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Lung ultrasound in the diagnosis of stroke-associated pneumonia

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Abstract

Pneumonia is a common complication in stroke patients; it is associated with an adverse outcome, prolonged hospital stay and increased health costs. The aim of this study was to assess the ability of lung ultrasound to rule in or rule out pneumonia in patients with stroke. Patients with ischemic or hemorrhagic stroke were included in the study if they had a clinical suspicion of pneumonia. Lung ultrasound imaging and chest X-ray studies were performed within 24 h from the onset of symptoms of pneumonia; the sonographer and radiologists were unaware of the chest X-ray study and ultrasound imaging results, respectively. In case of discordant results, lung computed tomography (CT) was performed if a definitive diagnosis was required to optimize clinical management. Seventy patients were included in the study. Among 24 patients with unilaterally positive chest X-ray studies, the ultrasound imaging was unilaterally positive in 19 cases (79.2 %), bilaterally positive in 3 cases (12.5 %) and negative in 2 cases (8.3 %). Among 44 patients with negative chest X-ray studies, ultrasound imaging was unilaterally positive in 17 cases (38.6 %), bilaterally positive in 2 cases (4.6 %), negative in 19 cases (43.2 %) and non-conclusive in 6 cases (13.6 %). A lung CT scan was performed in 9 of the 21 discordant cases, and it always confirmed the ultrasound imaging results. Ultrasound imaging and chest X-ray studies were concordant in 42 out of 63 cases, 66.7 % (Pearson χ2 = 11.97, p = 0.001). In conclusions, this study shows the utility of LUS imaging to rule in or rule out pneumonia in patients with stroke. We believe that lung ultrasound imaging can help clinicians in the diagnosis of stroke-associated pneumonia.

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References

  1. Finlayson O, Kapral M, Hall R, Asllani E, Selchen D, Saposnik G (2011) Risk factors, inpatient care, and outcomes of pneumonia after ischemic stroke. Neurology 77:1338–1345

    Article  CAS  PubMed  Google Scholar 

  2. Davenport RJ, Dennis MS, Wellwood I, Warlow CP (1996) Complications after acute stroke. Stroke 27:415–420

    Article  CAS  PubMed  Google Scholar 

  3. Saposnik G, Hill MD, O’Donnell M, Fang J, Hachinski V, Kapral MK (2008) Variables associated with 7-day, 30-day, and 1-year fatality after ischemic stroke. Stroke 39:2318–2324

    Article  PubMed  Google Scholar 

  4. Westendorp WF, Nederkoorn PJ, Vermeij JD, Dijkgraaf MG, van de Beek D (2011) Post-stroke infection: a systematic review and meta-analysis. BMC Neurol 20:11–110

    Google Scholar 

  5. Alberti A, Agnelli G, Caso V, Venti M, Acciarresi M, D’Amore C, Paciaroni M (2011) Non-neurological complications of acute stroke: frequency and influence on clinical outcome. Int Emerg Med 6(Suppl 1):119–123

    Article  Google Scholar 

  6. Hilker R, Poetter C, Findeisen N, Sobesky J, Jacobs A, Neveling M et al (2003) Nosocomial pneumonia after acute stroke: implications for neurological intensive care medicine. Stroke 34:975–981

    Article  PubMed  Google Scholar 

  7. Chamorro A, Horcajada JP, Obach V, Vargas M, Revilla M, Torres F et al (2005) The early systemic prophylaxis of infection after stroke study : a randomized clinical trial. Stroke 36:1495–1500

    Article  CAS  PubMed  Google Scholar 

  8. Adams HP Jr, Adams RJ, Brott T, del Zoppo GJ, Furlan A, Goldstein LB, for the Stroke Council of the Am Stroke Association et al (2003) Guidelines for the early management of patients with ischemic stroke: a scientific statement from the Stroke Council of the Am Stroke Association. Stroke 34:1056–1083

    Article  PubMed  Google Scholar 

  9. The European Stroke Organisation (ESO], Executive Committee and the ESO Writing Committee (2008) Guidelines for management of ischaemic stroke and transient ischaemic attack. Cerebrovasc Dis 25:457–507

    Google Scholar 

  10. American Thoracic Society; Infectious Diseases Society of America (2005) Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 15(171):388–416

    Google Scholar 

  11. Wunderink RG, Woldenberg LS, Zeiss J, Day CM, Ciemins J, Lacher DA (1992) The radiologic diagnosis of autopsy-proven ventilator-associated pneumonia. Chest 101:458–463

    Article  CAS  PubMed  Google Scholar 

  12. Esayag Y, Nikitin I, Bar-Ziv J, Cytter R, Hadas-Halpern I, Zalut T et al (2010) Diagnostic value of chest radiographs in bedridden patients suspected of having pneumonia. Am J Med 12:88.e1–e5

    Google Scholar 

  13. Albaum MN, Hill LC, Murphy M, Li YH, Fuhrman CR, Britton CA et al (1996) Interobserver reliability of the chest radiograph in community-acquired pneumonia: PORT Investigators. Chest 110:343–350

    Article  CAS  PubMed  Google Scholar 

  14. Mayo JR, Aldrich J, Muller NL, Fleischner Society (2003) Radiation exposure at chest CT: a statement of the Fleischner Society. Radiology 22:15–21

