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Lung ultrasound will soon be a 'new visual stethoscope' for distinction between pulmonary edema and COPD exacerbation, a group of physicians has asserted. "Lung ultrasound will soon be a "new visual stethoscope" for distinction between pulmonary edema and COPD exacerbation, a group of radiologists and emergency physicians has asserted.

The group reviewed the use of bedside ultrasound for the differentiation of the causes of dyspnea in the emergency room.

First put forward for medical use over 50 years ago, B-mode sonography is not traditionally used in the diagnosis of pulmonary conditions as the lung is considered "poorly accessible".

However, this application is based on sonographic artefacts rather than the conventional visualisation of structures. The artefacts, known as B lines, are described as "laser-like vertical beams" alined with respiratory movements, the researchers said.

They explained: "When such artifacts are widely detected on anterolateral transthoracic lung scans, we diagnose diffuse alveolar-interstitial syndrome, which is often a sign of acute pulmonary edema" – ruling out COPD exacerbation as the main cause of dyspnea.

While studies have shown that the lung ultrasound 'B+ pattern' is highly sensitive and specific in the identification of alveolar-interstitial syndrome, the authors did caution that additional consideration of the precise diagnostic criteria is needed.

However, they added: "Lung ultrasound has the advantage of being nonionizing, immediately implemented, highly feasible, and time saving.

"We think it will spread very soon as a new visual stethoscope in the daily practice of radiologists, emergency physicians, intensivists, cardiologists, and pulmonologists."


Usefulness of lung ultrasound in the bedside distinction between pulmonary edema and exacerbation of COPD
Emerg Radiol 2008;15:145-151"