LUNGULTRALJUD SOM METOD FÖR ATT UTVÄRDERA PLEURAVÄTSKA OCH INTERSTITIELL VÄTSKA

Abstract

Lungultrasonography as a method to evaluate pleural effusion and interstitial fluid Introduction The traditional way to visualize pleural effusion and interstitial fluid is x-ray of the lungs. Later the Computed Tomography (CT) has been a valuable modality in radiology to obtain higher resolution and better diagnostic possibilities. Ultrasonography has been in medical use since mid 50’s and it has many benefits compared to CT-scans when performed by trained clinicians; less expensive, no ionizing radiation, less time consuming and shown to have both sensitivity and specificity between 90-100 %. Aim This pilot study aims to evaluate how well a novice ultrasonography operator can detect pleural effusion and interstitial fluid compared with x-ray or compared to a senior specialist highly trained in ultrasonography. Method 60 patients seeking emergency care at Mölndals hospital was examined with lung ultrasonography. Ten sections of the thorax were examined and the findings were recorded in a protocol. Four second sequences from each section was recorded in the ultrasound machine to facilitate later examination by senior specialist. Four patients had x-ray and the remaining 56 patients were evaluated by a senior specialist using a separate protocol. Results From this data sensitivity and specificity was calculated. The sensitivity found in this study for pleural effusion was 40 % and for interstitial fluid 75 %. Specificity was in both aspects 100 %. Conclusions The sensitivity was significantly lower than previous studies has shown. When critically assessing the causes to the result, the following stands out as potential explanations. More strict inclusion criteria and increased study population would contribute to increase the number of patients with pathology . It would be beneficial to have more frequent feedback and bedside training by senior specialist to lessen the number of sequences with non-assessable quality and a higher competence level. Furthermore shortened over all study time would most likely increase consistency and quality of examinations.