title: Clinical application of lung ultrasound in patients with acute dyspnea: differential diagnosis between cardiogenic and pulmonary causes.
abstract: This review discusses the usefulness of bedside lung ultrasound in the diagnostic distinction between the various causes of acute dyspnoea in the emergency department, with special attention to the differential diagnosis of pulmonary oedema and exacerbation of chronic obstructive pulmonary disease (COPD). This is made possible by using mid- to low-end scanners and simple acquisition techniques accessible to both radiologists and clinicians. Major advantages include ready availability at the bedside, the absence of ionising radiation, high reproducibility and cost efficiency. The technique is based on the recognition and analysis of sonographic artefacts rather than direct visualisation of the pulmonary structures. These artefacts are caused by the interaction of water-rich structures and air, called comet tails or B-lines. When such artefacts are widely detected on anterolateral transthoracic lung scans, diffuse alveolar-interstitial syndrome can be diagnosed, which is often a sign of acute pulmonary oedema. This condition rules out exacerbation of COPD as the main cause of acute dyspnoea.
authors.affiliation: Institute of Radiology, S. Luigi Gonzaga University Hospital, Orbassano, Italy. luciano.cardinale@gmail.com
authors.forename: L
authors.initials: L
authors.lastname: Cardinale
authors.forename: G
authors.initials: G
authors.lastname: Volpicelli
authors.forename: F
authors.initials: F
authors.lastname: Binello
authors.forename: G
authors.initials: G
authors.lastname: Garofalo
authors.forename: S M
authors.initials: SM
authors.lastname: Priola
authors.forename: A
authors.initials: A
authors.lastname: Veltri
authors.forename: C
authors.initials: C
authors.lastname: Fava
mesh_terms: D000208:Acute Disease; D016477:Artifacts; D003937:Diagnosis, Differential; D004417:Dyspnea / Q000000981:diagnostic imaging / Q000209:etiology*; D004636:Emergency Service, Hospital; D006333:Heart Failure / Q000150:complications / Q000000981:diagnostic imaging*; D006801:Humans; D019095:Point-of-Care Systems; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000000981:diagnostic imaging*; D011654:Pulmonary Edema / Q000150:complications / Q000000981:diagnostic imaging*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013577:Syndrome; D014463:Ultrasonography
references.citation: Chest. 2008 Jul;134(1):117-25
references.pmid: 18403664
references.citation: J Am Soc Echocardiogr. 2006 Mar;19(3):356-63
references.pmid: 16500505
references.citation: J Ultrasound Med. 2003 Feb;22(2):173-80
references.pmid: 12562122
references.citation: Ultraschall Med. 2001 Feb;22(1):27-31
references.pmid: 11253553
references.citation: Am J Cardiol. 2004 May 15;93(10):1265-70
references.pmid: 15135701
references.citation: Chest. 2006 Aug;130(2):533-8
references.pmid: 16899855
references.citation: Crit Care Med. 2007 May;35(5 Suppl):S250-61
references.pmid: 17446785
references.citation: JAMA. 1995 Jan 25;273(4):313-9
references.pmid: 7815660
references.citation: Radiol Med. 2008 Mar;113(2):190-8
references.pmid: 18386121
references.citation: J Am Coll Cardiol. 1997 Nov 15;30(6):1527-33
references.pmid: 9362412
references.citation: Ann Emerg Med. 2003 Apr;41(4):532-45
references.pmid: 12658254
references.citation: J Gen Intern Med. 1993 Jul;8(7):383-92
references.pmid: 8410400
references.citation: Lancet. 1994 Feb 19;343(8895):440-4
references.pmid: 7905953
references.citation: Am J Emerg Med. 2006 Oct;24(6):689-96
references.pmid: 16984837
references.citation: Crit Care Med. 2005 Jun;33(6):1231-8
references.pmid: 15942336
references.citation: J Am Coll Cardiol. 1998 Oct;32(4):865-75
references.pmid: 9768704
references.citation: Chest. 2007 Apr;131(4):1013-8
references.pmid: 17426204
references.citation: J Am Coll Cardiol. 1995 Dec;26(7):1565-74
references.pmid: 7594087
references.citation: J Am Coll Cardiol. 2002 Jan 16;39(2):202-9
references.pmid: 11788208
references.citation: JAMA. 1989 Feb 10;261(6):884-8
references.pmid: 2913385
references.citation: Crit Care. 2006;10(3):R82
references.pmid: 16723034
references.citation: Eur J Heart Fail. 2008 Jan;10(1):70-7
references.pmid: 18077210
references.citation: BMJ. 1996 Aug 3;313(7052):300-1
references.pmid: 8704562
references.citation: J Gen Intern Med. 1986 Nov-Dec;1(6):386-93
references.pmid: 3794838
references.citation: Am J Respir Crit Care Med. 1997 Nov;156(5):1640-6
references.pmid: 9372688
references.citation: Eur J Heart Fail. 2002 Jan;4(1):91-8
references.pmid: 11812669
references.citation: Cardiovasc Ultrasound. 2008 Apr 29;6:16
references.pmid: 18442425
references.citation: Intensive Care Med. 1998 Dec;24(12):1331-4
references.pmid: 9885889
references.citation: JAMA. 1997 Jun 4;277(21):1712-9
references.pmid: 9169900
references.citation: Emerg Radiol. 2008 May;15(3):145-51
references.pmid: 18236088
references.citation: Intensive Care Med. 1999 Apr;25(4):383-8
references.pmid: 10342512
references.citation: Am J Emerg Med. 2008 Jun;26(5):585-91
references.pmid: 18534289
references.citation: Ann Emerg Med. 2006 Jan;47(1):13-8
references.pmid: 16387212
references.citation: AJR Am J Roentgenol. 1985 May;144(5):879-94
references.pmid: 3872571
references.citation: Chest. 2005 May;127(5):1690-5
references.pmid: 15888847
references.citation: J Am Coll Cardiol. 2001 Feb;37(2):379-85
references.pmid: 11216950
references.citation: Med Sci Monit. 2008 Mar;14(3):CR122-8
references.pmid: 18301355