Clinical Case 063: Ultra-sounds like pneumonia to me

A few months ago I posted on the use of US for diagnosing pneumonia.  Check out that post here.  I have been trying it out since, but haven’t seen a good going fresh pneumonia for a while…..

Since then the guys at Ultrasound podcast have released an awesome lecture by Vicki Noble on the same – it is 30 minutes well spent for anyone who wants to use US and change the way they approach dyspnoea in the ED.

Today we saw a sick kid with “a bit of a cough” who had good going consolidation on US of the chest and on CXR.  So I am putting up the images for you all to see.  It is a simple technique – just put the probe where you would usually put your bell and look for detail of lung, fluid collections, air bronchograms and “hepatisation” behind the white pleura.

It is quick, no radiation, painless, and easy to do at any hour of the day or night.

Sure, there is a learning curve.  Takes time to train the eyes and be confident, however the result is a pretty clear diagnosis to guide therapy and disposition decisions.  I think that in time, one can get good enough to pick pneumonia early and avoid some X-rays.  US compares well with plain films in terms of accuracy – but it leaves the stethoscope for dead – so I think I will use it when I am looking for a source in a sick patient, or when my exam is equivocal in a well looking patient.  Any thoughts on this?

Here is the plain film CXR

Pretty clear cut left lingula consolidation with some bronchograms. 

Here is an US image from the left anterior wall

If you are not familiar with chest US – this is a wildly abnormal image – usually no detail of the lung architecture can be seen below the pleura.

For a great demonstration of this check out the above mentioned US Podcast talk.  Matt and Mike pay me $20 everytime one of you click on their site – hurry and check it out – I think they are offering a prize for their 100th visitor.  Enjoy

Casey

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