Pleural effusions identified by thoracic ultrasound predict poor quality of life in patients with acute decompensated heart failure.

INTRODUCTION: Pleural effusion (PE) is a common manifestation of acute decompensated heart failure (ADHF); however, its influence on the quality of life (QoL) is unknown. OBJECTIVES: To identify whether PE detected using thoracic ultrasound (TUS) is associated with poorer QoL in patients with ADHF and a reduced ejection fraction (≤40 %). METHODS: We conducted a prospective, longitudinal, descriptive, observational, single-center study at a university hospital in Mexico. We included participants with a reduced left ventricular ejection fraction who were admitted for ADHF. We performed TUS and the Minnesota Living with Heart Failure Questionnaire (MLHFQ) within the first 48 h of hospitalization. RESULTS: Forty patients with ADHF (30 males and 10 females; mean age, 51.24 ± 16.942 years) were included in this study. The participants were categorized into two groups: those with (n = 25, 62.5 %) or without (n = 15, 37.5 %) PE on TUS. We found a statistically significant association between the presence of PEs and a worse perception of QoL. The mean MLHFQ score in the group of patients with PEs was 40 points, compared to 12 points in the group without PEs (p < 0.001). Poorer QoL was associated with a higher quantity of pleural fluid, as evidenced by the greater number of intercostal spaces occupied by the PE (p < 0.001). CONCLUSIONS: Patients with ADHF and a reduced ejection fraction who present with PE have a worse perception of QoL than patients without PE.

Thoracic Ultrasound Utility in Pulmonary Pathologies Following Blunt Chest Trauma: A Cross-Sectional Study From Barcelona, Venezuela.

Background The thoracic ultrasound (TUS) is a monitoring tool that has gained worldwide popularity in various scenarios, offering the opportunity for dynamic, bedside evaluations. Recent studies indicate that the use of TUS enables the diagnosis of pathologies resulting from blunt chest trauma (BCT), yielding favorable outcomes. This study aimed to compare the utility of TUS versus chest radiography (CXR) in diagnosing pulmonary pathologies resulting from closed-chest traumas. Methodology A prospective cross-sectional study was conducted with a sample of 58 patients diagnosed with BCT who sought emergency care at the "Dr. Luis Razetti" University Hospital in Barcelona, Venezuela, from November 2023 to January 2024. Results Of the patients, 75.9% (n = 44) were male, with an average age of 37.8 years (standard deviation = 18.4 years). Injuries were reported in 8.6% (n = 5) of the patients, including 60% (n = 3) pneumothorax and 40% (n = 2) hemothorax. Ultrasound results coincided with CXR in 94.8% (n = 55) of the cases, with a Cohen's kappa coefficient of 0.9 (95% confidence interval (CI) = 0.642-1.0). TUS demonstrated higher sensitivity than CXR (100% vs. 60%) for detecting hemothorax and pneumothorax in patients with BCT, with an area under the receiver operating characteristic curve of 0.991 (95% CI = 0.968-1.013). Conclusions BCT predominantly occurred in young males, resulting primarily in pneumothorax and hemothorax lesions, detectable with higher sensitivity through TUS compared to CXR. The use of TUS should be considered an essential component of the initial assessment for individuals with BCT.

Oral meloxicam given as an ancillary treatment at respiratory disease diagnosis was not associated with growth, clinical scores, or ultrasound scores in preweaned dairy calves.

Objective: To assess the efficacy of a single dose of oral meloxicam as an ancillary therapy to an antibiotic given at the time of respiratory disease identification on average daily gain (ADG), behavioral attitude, clinical respiratory, and lung ultrasound scores in preweaned dairy calves. Animals: 215 male and female Holstein, Jersey, and crossbred preweaned calves enrolled between 1 and 14 days of age at study enrollment on a single commercial dairy in the western US. Methods: The study took place from March 4, 2021, to November 21, 2021. In this double-blind placebo-controlled study, calves were given an antibiotic (1.1 mL of tulathromycin/kg, SC, once) and either a placebo (1 mg of lactose monohydrate/kg, in a gelatin capsule) or oral meloxicam (1 mg/kg) at the time of respiratory disease identification. Behavioral attitude, clinical respiratory, and lung ultrasound scores and ADG were assessed in preweaned dairy calves at different time points including the next health examination, 1 week later, or at weaning. Results: There was no association between treatment (placebo vs meloxicam) on ADG or respiratory disease status at weaning (P > .05). There was no effect of treatment on behavioral attitude, clinical respiratory, or lung ultrasound scores at the next health examination or 1 week later (P > .05). Clinical Relevance: The present study did not provide evidence that oral meloxicam given once is beneficial for growth, behavioral attitude, or clinical or lung ultrasound scores.

