary embolism and diaphragm function assessment. POLLUS-IM 2020 recommendations were established primarily for clinicians who utilize lung ultrasound in their everyday clinical work.

Keywords: chest ultrasound; internal medicine; lung ultrasound; recommendations.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flow diagram.
Figure 2
Figure 2
Lung ultrasound technique for internal medicine patients: Lung ultrasound examination in patients with internal diseases is performed with the convex and linear probe, in the supine and/or sitting position: (a) Scanning the anterior chest wall in the supine position; (b) Scanning the anterior chest wall while seated; (c) Assessment of the peaks through the supraclavicular fossa; (d) Assessment of the posterior chest wall in a sitting position; (e) Assessment of the posterolateral thoracic wall in a sitting position.
Figure 3
Figure 3
Normal pleural line (red arrow) and A-line artefacts (white arrows).
Figure 4
Figure 4
B-line artefacts (white arrows).
Figure 5
Figure 5
So called “white lung”, a significant number of B-lines which cannot be visualized separately (area between white arrows).
Figure 6
Figure 6
Pleural effusion: (a) a small amount of anechoic fluid (white arrow); (b) a massive amount of anechoic fluid (white arrow) and atelectasis (red arrow); (c) a massive amount of fluid (white arrow) and hyperechoic inclusions (red arrow) suggesting pleural empyema.
Figure 7
Figure 7
Subpleural consolidation (between red arrow).
See this image and copyright information in PMC

References

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