1048 K.F. Alkhayat, M.H. Alam-Eldeen tine diagnostic process of patients with suspected pneumonia
[2,4]. During the last 20 years, ultrasound has been shown to be highly effective in evaluating a range of pathologic pulmonary conditions [13]. One of the most widely practiced applications is the evaluation of pneumonia with ultrasound. Pointof-care ultrasound imaging, performed at the patient’s bedside, decreases the delays of chest radiography in the diagnosis of pneumonia [1,5].
The objective of this study was to determine the accuracy of chest US in diagnosing CAP compared with chest radiography. Patients and methods
The present study was carried out on 62 patients (28 males and
34 females), their age ranged from 25 to 80 years with
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The anterior chest wall was marked off from the parasternal line to the anterior axillary line. This zone was split into an upper region (from the collar bone to the second–third inter- costal space) and a lower region (from the third intercostal space to the diaphragm). The lateral area (anterior to posterior axillary line) was split into upper and lower halves. Finally, the posterior area was identified from the posterior axillary line to the paravertebral line [5].
The ultrasound transducer is moved until a rib interspace is located. The probe is then panned horizontally and vertically to the extent possible to allow the broadest sweep through the area being imaged [1]. Raising the arm above the patient’s head increases the rib space distance and facilitates scanning.
Before performing the US examination, the patient’s chest radiograph was reviewed to localize the area of interest.
Scanning was performed during quiet respiration, to allow for assessment of normal lung movement, and in suspended respiration, when a lesion can be examined in detail.
The echogenicity of a lesion was compared with that of the liver and characterized as hypoechoic, isoechoic, or hyperechoic [9].
US pattern in consolidated lung
The key to ultrasound visualization of pneumonia in the lungs is relative loss of aeration of a portion of the lung and a concomitant increase in the fluid
Pulmonary Enema can be identified in a PA and lateral chest radiograph, using a horizontal beam which is critical for the projection of air-fluid levels. It appears an increasingly diffuse in radiodensity in the hilar regions, interstitial spaces and the interlobar septa. Clinical indications or signs of the condition (pulmonary edema) include Signs of the condition include a rapid respiratory rate, heaving of the chest and abdomen, intercostal muscle retractions, and cyanosis. To improve the movement of air into and out of the chest, the patient will often sit upright to breathe and resist laying down. (Venes, D, 2005 p. 666 )
CT angiogram of the pulmonary arteries (CTPA) was added to the investigation process of detecting PE, and became one of the important diagnostic tests for PE after the introduction of the new multi detector CT scanner in 1998 (Wiener, R. et al. 2013). CTPA examinations have varies technical and practical aspects, and the operating technologist should be aware of these aspects to optimize the examination. Firstly, the acquisition of the scan has to be taken by using all detectors. This helps to minimize the thickness of the images up to 0.5 mm to show a detailed anatomical structure of the pulmonary arteries. It also helps to reduce the scanning duration of the entire chest to approximate 5 seconds. Secondly, the patient has to be properly instructed. The technologist should inform the patient about the breath holding technique and to not move during the scan. These things can reduce the motion artifacts in the images. The patients also have to be told that an intravenous contrast agent will be injected, which will give the arteries a bright appearance in the images, and they will feel worm during the injection as side effect of the contrast agent. Thirdly, the range of the scan should be from the apex to the costophrenic angle of both lungs, the reason is to ensure a full coverage of the
A chest x-ray is the primary way to diagnose a pneumothorax. Generally two chest x-rays will be taken, one on inspiration and one on expiration. This allows to better visualize the collapsed lung. An additional CT scan may be required. Ultrasound may also be used.
According to the University of Virginia (n.d.) in the radiographic findings seen in patients with pneumonia are airspace opacity, lobar consolidation, or interstitial opacities; pneumonia is a space occupying lesion without volume loss (University of University, n.d.).
Furthermore, after reviewing J.B.’s past medical, surgical, social and family history, medication, allergies, and review the systems, the nurse practitioner student ruled out postnasal drip as the differential diagnosis because J.B. denied having a postnasal drip that might cause coughs. Upon the physical examination, the student ruled out pneumonia because J.B. had clear bilateral lung sounds. The student did not rule out pneumonia before the physical examination is because signs and symptoms alone are not reliable to rule out pneumonia. Long, Long, & Koyfman (2017) states that the diagnosis of pneumonia requires a combination of clinical presentation, medical history, and physical examinations. The physical examinations, including dullness to percussion, wheezes, and crackles are the most reliable findings. Therefore, the final
When observing a radiograph of the chest, specifically at the mediastinal outlines, the trachea should be centered but may be slightly to the right of the mid line. This happens because the trachea passes on the right side of the aorta. If the trachea is not generally centered, it is important to decipher if it because of rotation or pathology. Notice the width of the chest and heart. The heart should not be any larger than half the width of the chest. This is called the cardio-thoracic ratio. While looking at the heart size, observe the location of the heart. Approximately one third of the heart should be towards the right, leaving the other two thirds towards the left of the center. It is critical examine the lungs for any abnormality.
