Effectiveness of chest radiography, lung ultrasound and thoracic computed tomography in the diagnosis of congestive heart failure

Core Tip

Core tip: Acute decompensated heart failure (ADHF) is a frequent emergency condition that represents a diagnostic challenge for the emergency physicians. Imaging has a fundamental role in the diagnosis of heart failure, but the efficacy of the diagnostic process is highly dependent from the ability to integrate information drawn from lung ultrasound (LUS), chest radiography and computed tomography (CT). Chest radiography and LUS are the most used diagnostic tools: the first one combining relative low cost with the panoramic view that allows exclusion of many pulmonary conditions that comes into the differential diagnosis; otherwise the second one has higher sensitivity in the diagnosis of the early signs of pulmonary congestion and permit to perform the examination at bedside during the first clinical approach. CT scan is the best method to have a panoramic thoracic view and CT scan is a powerful method but it has many limitations due to costs, availability in emergency situations and relatively high radiation exposure. The modern clinician and radiologist should be aware of the potential and limitations of these diagnostic tools and be prepared to integrate information derived from a correct use of ultrasound, conventional radiology and CT.