CASE REPORT
Assessment of the applicability of transthoracic lung ultrasound for diagnosing purulent lobar pneumonia: A case study
Jolanta Grabala 1  
,   Michał Grabala 2  
,   Dariusz Onichimowski 3, 4,   Paweł Grabala 5, 6  
 
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1
Department of Anesthesiology and Intensive Care, Regional Specialist Hospital in Bialystok, Poland
2
MSWiA Specialized Hospital, Department of General Surgery and Oncology, Bialystok, Poland
3
Department of Anaesthesiology and Intensive Care, Regional Specialist Hospital in Olsztyn, Poland
4
Department of Anaesthesiology and Intensive Care, Faculty of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, Poland
5
Department of Pediatric Orthopaedics and Traumatology, Faculty of Medicine, Medical University of Bialystok, Poland
6
Department of Neurosurgery, Polish Mothers’ Memorial Hospital-Research Institute, Lodz, Poland
CORRESPONDING AUTHOR
Paweł Grabala   

Medical University of Bialystok, The Faculty of Medicine, Department of Pediatric Orthopaedics and Traumatology, Waszyngtona 17, 15-274 Bialystok, Poland. Tel.: +48 787 11 11 00, Fax: +48 85 745 08 95.
Submission date: 2018-11-22
Final revision date: 2020-04-21
Acceptance date: 2020-04-21
Online publication date: 2020-10-30
 
Pol. Ann. Med. 2020;27(2):174–177
 
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Purulent lobar pneumonia is an inflammation of pulmonary tissue that may progress to parenchymal necrosis and abscess formation. The authors present a case of purulent lobar pneumonia diagnosed using transthoracic lung ultrasound (TLU). Abscess-type lesions had not been visualized in previous computed tomography (CT) scans.

Aim:
To analyze the potential of TLU as a diagnostic tool for purulent lobar pneumonia.

Case study:
A 55-year-old patient with a several-week history of cough, abdominal pain, and diarrhea was admitted to the intensive care unit due to rapidly progressing cardiopulmonary failure. CT revealed merging parenchymal/interstitial densities within the right lung. Broad-spectrum antibiotics were initiated. TLU revealed the presence of lesions characteristic of pneumonia with the development of abscesses and acute respiratory distress syndrome. Despite treatment initiation, the patient’s condition progressively worsened. On the 3rd day of hospitalization, the patient passed away. At autopsy, purulent lobar pneumonia was identified as the direct cause of death.

Results and discussion:
Despite broad and well-documented knowledge regarding its applicability, ultrasound has not been widely used as a diagnostic tool.

Conclusions:
TLU is a safe, repeatable, and inexpensive diagnostic tool. The use of ultrasound in diagnosing pneumonia is well documented, and based on specific diagnostic criteria. As a diagnostic tool for pneumonia, dynamic air bronchogram had a high specificity and positive predictive value. The high sensitivity and specificity of TLU, as pertains to detecting necrosis or abscesses in the course of pneumonia, is comparable with CT. TLU facilitated visualization of small-diameter abscesses.

CONFLICT OF INTEREST
No conflict of interest.
FUNDING
This work was financed by own funds of all authors.
 
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