即时肺部超声诊断耶氏肺囊虫肺炎:来自现场的记录。

IF 3.6 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Critical Ultrasound Journal Pub Date : 2018-04-17 DOI:10.1186/s13089-018-0089-0
Maria Teresa Giordani, Francesca Tamarozzi, Daniel Kaminstein, Enrico Brunetti, Tom Heller
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引用次数: 11

摘要

背景:胸部超声有助于评估急性呼吸困难患者的肺部病理。一些研究已经证明了即时超声对肺外结核和HIV合并感染患者的疗效。这项回顾性、开放标签的病例对照研究探讨了肺部超声在hiv阳性患者诊断肺孢子虫肺炎(PJP)中的作用。特别是,它强调了特定的超声特征的潜在作用,这可能是独特的人口。方法:分析2013年1月1日至2017年6月31日意大利维琴察san Bortolo医院感染性疾病和热带医学科收治的所有hiv阳性、出院诊断为急性肺损伤(ALI)并为临床目的接受即时胸部超声检查的患者记录。根据循证建议对患者进行扫描。结果:273例hiv阳性患者中,81例(29.6%)被诊断为ALI。24例患者有完整的文献记录,其中14例(58.3%)微生物学证实PJP (PJP+), 10例(41.7%)有其他疾病(PJP-)。b线、胸膜下实变和囊性改变在PJP患者中更为常见(14/14比6/10,p = 0.0198;14/14 vs. 4/10, p = 0.0016;8/14 vs. 0/10, p = 0.0019)。特别是,在我们的队列中,所有PJP+患者中都存在b线和胸膜下实变,敏感性为100%,但其特异性较低(分别为45%和60%)。相反,合并囊性改变的实变对PJP的特异性非常高(100%),但敏感性很低(57%)。PJP+患者未见胸膜积液和线状支气管空气征实变。结论:b线、胸膜下实变和囊性改变提示PJP。肺实变伴支气管充气征和胸腔积液应提示怀疑其他病因。这些发现有可能在资源有限的环境中对艾滋病毒阳性患者的日常管理有用,因为其他诊断工具很少可用。
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Point-of-care lung ultrasound for diagnosis of Pneumocystis jirovecii pneumonia: notes from the field.

Background: Thoracic ultrasound is helpful to evaluate lung pathology in patients with acute dyspnea. Several studies have demonstrated the efficacy of point-of-care ultrasound in patients with extrapulmonary TB and HIV co-infection. This retrospective, open-label case-control study explores the role of lung ultrasound in the diagnosis of Pneumocystis jirovecii pneumonia (PJP) in HIV-positive patients. In particular, it highlights the potential role of specific sonographic features that may be unique to this population.

Methods: The record of all HIV-positive patients admitted from 1.1.2013 to 31.6.2017 to the Department of Infectious Diseases and Tropical Medicine of san Bortolo Hospital, Vicenza, Italy, with a discharge diagnosis of acute lung injury (ALI) and who received point-of-care ultrasound of the chest for clinical purposes was included in the analysis. The patients were scanned according with the evidence-based recommendation.

Results: Of 273 HIV-positive patients whose records were reviewed, 81 (29.6%) were diagnosed with ALI. Complete documentation was available for 24 patients, of which 14 (58.3%) had microbiologically confirmed PJP (PJP+) and 10 (41.7%) had other conditions (PJP-). B-lines, subpleural consolidations, and cystic changes were significantly more frequent in patients with PJP (14/14 vs. 6/10, p = 0.0198; 14/14 vs. 4/10, p = 0.0016; 8/14 vs. 0/10, p = 0.0019, respectively). In particular, B-lines and subpleural consolidations were present in all PJP+ patients in our cohort giving a sensitivity of 100%, but their specificity was low (45 and 60%, respectively). On the contrary, the presence of consolidations with cystic changes had a very high specificity for PJP (100%), but low sensitivity (57%). Pleural effusions and consolidations with linear air bronchograms were not observed in PJP+ patients.

Conclusions: B-lines, subpleural consolidations, and cystic changes are suggestive of PJP. Lung consolidation with air bronchograms and pleural effusion should prompt suspicion of other etiologies. These findings have the potential to be useful in the daily management of HIV-positive patients in resource-limited settings where other diagnostic tools are rarely available.

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Critical Ultrasound Journal
Critical Ultrasound Journal RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING-
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