Lung ultrasound in internal medicine: A bedside help to increase accuracy in the diagnosis of dyspnea

Published:August 06, 2017DOI:


      • Lung US contributes to the differential diagnosis of dyspnea in Internal Medicine.
      • At the bedside, it provides high sensitivity and specificity.
      • A generalized interstitial syndrome discriminates cardiac from pulmonary dyspnoea.
      • A wider use of this portable technique in the Internal Medicine wards is warranted.



      Dyspnea is one of the most frequent causes of admission in Internal Medicine wards, leading to a sizeable utilization of medical resources.

      Study design and methods

      The role of bedside lung ultrasound (LUS) was evaluated in 130 consecutive patients (age: 81 ± 9 years), in whom blindly collected LUS results were compared with data obtained by clinical examination, medical history, blood analysis, and chest X-ray. Dyspnea etiology was classified as “cardiac” (n = 80), “respiratory” (n = 36) or “mixed” (n = 14), according to the discharge diagnosis (congestive heart failure either alone [n = 80] or associated with pneumonia [n = 14], pneumonia [n = 24], and obstructive disventilatory syndrome [n = 12]). An 8-window LUS protocol was applied to evaluate B-line distribution, “interstitial syndrome” pattern, pleural effusion and images of static or dynamic air bronchogram/focal parenchymal consolidation.


      The presence of a generalized “interstitial syndrome” at the initial LUS evaluation allowed to discriminate “cardiac” from “pulmonary” Dyspnea with high sensitivity (93.75%; confidence intervals: 86.01%–97.94%) and specificity (86.11%; 70.50%–95.33%). Positive and negative predictive values were 93.76% (86.03%–97.94%) and 86.09% (70.47%–95.32%), respectively. Moreover, LUS diagnostic accuracy for the diagnosis of pneumonia was not inferior to that of chest X-ray.


      Bedside LUS evaluation contributes with high sensitivity and specificity to the differential diagnosis of Dyspnea. This holds true not only in the emergency setting, but also in the sub-acute Internal Medicine arena. A wider use of this portable technique in our wards is warranted.


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