Chest Imaging in the Diagnosis and Management of Pulmonary Tuberculosis: The Complementary Role of Thoraci Ultrasound

Abstract

Tuberculosis (TB) is a severe infectious disease that still represents a major cause of mortality and morbidity worldwide. For these reasons, clinicians and radiologists should use all the available diagnostic tools in the assessment of the disease in order to provide precise indications about starting an anti-tubercular treatment and reduce risk of TB transmission and complications especially in developing countries where the disease is still endemic. As TB mycobacteria are mainly transmitted through respiratory droplets, the pulmonary parenchyma is usually the first site of infection. As a result, chest imaging plays a central role in the diagnostic process. Thoracic ultrasound (TUS) is a portable, non-invasive, radiation-free, and cost-contained technology which could be easily available in resource-limited settings. This perspective article focuses on the potential role of TUS in the diagnosis and management of patients with pulmonary TB. Unfortunately, there are still insufficient evidence and too contrasting data to judge TUS as an appropriate diagnostic method for the screening of the disease. Despite this, TUS may have a useful role in identifying pleural and anterior pericardial effusions or in the identification of abscesses of the anterior chest wall and paraspinal collections in low- and middle-income settings. In addition, TUS seems to have a milestone role in guiding minimally invasive interventional procedures, such as placement of chest tubes, drainage of loculated collections, thoracentesis and pericardiocentesis, and percutaneous biopsy of subpleural pulmonary consolidations or pleural plaques.

Parenchymal Cavitations in Pulmonary Tuberculosis: Comparison between Lung Ultrasound, Chest X-ray and Computed Tomography

“…On the other hand, our work underlines some advantages of LUS that are widely useful for radiologists and clinicians: it is widely available, is safer and cheaper compared with CT and can be easily performed in every hospital and health facility, in low- to middle-income countries as well [ 31 , 32 ]. Moreover, LUS does not require any patient transport because it is a bedside exam, nor does it require the presence of expensive CT scanners or dedicated technicians [ 33 , 34 , 35 ]. An interesting emerging field of study could be the introduction of new Artificial Intelligence (A.I.)…”

Value of ultrasonography in determining the nature of pleural effusion: Analysis of 582 cases

“…In 1992, Yang et al first used high-frequency, real-time sonography to determine the nature of pleural effusion. [13] Previously, most reported studies were performed using contact B-scans. [14][15][16] Yang et al analyzed sonographic images of 320 patients with pleural effusion.…”

Utility and Limits of Lung Ultrasound in Childhood Pulmonary Tuberculosis: Lessons from a Case Series and Literature Review

“…After comparing the limits and advantages of the method, they concluded that the use of LUS could have had a good rationale in circumstances that include avoiding exposure to ionizing radiation such as patients who need frequent follow-ups and in countries with limited resources. In fact, according to the authors there were still insufficient evidences to judge the diagnostic accuracy of LUS for a screening purpose in TB [ 25 ].…”

“…In adults, subpleural nodule and lung consolidation were the lung ultrasound findings with the highest sensitivities, ranging from 72.5% to 100.0% and 46.7% to 80.4%, respectively. Only the study by Heuvelings et al [ 24 , 25 ] provided detailed data on LUS findings in pediatric PTB (consolidations were the most common parenchymal alteration in children and LUS sensitivity was 45.6% in their detection). The authors concluded that there was no consensus on the optimal protocols for acquiring and analyzing LUS images for PTB.…”

“…Data on the use of LUS for the diagnosis and follow-up of childhood PTB are limited and in some respects contradictory [ 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ]. Precisely because in some contexts such as in poor countries—which are also the countries in which childhood pulmonary tuberculosis is most widespread—LUS is the only tool that can be used, it is important to study its role in supporting the clinical diagnosis of childhood PTB.…”