Şüpheli Pnömonide Toraks Ultrasonografisi ve Akciğer Radyografisinin Karşılaştırmalı Bulguları

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

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