Has lung ultrasound an impact on the management of patients with acute dyspnea in the emergency department?

Lung ultrasound (LUS) has emerged as a rapid, immediately available, non-invasive bedside tool for detection of several pulmonary and/or pleural diseases [1,2]. However, no data are available for its impact on patient management in the emergency department. We studied 50 adult patients (25 women, median age 80.5 years, interquartile range 12.3 years) presenting with acute undifferentiated dyspnea to the emergency department of ‘Edoardo Agnelli’ Hospital (Pinerolo, Turin), and evaluated the LUS diagnostic impact by comparing the main diagnosis (cardiac, respiratory, or combined dyspnea), the most likely pathophysiologic dysfunction, and the etiological diagnosis, as indicated by the emergency physician caring for the patient, before and after LUS. Reference diagnosis was established by two expert emergency physicians, blinded to LUS results, who independently reviewed the entire medical record. Moreover, we asked the emergency physician how LUS findings changed patient management. We used a previously described eight-region scanning protocol [3] and assessed five major syndromes (see Figure 1) [1]. Diffuse interstitial syndrome (IS) was the most common finding (58%), followed by pleural effusion (52%), focal IS (18%), alveolar consolidation (14%), and pneumothorax (8%). Twenty-seven patients had two or more LUS pathological findings (for example,