Sonographic diagnosis of pneumonia and bronchopneumonia

Objectives: The usefulness of sonography in the diagnosis of pneumonia and bronchopneumonia is considered. Ultrasound is compared with conventional radiology. Methods: Eighty patients with respiratory failure (40 of whom were HIV positive) were randomly divided into two groups of 40. The first group was X-rayed and subsequently subjected to an ultrasound examination of the chest. The second group was examined, first by ultrasound and subsequently with conventional radiology. Results: The study shows that the infective lung diseases that cause alveolar consolidation present similar, characteristic ultrasound patterns: large hypoechoic lesions or small roundish subpleural hypoechoic lesions with fine echoes inside and occasionally with asonic canalicular formations and hypoechoic linear structures with comet tails (‘liver like’ images). The diagnostic sensitivity of the ultrasound examination is comparable to that of conventional radiology (100% vs. 90%). On the other hand, ultrasound does not detect alterations of interstitial pneumonia, whereas conventional radiology is diagnostically effective. High resolution computed tomography and bronchoscopy must be employed in doubtful cases. Conclusion: Ultrasound is shown to be reliable, safe and easy to carry out, especially in immunocompromised bedridden patients, and it can play a significant role in the diagnosis of pneumonia and bronchopneumonia.