Pleural Effusions Identified by Point-of-Care Ultrasound Predict Poor Outcomes in Decompensated Cirrhosis.

Chronic liver disease (CLD) may be associated with pleural effusions (PEs). This article prospectively evaluates whether detection of PEs on thoracic ultrasound (TUS) at the bedside independently predicts mortality and length of stay (LOS) in hospitalized patients with a decompensated CLD. A total of 116 consecutive inpatients with decompensated cirrhosis underwent antero-posterior chest radiographs (CXR) and TUS to detect PEs. Their median age was 54 y (interquartile range, 47-62), 90 (70.6%) were male, and 61 (52.6%) fell into the Child-Pugh class C categorization. TUS identified PEs in 58 (50%) patients, half of which were small enough to preclude thoracentesis. CXR failed to recognize approximately 40% of PEs seen on TUS. The identification of PEs by TUS was associated with a longer LOS (10 vs. 5.5 d, p < 0.001) and double mortality (39.7% vs. 20.7%, p = 0.021). In multivariate analysis, PEs were independently related to poor survival (hazard ratio 2.08, 95% confidence interval [CI] 1.02-4.25; p = 0.044). Patients with both Child-Pugh C stage and PEs had the lowest survival rate (70 vs. 317 d, p = 0.001). In conclusion, PEs identified by TUS in hospitalized patients with decompensated CLD independently predict a poor outcome and portend a longer LOS.

Damage control in penetrating cardiac trauma.

Definitive management of hemodynamically stable patients with penetrating cardiac injuries remains controversial between those who propose aggressive invasive care versus those who opt for a less invasive or non-operative approach. This controversy even extends to cases of hemodynamically unstable patients in which damage control surgery is thought to be useful and effective. The aim of this article is to delineate our experience in the surgical management of penetrating cardiac injuries via the creation of a clear and practical algorithm that includes basic principles of damage control surgery. We recommend that all patients with precordial penetrating injuries undergo trans-thoracic ultrasound screening as an integral component of their initial evaluation. In those patients who arrive hemodynamically stable but have a positive ultrasound, a pericardial window with lavage and drainage should follow. We want to emphasize the importance of the pericardial lavage and drainage in the surgical management algorithm of these patients. Before this concept, all positive pericardial windows ended up in an open chest exploration. With the coming of the pericardial lavage and drainage procedure, the reported literature and our experience have shown that 25% of positive pericardial windows do not benefit and/or require further invasive procedures. However, in hemodynamically unstable patients, damage control surgery may still be required to control ongoing bleeding. For this purpose, we propose a surgical management algorithm that includes all of these essential clinical aspects in the care of these patients.

El manejo definitivo de los pacientes hemodinámicamente estables con heridas cardíacas penetrantes continúa siendo controversial con abordajes invasivos versus manejos conservadores. Estas posiciones contrarias se extienden hasta aquellos casos de pacientes hemodinámicamente inestables donde se ha descrito y considerado la cirugía de control de daños como un procedimiento útil y efectivo. El objetivo de este artículo es presentar la experiencia en el manejo quirúrgico de heridas cardíacas penetrantes con la creación de un algoritmo práctico que incluye los principios básicos del control de daños. Se recomienda que a todos los pacientes con heridas precordiales penetrantes se les debe realizar un ultrasonido torácico como componente integral de la evaluación inicial. Aquellos que presenten un ultrasonido torácico positivo y se encuentren hemodinámicamente estables se les debe realizar una ventana pericárdica con posterior lavado. Se ha demostrado que el 25% de las ventanas pericárdicas positivas no se benefician ni requieren de posteriores abordajes quirúrgicos invasivos. Antes de este concepto, todos los pacientes con ventana pericárdica positiva terminaban en una exploración abierta del tórax y del pericárdico.Los pacientes hemodinámicamente inestables requieren de una cirugía de control de daños para un adecuado y oportuno control del sangrado. Con este propósito, se propone un algoritmo de manejo quirúrgico que incluye todos estos aspectos esenciales en el abordaje de este grupo de pacientes.

