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Category: Volume 08 Issue 07 July 2020
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Title: Role of Grey Scale and Color Doppler Ultrasound in Diagnosis of Lung Abscess

Authors: Maha M. ElKholy, Hala A. Mohammad, Nasr M. Osman, Bahaa Ibrahim Mohamed, Rasha M. Emam

 DOI: https://dx.doi.org/10.18535/jmscr/v8i7.34

Abstract

The main purpose of this work is to compare the diagnostic accuracy (DA) of chest X ray (CXR), chest computerized tomography (CT)and lung grey scale ultrasonography (US)in evaluation of lung abscess and determine the role of color doppler ultrasound in diagnosis of lung abscess.

Sixteen patients with suspected lung abscess were evaluated by CXR, chest CT, grey scale and colour doppler chest sonography. Chest CT revealed the highest DA (98.5%) with 100% sensitivity, 98.3% specificity, 88.9% PPV and 100% NPV. The specificity, sensitivity, PPV, NPV and DA of chest X ray were 98.3%, 75%, 85.7%, 96.6% and 95.5% respectively. Grey scale US had the least sensitivity (53.3%), specificity was 98.2%, PPV 96.7%, NPV 67.7% and DA 93.1%. CDS showed absent vascularity were observed in 9 lesions (60%), scanty and marked vascularity were equally detected each in 3 lesions (20%) with 66.7% showing THI flow and 33.3% showing MHI flow. The present study revealed that chest CT is considered the most accurate radiological procedure for diagnosis of lung abscess. Although its low sensitivity, grey scale US has a relatively high specificity in diagnosing lung abscess.

Keywords: Lunggrey scale ultrasonography, Lung abscess, Chest X ray, Computed tomography, Color Doppler sonography.

