Şüpheli Pnömonide Toraks Ultrasonografisi ve Akciğer Radyografisinin Karşılaştırmalı Bulguları

Yıl 2025, Cilt: 7 Sayı: 3, 102 - 106, 13.01.2026

Mehmet Sinan Bodur , Barış Çil , Yasemin Bodur Fatma Tokgöz Akyıl , Tülin Sevim

Öz

Amaç: Pnömoni belirtileri gösteren erişkinlerde torasik ultrasonografi (TUS) ve standart göğüs radyografisi (GRT) arasındaki modaliteler arası uyumu ölçmek.
Yöntem ve Gereç: Gözlemsel kesitsel tanı uyumu çalışmasında, acil/ayaktan pulmonoloji servislerinde değerlendirilen 63 ardışık erişkine posteroanterior (PA) ± lateral GRT ve TUS uygulandı. Görüntüleme bulguları (konsolidasyon, hava bronkogramı, plevral efüzyon, atelektazi, kitle, diyafram anomalisi) önceden tanımlandı. Modaliteler arası uyum Cohen’in κ katsayısı ile değerlendirildi; gözlenen uyum yüzdesi (Po) de raporlandı.
Bulgular: 63 katılımcının %52,3’ü (n=33) klinik olarak pnömoni tanısı aldı. Bu alt grupta, CXR ve TUS karşılaştırması %81,8’e karşı %63,6 oranında konsolidasyon, %12,1’e karşı %45,5 oranında hava bronkogramı ve %33,3’e karşı %42,4 oranında plevral efüzyon tespit etti. Plevral efüzyon (κ=0,755, p<0,001) ve konsolidasyon (κ=0,711, p<0,001) için uyum önemli, hava bronkogramı için orta (κ=0,480, p<0,001) ve atelektazi için hafif (κ=0,141, p=0,29) düzeydeydi.
Sonuç: TUS, plevral efüzyon ve plevral temas konsolidasyonu için yatak başında CXR’yi tamamlayarak, naklin zor olduğu veya yeniden değerlendirmenin sık olduğu durumlarda daha hızlı ve daha düşük radyasyonlu bakım sağlar. Bununla birlikte, plevraya temas etmeyen merkezi yerleşimli konsolidasyonlar TUS ile saptanamayabilir; bu nedenle negatif TUS sonucu merkezi pnömoniyi dışlamaz. Pulmonologlar için kısa ve standart bir eğitim, daha geniş ve daha tekrarlanabilir kullanımı destekleyebilir.

Anahtar Kelimeler

torasik ultrasonografi , göğüs radyografisi , pnömoni , tanısal uyum , hasta başı ultrason , pulmonolog eğitimi

Comparative Findings of Thoracic Ultrasonography and Chest Radiography in Suspected Pneumonia

Öz

Objective: To quantify the inter-modality agreement between thoracic ultrasonography (TUS) and standard chest radiography (CXR) in adults presenting with symptoms suggestive of pneumonia.
Material and Method: In an observational cross-sectional diagnostic agreement study, 63 consecutive adults evaluated in emergency/outpatient pulmonology settings underwent posteroanterior (PA) ± lateral CXR and TUS. Imaging findings (consolidation, air bronchogram, pleural effusion, atelectasis, mass, diaphragmatic abnormality) were defined a priori. Inter-modality agreement was assessed with Cohen’s κ; observed percent agreement (Po) was also reported.
Results: Of 63 participants, 52.3% (n=33) carried a clinical working diagnosis of pneumonia. In that subgroup, CXR vs TUS detected consolidation in 81.8% vs 63.6%, air bronchogram in 12.1% vs 45.5%, and pleural effusion in 33.3% vs 42.4%. Agreement was substantial for pleural effusion (κ=0.755, p<0.001) and consolidation (κ=0.711, p<0.001), moderate for air bronchogram (κ=0.480, p<0.001), and slight for atelectasis (κ=0.141, p=0.29).
Conclusion: TUS complements CXR at the bedside for pleural effusion and pleural-contact consolidation, enabling faster, lower-radiation care when transport is difficult or reassessment is frequent. However, centrally located consolidations without pleural contact may not be visualized by TUS, and therefore a negative TUS does not reliably exclude non-pleural pneumonia.
Brief, standardized training for pulmonologists may support wider and more reproducible use.