We found that sensitivity, specificity and accuracy of lung US in the diagnosis of thoracic non pulmonary lesions were: pleural effusion (100%, 100%, 100%), pleural masses (83%, 78%, 80%), pneumothorax (80%, 95%, 91.66%), mediastinal lymphadenopathy (75%,
Size of the lung masses of inadequate sample groups (37.7±5.3) were significantly smaller statistically (p value=0.01) compared to the group where sample was adequate (54.69±3.49). This is in agreement with the study by Guimarães et al In this study, lesions with diameters equal to or larger than 40 mm supplied larger amounts of adequate material for analysis than lesions with diameters of less than 40 mm. This study also stated that the superior lobe lesions supplied a proportionally larger amount of adequate material for analysis when compared with other locations. However this finding was not noted in my study. Layfield et al. reported that the location of thoracic lesions affect the sample adequacy of CT guided FNAC of the lung lesions, with peripheral and larger lesions providing more adequate sample. However Yankelevitz et al. & Guimarães et al23 both showed that the distance between the lesion and the pleural surface did not influence the probability of obtaining adequate sample. In my study also, there was no statistically significant difference in obtaining adequate material between the peripheral and deep seated
While the portable chest radiograph still remains a mandatory component in the diagnosis of ventilated patients with suspected pneumonia, as with clinical criteria for diagnosing VAP, it too has problems with both sensitivity and specificity. Poor-quality films further compromise the accuracy of chest X rays.
Chest radiography examination is a most common procedure to be performed in clinical practice. Chest radiography play an important role in diagnosis. A standard x-ray are performed with the patient standing facing a cassette and SID should be at 72 inches. When taking a chest radiographs in PA view, ensure that the patient is standing evenly on both feet and chin raised. Rotate the shoulder forward against the image receptor and exposure should be made at the end of second full inspiration. Centered CR to midsagittal plane at level of T7 below vertebra prominens an collimate on four sides to area of lung fields. Positioning and use of the correct technical factors has a significant influence on the appearance of air, fluid and blood vessel
Chest CT scans can detect earlier disease than can be detected by airflow obstruction seem on spirometry (Friedman, 2008).
The research was focused on finding if the same strategy can be used in treating pneumonia today. The nature of the X-ray induced anti-inflammatory effect which may provide a molecular framework that accounts for the historical clinical efficacy of X-ray treatment of pneumonia Calabrese and Dhawan (2013).
The patient would usually seek consult to his doctor complaining of cough, chest wall pain, fever, fatigue, difficulty of
Throughout the short story "Tell-Tale Heart" by Edgar Allen Poe, the main character is motivated by his insecurities, his comfort, and his mental health, which lead him to murder an elderly man. The character had many insecurities along with a mental disorder which caused him to have hallucinations of the elderly man's “evil” eye. I have diagnosed him with bipolar 1 with psychotic features. I have diagnosed him with this because in the story he says “TRUE! --nervous --very, very dreadfully nervous I had been and am; but why will you say that I am mad? The disease had sharpened my senses --not destroyed --not dulled them. Above all was the sense of hearing acute. I heard all things in the heaven and in the earth. I heard many things in hell.” In this quote, he confesses to hearing things in heaven and in hell and believes it is normal. In the next couple of paragraphs, I’ll be explaining that the main character is not guilty by reason of insanity and hopefully you will agree with me.
Pneumonia is a term used to refer to the inflammation of the air sacs in the lungs. It can affect the right or left lung air sacs and at times both are affected. Pneumonia occurs when one breathes germs into their lungs. The lungs function is to remove carbon dioxide from the bloodstream and deliver oxygen to the blood. Pneumonia starts when fungi, bacteria and viruses are introduced into the lungs when a person inhales. The natural immune system responds to these foreign bodies in the air sacs of the lungs by inflammation. Fluids and pus from the inflammation may collect in the lung and in the usual process of gaseous exchange in the lungs.