An 88‐year‐old man with a medical history of atrial fibrillation presented with dyspnea for 1 week. He endorsed bilateral leg edema, orthopnea, and productive cough of pinkish sputum. He denied fevers, chest pain, and palpitations and had no recent travel history, prolonged period of immobility, or reported history of congestive heart failure. He was started on levofloxacin by his PMD 2 days prior and had no symptomatic improvement. Vital signs revealed no fever, mild tachypnea, and an oxygen saturation of 92% on room air. On physical exam, he had bibasilar pulmonary rales and 1+ bilateral lower‐extremity edema. Chest x‐ray (CXR) showed a right lower opacity consistent with pneumonia, and the patient was started on intravenous antibiotics by the emergency department and admitted to medicine. Careful examination of the patient by the medical team raised concern for possible congestive heart failure. A bedside ultrasound (US) of the lungs and heart was performed that revealed severe left ventricular systolic dysfunction, moderate bilateral pleural effusions, and a right lower lobe alveolar consolidation pattern, clinically consistent with compressive atelectasis. Antibiotics were discontinued, a CT scan of the chest ordered by the ER was cancelled, and diuresis with furosemide was initiated. The patient was treated for acute systolic heart failure and discharged a few days later.
The physical examination is a fundamental and necessary skill important for the hospitalist in order to make an accurate and timely diagnosis. Radiologic imaging is a modality that hospitalists often defer to specialists; however, this does not need to be the case. Bedside ultrasonography is an established tool currently implemented in the emergency department and intensive care units throughout the country. Multiple studies have demonstrated utility, efficacy, and feasibility in the use of bedside lung US. Lung US is easy to learn, shown to be superior to CXR and as good as CT scan regarding fluid status. This case demonstrates that a rapid diagnosis can be obtained and treatment initiated without the delay incurred via the more traditional imaging route.
Recently there has been a paradigm shift, in that bedside US is being performed by the treating physician. Image acquisition and interpretation are immediate, and there is no time dissociation between ordering a radiologic exam, its performance, and interpretation. The bedside US may be regarded as an extension of the physical exam that is gaining more popularity in the 21st century. Essentially, it is an upgraded higher‐frequency stethoscope that allows the hospitalist to take a deeper look into the patient. In the era of “Obamacare” and accountable care organizations, lung US presents an opportunity to equip the hospitalist with a new tool that is superior to traditional CXR, with the potential to improve patient care and reduce medical costs.
To cite this abstract:Chaudhry A, Loukas E. Bedside Lung Ultrasound: The Hospitalist's New Best Friend. Abstract published at Hospital Medicine 2013, May 16-19, National Harbor, Md. Abstract 290. https://www.shmabstracts.com/abstract/bedside-lung-ultrasound-the-hospitalists-new-best-friend/. Accessed February 16, 2019.