Accuracy of lung ultrasound in pleuritic chest pain: Preliminary data of a multicentric study

Introduction: Non-cardiac chest pain represents a diagnostic challenge, as it is a common symptom of a broad spectrum of diseases. The present study focuses on infectious diseases, testing the accuracy of lung ultrasound in detecting community acquired pneumonia (CAP) in patients with pleuritic pain. Methods: Consecutive patients admitted to the emergency department or respiratory unit with pleuritic pain underwent lung ultrasound with a standardized protocol and chest X-ray in two projections in the upright position. Final diagnosis was established by an independent committee. Results: 132 patients (70 females, 52%) aged 54±19 yrs, BMI of 23.8 ± 5.1 kg/m2(mean±SD), were enrolled. 131 patients underwent chest X-ray (one patient was pregnant). In all patients lung ultrasound was performed. The duration of the exam was 5±2 minutes. 38 patients (29%) underwent computed tomography for clinical reasons. Final diagnoses were: 62 CAP (47%), 51 chest pain (39%), 7 lung tumors (5%), 5 pleuritis (4%), 3 pneumothorax (2%), 4 miscellaneous (3%). Sensitivity and specificity of chest X-ray in CAP diagnosis were, respectively, 86.5% (IC 95%, 76.9%-92.5%) and 89.5% (IC 95%, 78.9%-95.1%). Sensitivity and specificity of lung ultrasound were 93.5% (IC 95%, 85.7%-97.2%) and 96.4% (IC 95%, 87.7%-99%) respectively. Positive predictive values of RX and lung ultrasound were, respectively, 91.4% (IC 95%, 84.9%-98.0%) and 97.3% (IC 95%, 93.6%-100%); negative predictive values were 83.6% (IC 95%, 74.3%-92.9%) and 91.4% (IC 95%, 84.2%-98.6%). Conclusions: Preliminary data suggest that ultrasound is an accurate diagnostic technique for CAP diagnosis in patients with pleuritic chest pain (clinicaltrial.gov NCT02107001).