Lung ultrasound (LUS) in pulmonary tuberculosis: correlation with chest CT and X-ray findings

Abstract

Background The aim is to describe lung ultrasound (LUS) ndings in a cohort of patients with suspected pulmonary tuberculosis (PTB) and compare them with computed tomography (CT) and chest x-ray (CXR) ndings in order to evaluate the potentiality of LUS in TB diagnosis.Methods In this prospective study, 82 subjects with suspected TB were enrolled after being evaluated with CXR and chest CT. LUS was performed by blinded radiologists within 3 days after admission. A semiquantitative index was used: score 1 (lesions that extend for about 1 -15% of the affected zone), score 2 (15 -40%) and score 3 (40-100%).Results Microbiological analysis con rmed TB diagnosis in 58/82 (70.7%). CT was positive in all patients, LUS in 79/82 (96,3%) CXR in 78/82 (95,1%) and adding LUS and CXR in 100%. In PTB patients we found a great number of lungs zones with micronodules and with total ndings than non-TPB patients (p<0,05). Overall LUS sensitivity was 80%, greater for micronodules (82%) and nodules (95%), lower for consolidation with air bronchogram (72%) and cavitations (33%). We reported 5 complicated pleural effusion at LUS, only 1 in CT. CXR overall sensitivity was 81%. Adding CXR and LUS ndings we reported a sensitivity of 90%. Conclusion LUS could be considered a valid, non-invasive and cost-effective diagnostic tool especially in world regions where CT were not available, also in addiction with CXR. Trial Registration This study was approved by the Ethics Committee of our University Hospital (rif. CEAVC 14816).

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

“…The radiologist filled out a predefined form where the localization of the cavitations was outlined. Each marker was localized as apical, middle or inferior, anterior or posterior or left and right with the same approach as explained in our previous work [ 11 ]. At CXR, we were not able to evaluate anterior and posterior regions with only AP or PA projections, so we localized CXR without considering anterior and posterior regions.…”

“…The main limitations are represented by ionizing radiation exposure, poor access to high-quality radiologic equipment, limited access in rural areas and prohibitive costs for patients’ diagnosis. Nowadays, lung ultrasound (LUS) is considered a valid tool in the diagnosis of many lung pathologies and is mainly a safe, portable and cost-effective imaging modality [ 9 , 10 , 11 , 12 ]. With LUS, it is possible to identify an interstitial syndrome characterized by a smooth thickening of the interlobular septa (represented as an increase in the B-lines) and areas of partial alveolar fillings, the so-called “white lung” corresponding to the ground glass opacities that can be highlighted in CT [ 9 , 10 ].…”

“…With LUS, it is possible to identify an interstitial syndrome characterized by a smooth thickening of the interlobular septa (represented as an increase in the B-lines) and areas of partial alveolar fillings, the so-called “white lung” corresponding to the ground glass opacities that can be highlighted in CT [ 9 , 10 ]. Moreover, it is possible to detect alveolar consolidations as an area of hepatization with a dynamic air bronchogram or an area of atelectasis or pneumonia in patients with a static air bronchogram [ 8 , 11 ]. We previously described the role of LUS in pulmonary TB in the work “Lung ultrasound (LUS) in pulmonary tuberculosis: correlation with chest Computed Tomography and X-ray findings” [ 11 ].…”

“…Moreover, it is possible to detect alveolar consolidations as an area of hepatization with a dynamic air bronchogram or an area of atelectasis or pneumonia in patients with a static air bronchogram [ 8 , 11 ]. We previously described the role of LUS in pulmonary TB in the work “Lung ultrasound (LUS) in pulmonary tuberculosis: correlation with chest Computed Tomography and X-ray findings” [ 11 ]. We analyzed a population of patients with clinical/radiological/epidemiological suspicion of pulmonary TB who accessed the Emergency Department of our hospital between September 2017 and February 2020.…”

“…Overall, LUS sensitivity in detecting TB was 80%, greater for micronodules (82%) and nodules (95%) and lower for consolidation with an air bronchogram (72%) and cavitations (33%). Among the 82 patients enrolled, 48 presented cavitations at CT (42 TB patients and 6 non-TB patients), with lower identification by chest X-ray and LUS [ 11 ].…”