References

  1. Albert RK., Spiro SG., Jett JR. (2009): Infectious diseases. Bacterial pneumonia. In: Clinical respiratory medicine; Rabbat A., Huchon GJ. (eds), 3rd, Mosby, Inc., an affiliate of Elsevier Inc., Philadelphia. Ch 7. PP: 333-350.
  2. Biederer J., Wildberger J., Bolte H., et al., (2008): Protokollempfehlungen für die Computertomographie der Lunge: Konsensus der Arbeitsgemeinschaft Thoraxdiagnostik der DRG. ; 180:471–479.
  3. Bouhemad B., Zhang , Lu Q., Rouby J. (2007): Clinical review: Bedside lung ultrasound in critical care practice. Crit Care; 11(1): 205.
  4. Caiulo VA., Gargani L., Caiulo S., Fisicaro A., Moramarco F., Latini G. (2013): Lung ultrasound characteristics of community-acquired pneumonia in hospitalized children.Pediatr Pulmonol; 48:280–287.
  5. Chen HJ., Yu YH., Tu CY., Chen CH., Hsia TC., Tsai KD., Shih CM., Hsu WH. (2009): Ultrasound in Peripheral Pulmonary Air-Fluid Lesions: Color Doppler Imaging as an Aid in Differentiating Empyema and Abscess. Chest; 135(6):1426-1432.
  6. Civardi G., Fornari F., Cavanna L., Di Stasi M., Sbolli G. et al., (1993): Vascular signals from pleural-based lung lesions studied with pulsed Doppler ultrasonography. J Clin Ultrasound; 21:617–622.
  7. Islam S. and Tonn H. (2009). Thoracic ultrasound overview. In: Bolliger CT, Herth FJF, Mayo PH, Miyazawa T, Beamis JF, eds. Clinical Chest Ultrasound. Sidney: Karger; p. 11-20.
  8. Koenig SJ., Narasimhan M., Mayo PH. (2011): Thoracic Ultrasonography for the Pulmonary Specialist. Chest; 140(5):1332-1341.
  9. Koh DM., Burke S., Davies N., Padley SPG. (2002): Transthoracic US of the Chest: Clinical Uses and Applications. RadioGraphics; 22, e1-.
  10. Kuhajda , Zarogoulidis K., Tsirgogianni K.,Tsavlis D., TsavlisD., Kosmidis C.,Tsakiridis K., Mpakas A.,Zarogoulidis P.,ZissimopoulosA., Baloukas D.,Kuhajda D. (2015): Lung abscess-etiology, diagnostic and treatment options. Ann Transl Med; 3(13):183.
  11. Lange S., Walsh G. (2007): Infection and inflammatory disorders. In: Radiology of chest diseases, 3rd, Grammlich, Plezhausen, Germany.ch 3. PP 64-109.
  12. Lichtenstein DA. and Menu YA. (1995): Bedside Ultrasound Sign Ruling out Pneumothorax in the Critically III: Lung Sliding. Chest; 108:1345-1348.
  13. Mathis G (2007): Subpleural Lung Consolidations (Inflammatory consolidations in the lung). In: Chest sonography, 2nd edition, Springer-Verlag Berlin Heidelberg. Ch 4. PP.50-63.
  14. Moreira Jda S., Camargo Jde J., Felicetti JC., Goldenfun PR., Moreira AL., Porto Nda S. (2006): "Lung abscess: analysis of 252 consecutive cases diagnosed between 1968 and 2004".Jornal brasileiro de pneumologia : publicaça̋o oficial da Sociedade Brasileira de Pneumologia e Tisilogia. 32 (2): 136–43.
  15. Patradoon-Ho P. and Fitzgerald DA. (2007): Lung abscess in children. Paediatr Respir. Rev.; 8:77-84.
  16. Reed A., Shogan P., Folio L. (2010): Radiology corner: Thoracic empyema versus lung abscess. Mil Med; 175(9): 701-702.
  17. Reissig A, Gramegna A and Aliberti S (2012): Review article. The role of lung ultrasound in the diagnosis and follow- up of community-acquired pneumonia. European Journal of Internal Medicine; 23(5):391-397.
  18. Reissig A., Kroegel C. (2007): Sonographic diagnosis and follow-up of pneumonia: a prospective study. Respiration; 74:537-547.
  19. Reynolds JH., McDonald G., Alton H., Gordon SB. (2010): Pneumonia in the immunocompetent patient. Br J Radiol; 83(996):998-1009.
  20. Sartori S. and Tombesi P. (2010): Emerging roles for transthoracic ultrasonography in pulmonary diseases. World J Radiol; 2(6): 203–214.
  21. Seo H., Cha SI., Shin KM., et al., (2013):Focal necrotizing pneumonia is a distinct entity from lung abscess. Respirology ; 18:1095-100.
  22. Sripathi S. and Mahajan A. (2013): Comparative Study Evaluating the Role of Color Doppler Sonography and Computed Tomography in Predicting Chest Wall Invasion by Lung Tumors. Journal of ultrasound in medicine; 32 (9): 1539-1546.
  23. Stark DD., Federle MP., Goodman PC., Podrasky AE., Webb WR. (1983): Differentiating Lung Abscess and Empyema: Radiography and Computed Tomography. AJR; 141:163-167.
  24. Tsai TH, Jerng JS and Yang PC (2008): Clinical Applications of Transthoracic Ultrasound in Chest Medicine. J Med Ultrasound;16(1):7–25.
  25. Wielpütz MO., Heußel CP., Herth FJF., Kauczor HU. (2014): Radiological diagnosis in lung disease. Factoring treatment options into the choice of diagnostic modality. Disch Arztebl Int; 111(11):181-187.
  26. Yang PC (1997): Ultrasound-guided transthoracic biopsy of peripheral lung, pleural, and chest wall lesions. J Thorac Imaging; 12:272-284.
  27. Yang PC., Luh KT., Lee YC., Chang DB., Yu CJ., Wu HD., Lee LN., Kuo SH. (1991): Lung abscesses: US examination and US-guided transthoracic aspiration. Radiology; 180(1):171-5.
  28. Yuan A., Chang DB., Yu CJ., Kuo SM., Luh KT., Yang PC. (1994): Color Doppler sonography of benign and malignant pulmonoray masses. Am J Roentgenol; 163:545–549.

Corresponding Author

Bahaa Ibrahim Mohamed

Department of Chest, Minia University, Egypt