Anahtar Kelimeler

thoracic ultrasonography , chest radiography , pneumonia , diagnostic agreement , point-of-care ultrasound , pulmonologist training

Kaynakça

• Martin-Loeches I, Torres A, Nagavci B, Aliberti S, Antonelli M, Bassetti M, et al. ERS/ESICM/ESCMID/ALAT guidelines for the management of severe community-acquired pneumonia. Intensive Care Med. 2023;49(6):615-32. doi:10.1007/s00134-023-07033-8
• Jones BE, Ramirez JA, Oren E, Soni NJ, Sullivan LR, Restrepo MI, et al. Diagnosis and Management of Community-acquired Pneumonia. An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med. Published online July 18, 2025:rccm.202507-1692ST. doi:10.1164/rccm.202507-1692ST
• Reissig A, Copetti R. Lung Ultrasound in Community-Acquired Pneumonia and in Interstitial Lung Diseases. Respiration. 2014;87(3):179-189. doi:10.1159/000357449
• Soni NJ, Franco R, Velez MI, Schnobrich D, Dancel R, Restrepo MI, Mayo PH. Ultrasound in the diagnosis and management of pleural effusions. J Hosp Med. 2015;10(12):811-6. doi:10.1002/jhm.2434
• Mongodi S, Via G, Girard M, et al. Lung Ultrasound for Early Diagnosis of Ventilator-Associated Pneumonia. Chest. 2016;149(4):969-80. doi:10.1016/j.chest.2015.12.012
• Meli M, Spicuzza L, Comella M, Spina ML, Trobia GL, Parisi GF, et al. The Role of Ultrasound in the Diagnosis of Pulmonary Infection Caused by Intracellular, Fungal Pathogens and Mycobacteria: A Systematic Review. Diagnostics. 2023;13(9):1612. doi:10.3390/diagnostics13091612
• Hoppmann RA, Mladenovic J, Melniker L, Badea R, Blaivas M, Montorfano M, et al. International consensus conference recommendations on ultrasound education for undergraduate medical students. Ultrasound J. 2022;14(1):31. doi:10.1186/s13089-022-00279-1
• Zieleskiewicz L, Papinko M, Lopez A, Baldovini A, Fiocchi D, Meresse Z, et al. Lung Ultrasound Findings in the Postanesthesia Care Unit Are Associated With Outcome After Major Surgery: A Prospective Observational Study in a High-Risk Cohort. Anesth Analg. 2021;132(1):172-81. doi:10.1213/ANE.0000000000004755
• Abdalla W, Elgendy M, Abdelaziz A, Ammar M. Lung ultrasound versus chest radiography for the diagnosis of pneumothorax in critically ill patients: A prospective, single-blind study. Saudi J Anaesth. 2016;10(3):265. doi:10.4103/1658-354X.174906
• Schmidt S, Behnke N, Dieks JK. Chest X-rays and Lung Ultrasound Are Not Interchangeable in Intensive Care Practice. Diagnostics. 2023;14(1):82. doi:10.3390/diagnostics14010082
• Boccatonda A, Cocco G, D’Ardes D, Delli Pizzi A, Vidili G, De Molo C, et al. Infectious Pneumonia and Lung Ultrasound: A Review. J Clin Med. 2023;12(4):1402. doi:10.3390/jcm12041402
• Roberts ME, Rahman NM, Maskell NA, Bibby AC, Blyth KG, Corcoran JP, et al. British Thoracic Society Guideline for pleural disease. Thorax. 2023;78(11):1143-56. doi:10.1136/thorax-2023-220304
• Tárnoki DL, Karlinger K, Ridge CA, Kiss FJ, Györke T, Grabczak EM, Tárnoki AD. Lung imaging methods: indications, strengths and limitations. Breathe. 2024;20(3):230127. doi:10.1183/20734735.0127-2023
• Desai D, Shah A, Dela J, Mugibel TA, Sumaily KM, Sabi EM et al. Lung Ultrasonography Accuracy for Diagnosis of Adult Pneumonia: Systematic Review and Meta-Analysis. Adv Respir Med. 2024;92(3):241-53. doi:10.3390/arm92030024
• Garin N, Marti C, Scheffler M, Stirnemann J, Prendki V. Computed tomography scan contribution to the diagnosis of community-acquired pneumonia. Curr Opin Pulm Med. 2019;25(3):242-8. doi:10.1097/MCP.0000000000000567
• Hew M, Tay TR. The efficacy of bedside chest ultrasound: from accuracy to outcomes. Eur Respir Rev. 2016;25(141):230-46. doi:10.1183/16000617.0047-2016
• Marini TJ, Rubens DJ, Zhao YT, Weis J, O’Connor TP, Novak WH, Kaproth-Joslin KA. Lung Ultrasound: The Essentials. Radiol Cardiothorac Imaging. 2021;3(2):e200564. doi:10.1148/ryct.2021200564