What is the role of ultrasonography in the workup of cardiogenic pulmonary edema (CPE)?

Updated: Jul 23, 2020
  • Author: Ali A Sovari, MD, FACP, FACC; Chief Editor: Gyanendra K Sharma, MD, FACC, FASE  more...
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Answer

In cases in which there is a moderate to high pretest probability of acute CPE, ultrasonography can be useful in strengthening a working diagnosis. Findings of B-lines on ultrasonography have been reported to have a sensitivity of 94.1% and a specificity of 92.4% for acute CPE. [6, 7]

Transthoracic lung ultrasonography may also be useful for differentiating between chronic obstructive pulmonary disease and chronic heart failure as causes of exacerbation of chronic dyspnea. [8]

In a prospective study of 134 patients, Sekiguchi et al found that combined cardiac and thoracic critical care ultrasonography (CCUS) assists in early bedside differential diagnosis of CPE, acute respiratory distress syndrome (ARDS), and other causes of acute hypoxemic respiratory failure (AHRF). Analysis of CCUS findings revealed that a low B-line ratio was predictive of miscellaneous cause vs CPE or ARDS. In the further differentiation of CPE from ARDS, moderately or severely decreased left ventricular function, left-sided pleural effusion (> 20 mm), and a large inferior vena cava minimal diameter (> 23 mm) were predictive of CPE. [9]


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