Authors (including presenting author) :
Kwok CT(1), Patrick Tam(1), Tseng CK(1), Cheng YF(1), Yim CW(1), Poon YN(1), Ling SO(1), Thomas Mok(1), Kwan HY(1)
Affiliation :
Department of Respiratory Medicine, Kowloon Hospital
Introduction :
Ultrasonography (USG) is a non-invasive imaging technique that has been widely adopted to aid clinical diagnosis and to guide interventional procedure. However, the waiting time for USG done by radiologist is often very long, especially for elective cases. In the Department of Respiratory Medicine, Kowloon Hospital (KH RMD), availability of portable device allows pulmonologist to perform USG imaging and pulmonary intervention at bed-side in real-time, thus improving diagnostic efficacy and enhancing patient safety.
Objectives :
To review the clinical application of USG in our department and review its diagnostic values.
Methodology :
In KH RMD, all USG performed by pulmonologists at bed-side were kept record. We reviewed those performed from 1st April 2024 to 30th November 2024. The number of diagnostic USG and USG guided intervention performed were assessed. Their indications and clinical outcomes were summarized.
Result & Outcome :
Eighty-seven USG were performed by pulmonologist at bed-side in the reviewed period. Diagnostic imaging were performed in 17(20%) cases; while USG guided intervention were performed in 70(80%) cases. The clinical indications of USG included diagnosis of lung pathologies (9%), assessment of diaphragmatic function (11%), pleural intervention (51%) and pathological diagnosis of lung lesions (29%).
USG allowed accurate diagnosis of lung pathologies with typical features including flapping lung sign for pleural effusion; identification of lung point for pneumothorax; presence of numerous B lines for interstitial syndrome; and absence of Doppler flow and presence of echogenic material in right internal jugular vein in diagnosing superior vena cava obstruction. Measuring diaphragmatic excursion and thickness fraction help early diagnosis of diaphragmatic dysfunction and further work-up as it could signify underlying neuromuscular diseases or other extra-pulmonary pathology.
USG guided pleural intervention allow accurate identification of entry site and thus enhance patient safety. It could be applied to chest tapping, pleural and bone biopsy, and drainage of pneumothorax and pleural effusion. Obtaining specimen for pathological diagnosis of lung lesion or lymph nodes through real-time USG guided percutaneous biopsy allowed fast-track diagnosis of lung cancer and early treatment. No significant procedure related complications have been reported from our cohort.
Pulmonologists should be trained with the relevant skills and encouraged to perform USG at bed-side for patients presenting with various pulmonary conditions. Increasing utilization of bedside USG help ensuring procedural and patient safety and better allocation of resources, as radiologists could focus on difficult and complicated cases.