    Article  Google Scholar 

  15. Mathis G (1997) Thoraxsonography—part II: peripheral pulmonary consolidations. Ultrasound Med Biol 23:1141–1153

    Article  CAS  PubMed  Google Scholar 

  16. ****Mathis G (2008) Subpleural Lung Consolidations. In: Mathis G. Chest sonography. II edition. Berlin Heidelberg, Germany: Springer-Verlag 50-62

  17. Reissig A, Kroegel C (2007) Sonographic diagnosis and follow-up of pneumonia: a prospective study. Respiration 74:537–547

    Article  PubMed  Google Scholar 

  18. Bouhemad B, Zhang M, Lu Q, Rouby JJ (2007) Clinical review: bedside lung ultrasound in critical care practice. Crit Care 11:205

    Article  PubMed  Google Scholar 

  19. Licthenstein D, Lascols N, Meziere G, Gepner A (2004) Ultrasound diagnosis of alveolar consolidation in critically ill. Intensive Care Med 30:276–281

    Article  Google Scholar 

  20. Lyden P, Brott T, Tilley B et al (1994) Improved reliability of the NIH Stroke Scale using video training. Stroke 25:2220–2226

    Article  CAS  PubMed  Google Scholar 

  21. Paciaroni M, Silvestrelli G, Caso V, Corea F, Venti M, Milia P et al (2003) Neurovascular territories involved in different etiological subtype of ischemic stroke in the Perugia Stroke Registry. Eur J Neurol 10:361–365

    Article  CAS  PubMed  Google Scholar 

  22. Centers for Disease Control and Prevention (1997) Guidelines for prevention of nosocomial pneumonia. MMWR Recommend Rep 46(RR-1):1–79

    Google Scholar 

  23. Soldati G, Testa A, Silva FR, Carbone L, Portale G, Silveri NG (2006) Chest ultrasonography in lung contusion. Chest 130(533):538

    Google Scholar 

  24. Lichtenstein DA, Meziere GA (2008) Relevance of lung ultrasound in the diagnosis of acute respiratory failure. The BLUE protocol. Chest 134:117–125

    Google Scholar 

  25. Lichtenstein DA, Meziere GA, Biderman P, Gepner A, Barre O (1997) The comet-tail artifact. An ultrasound sign of alveolar–interstitial syndrome. Am J Respir Crit Care Med 156:1640–1646

    Article  CAS  PubMed  Google Scholar 

  26. Volpicelli G, Mussa A, Garofalo G, Cardinale L, Casoli G, Perotto F et al (2006) Bedside lung ultrasound in the assessment of alveolar interstitial syndrome. Am J Em Med 24:689–696

    Article  Google Scholar 

  27. Soldati G, Copetti R, Sher S (2009) Sonographic interstitial syndrome: the sound of lung water. J Ultrasound Med 28:163–174

    PubMed  Google Scholar 

  28. Gutierrez M, Salaffi F, Carotti M, Tardella M, Pineda C, Bertolazzi C et al (2011) Utility of a simplified ultrasound assessment to assess interstitial pulmonary fibrosis in connective tissue disorders—preliminary results. Arthritis Res Ther 13:R134

    Google Scholar 

  29. Mathis G (1997) Thoraxsonography—Part I: chest wall and pleura. Ultrasound Med Biol 23:1131–1139

    Article  CAS  PubMed  Google Scholar 

  30. Cortellaro F, Colombo S, Coen D, Duca PG (2010) Lung ultrasound is an accurate diagnostic tool for the diagnosis of pneumonia in the emergency department. Emerg Med J

  31. Parlamento S, Copetti R, Di Bartolomeo S (2009) Evaluation of lung ultrasound for the diagnosis of pneumonia in the ED. Am J Emerg Med 27:379–384

    Google Scholar 

  32. Zanobetti M, Poggioni C, Pini R (2011) Can chest ultrasonography replace standard chest radiography for evaluation of acute dyspnea in the ED? Chest 139:1140–1147

    Article  PubMed  Google Scholar 

  33. International Liaison Committee on Lung Ultrasound (ILC-LUS) for the International Consensus Conference on Lung Ultrasound (ICC-LUS) (2012) International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med 38:577–591

    Article  Google Scholar 

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Conflict of interest

Maurizio Paciaroni received honoraria as a member of the speaker bureau of Sanofi-Aventis. Giancarlo Agnelli received honoraria as a member of the speaker bureau of Astra Zeneca and Bayer.

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Authors and Affiliations

  1. Stroke Unit, Division of Internal and Cardiovascular Medicine, Santa Maria della Misericordia Hospital, University of Perugia, Sant’Andrea delle Fratte, 06100, Perugia, Italy

    Chiara Busti, Giancarlo Agnelli, Maura Marcucci & Maurizio Paciaroni

  2. Department of Radiology, Santa Maria della Misericordia Hospital, University of Perugia, Sant’Andrea delle Fratte, 06100, Perugia, Italy

    Michele Duranti & Cristina Orlandi

Authors
  1. Chiara Busti
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  2. Giancarlo Agnelli
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  3. Michele Duranti
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  4. Cristina Orlandi
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  5. Maura Marcucci
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  6. Maurizio Paciaroni
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Correspondence to Chiara Busti.

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Busti, C., Agnelli, G., Duranti, M. et al. Lung ultrasound in the diagnosis of stroke-associated pneumonia. Intern Emerg Med 9, 173–178 (2014). https://doi.org/10.1007/s11739-012-0832-7

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  • DOI: https://doi.org/10.1007/s11739-012-0832-7

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