Point-of-care lung ultrasound for the assessment of pneumonia: a narrative review in the COVID-19 era.

In the coronavirus disease-2019 (COVID-19) era, point-of-care lung ultrasound (LUS) has attracted increased attention. Prospective studies on LUS for the assessment of pneumonia in adult patients were extensively carried out for more than 10 years before this era. None of these prospective studies attempted to differentiate bacterial and viral pneumonia in adult patients using LUS. The majority of studies considered the LUS examination to be positive if sonographic consolidations or multiple B-lines were observed. Significant differences existed in the accuracy of these studies. Some studies revealed that LUS showed superior sensitivity to chest X-ray. These results indicate that point-of-care LUS has the potential to be an initial imaging modality for the diagnosis of pneumonia. The LUS diagnosis of ventilator-associated pneumonia in intensive care units is more challenging in comparison with the diagnosis of community-acquired pneumonia in emergency departments due to the limited access to the mechanically ventilated patients and the high prevalence of atelectasis. However, several studies have demonstrated that the combination of LUS findings with other clinical markers improved the diagnostic accuracy. In the COVID-19 era, many case reports and small observational studies on COVID-19 pneumonia have been published in a short period. Multiple B-lines were the most common and consistent finding in COVID-19 pneumonia. Serial LUS showed the deterioration of the disease. The knowledge and ideas on the application of LUS in the management of pneumonia that are expected to accumulate in the COVID-19 era may provide us with clues regarding more appropriate management.

Validity of sonographic screening for the detection of abdominal cancers.

PURPOSE: This study assessed the prevalence of abdominal cancers and the validity of sonographic screening for abdominal cancers in an asymptomatic population. METHODS: We investigated the findings of the first sonographic screening of 16,024 residents of Osaka Prefecture. A comparison of records was carried out between the list of those screened and the Osaka Cancer Registry to identify false-negative results of our screening. RESULTS: The rate of subjects who required further testing after screening was 4.76% (762/16,024). Eleven of the 762 subjects with a positive sonographic screening study had abdominal cancers detected on further testing. Three subjects had false-negative screening results. The positive predictive value of sonographic screening was 1.4% (11/762), and the rate of screening-detected cancers was 0.069% (11/16,024). The prevalence of abdominal cancers was 0.087% (14/16,024), the sensitivity of screening sonography for the detection of abdominal cancers was 78.6% (11/14), and the specificity was 95.3% (15,259/16,010). Seven of 11 screening-detected cancers were resected curatively, and 6 of these patients are still alive. Five of these 6 cancers were renal cell carcinomas. CONCLUSIONS: The sensitivity of screening sonography was relatively high and the specificity was sufficient among our asymptomatic population. The present study suggests that the target organ for sonographic screening to detect curable cancers should be the kidneys.