Thoracic ultrasound: A complementary diagnostic tool in cardiology

Abstract

Clinical assessment and workup of patients referred to cardiologists may need an extension to chest disease. This requires more in-depth examination of respiratory co-morbidities due to uncertainty or severity of the clinical presentation. The filter and integration of ecg and echocardiographic information, addressing to the clues of right ventricular impairment, pulmonary embolism and pulmonary hypertension, and other less frequent conditions, such as congenital, inherited and systemic disease, usually allow more timely diagnosis and therapeutic choice. The concurrent use of thoracic ultrasound (TUS) is important, because, despite the evidence of the strict links between cardiac and respiratory medicine, heart and chest US imaging approaches are still separated. Actually, available expertise, knowledge, skills and training and equipment’s suitability are not equally fitting for heart or lung examination and not always already accessible in the same room or facility. Echocardiography is useful for study and monitoring of several respiratory conditions and even detection, so that this is nowadays an established functional complementary tool in pulmonary fibrosis and diffuse interstitial disease diagnosis and monitoring. Extending the approach of the cardiologist to lung and pleura will allow the achievement of information on pleural effusion, even minimal, lung consolidation and pneumothorax. Electrocardiography, pulse oximetry and US equipment are the friendly extension of the physical examination, if their use relies on adequate knowledge and training and on appropriate setting of efficient and working machines. Lacking these premises, overshadowing or misleading artefacts may impair the usefulness of TUS as an imaging procedure.

Keywords: Thoracic ultrasound, Echocardiography, Congestive heart failure, Pneumonia, Pleural effusion, Cancer, Pneumothorax, Clinical risk management

Core tip: Thoracic ultrasound (TUS) is an imaging tool, well developed but not uniformly used, which provides information on pleura, lung and heart disease; TUS is a procedure that deserves greater dissemination, since quite neglected by cardiologists, pneumologists and even radiologists in the current practice; small pleural effusions (useful for monitoring congestive heart failure), lung consolidation (particularly relevant in pneumonia) and pneumothorax, even with different reliability, may be detected; adequate training, avoiding overshadowing or misleading artefacts, is needed and must be integrated within curricula.