Don’t Forget Diagnostic Ultrasound
In my opinion, diagnostic evaluation using thoracic sonography should not be forgotten in the diagnosis of pulmonary and thoracic disorders; this modality is of confirmed relevance not only in diagnosing pleural effusion.
Transcutaneous thoracic ultrasonography is more diagnostically conclusive in detecting pleural effusion than the methods listed in the article. Septations can also be more easily identified than on a computed tomography scan of the thorax. As far as the legal situation is concerned, it needs to be borne in mind that a thoracic overview radiograph taken solely for the purposes of detecting a pleural effusion can be classed as a physical assault.
In peripheral pulmonary and pleural disorders extending to the thoracic wall sonography also offers advantages compared with methods that expose patients to radiation or are expensive. Large studies have shown the value of sonography in the diagnostic evaluation and assessment of the course of pneumonia and peripheral pulmonary embolism (1).
Sonographically guided biopsy of lesions extending to the thoracic wall is a diagnostically safe method that is low in complications, and effective. Signal amplification ultrasound is gaining importance in the detection of vital tumor areas for a diagnostically more conclusive biopsy.
Intensive care medicine and emergency medicine without ultrasound diagnosis have become inconceivable. Indications for further diagnostic approaches can be defined with greater certainty on this basis (2).
The German Federal Association of Pneumologists recommends in children primarily the use of thoracic ultrasound, and radiography only in case of doubt.
I cannot go into the role of endoscopic ultrasound here. I wish to mention, however, that by using ultrasound in the diagnostic evaluation of pulmonary embolism, the heart and the femoral veins can be assessed at the same time (3).
Dr. med. Jörg-Carsten Kämmer
Thoracic sonography task force of the German Society for Ultrasound in Medicine (DEGUM)
Klinik für Innere Medizin, St. Hedwig-Krankenhaus, Berlin
|1.||Reißig A, Görg C, Mathis G: Transthoracic sonography in the diagnosis of pulmonary diseases: a systematic approach. Ultraschall Med 2009; 30: 438–54; quiz 455–6. CrossRef MEDLINE|
|2.||Volpicelli G, et al.: International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med 2012; 38: 577–91. CrossRef MEDLINE|
|3.||Mathis G: Sonographie bei Lungenembolie: drei Fliegen auf einen Streich [Ultrasound in pulmonary embolism: killing three birds with one stone]. Pneumologie 2006; 60: 600–6. CrossRef MEDLINE|
|4.||Wielpütz, MO, Heußel CP, Herth FJF, Kauczor H: Radiological diagnosis in lung disease: Factoring treatment options into the choice of diagnostic modality. Dtsch Arztebl Int 2014; 111: 181–7. VOLLTEXT|