Damage control in penetrating cardiac trauma / El control de daños en el trauma cardíaco penetrante

Abstract Definitive management of hemodynamically stable patients with penetrating cardiac injuries remains controversial between those who propose aggressive invasive care versus those who opt for a less invasive or non-operative approach. This controversy even extends to cases of hemodynamically unstable patients in which damage control surgery is thought to be useful and effective. The aim of this article is to delineate our experience in the surgical management of penetrating cardiac injuries via the creation of a clear and practical algorithm that includes basic principles of damage control surgery. We recommend that all patients with precordial penetrating injuries undergo trans-thoracic ultrasound screening as an integral component of their initial evaluation. In those patients who arrive hemodynamically stable but have a positive ultrasound, a pericardial window with lavage and drainage should follow. We want to emphasize the importance of the pericardial lavage and drainage in the surgical management algorithm of these patients. Before this concept, all positive pericardial windows ended up in an open chest exploration. With the coming of the pericardial lavage and drainage procedure, the reported literature and our experience have shown that 25% of positive pericardial windows do not benefit and/or require further invasive procedures. However, in hemodynamically unstable patients, damage control surgery may still be required to control ongoing bleeding. For this purpose, we propose a surgical management algorithm that includes all of these essential clinical aspects in the care of these patients.

Resumen El manejo definitivo de los pacientes hemodinámicamente estables con heridas cardíacas penetrantes continúa siendo controversial con abordajes invasivos versus manejos conservadores. Estas posiciones contrarias se extienden hasta aquellos casos de pacientes hemodinámicamente inestables donde se ha descrito y considerado la cirugía de control de daños como un procedimiento útil y efectivo. El objetivo de este artículo es presentar la experiencia en el manejo quirúrgico de heridas cardíacas penetrantes con la creación de un algoritmo práctico que incluye los principios básicos del control de daños. Se recomienda que a todos los pacientes con heridas precordiales penetrantes se les debe realizar un ultrasonido torácico como componente integral de la evaluación inicial. Aquellos que presenten un ultrasonido torácico positivo y se encuentren hemodinámicamente estables se les debe realizar una ventana pericárdica con posterior lavado. Se ha demostrado que el 25% de las ventanas pericárdicas positivas no se benefician ni requieren de posteriores abordajes quirúrgicos invasivos. Antes de este concepto, todos los pacientes con ventana pericárdica positiva terminaban en una exploración abierta del tórax y del pericárdico. Los pacientes hemodinámicamente inestables requieren de una cirugía de control de daños para un adecuado y oportuno control del sangrado. Con este propósito, se propone un algoritmo de manejo quirúrgico que incluye todos estos aspectos esenciales en el abordaje de este grupo de pacientes.

Extension of the thoracic spine sign as a diagnostic marker for thoracic trauma.

INTRODUCTION: The initial evaluation of patients with thoracic trauma remains a diagnostic challenge for surgery and emergency physicians. Chest sonography plays a key role in the approach for this group of patients, through extended and focused evaluation with trauma sonography (E-FAST). OBJECTIVES: To establish the diagnostic performance of the extension of the thoracic spine sign using chest sonography in trauma to diagnose hemothorax and compare it with the gold standard test chest computed tomography (CT). METHODS: This prospective observational study was conducted over 1 year. Patients who attended the emergency room with closed or penetrating thoracic or thoraco-abdominal trauma, an indication for a chest CT as part of a diagnostic evaluation according to institutional protocols, and who previously underwent a chest sonogram to determine the extent of the thoracic spine sign to diagnose hemothorax. Sonographic results were compared to a radiologist's interpretation of the chest CT. The radiologists were blinded to the initial sonogram interpretation. RESULTS: Seventy-six patients were enrolled with an average age of 32 years. They mainly had closed trauma, which accounted for 77.6% of samples, and 222 chest images were taken. The sensitivity and specificity for this study were 78.7% and 92.6%, respectively, with a positive predictive value and negative predictive value of 65% and 97.8%, respectively. CONCLUSIONS: Extension of the thoracic spine sign allows rapid identification of the presence, and more precisely, the absence of pleural effusion. This, therefore, allows an appropriate diagnosis and approach in the emergency room in patients with chest trauma.

Comparative study between radiology and ultrasound in the evaluation of extracardiac thoracic diseases in dogs and cats / Estudo comparativo entre radiologia e ultrassonografia na avaliação de doenças torácicas extracardíacas em cães e gatos

This study compared radiographic and B-mode and Doppler ultrasound exams of the thoracic cavity, excluding the heart, in canine and feline species, in which the radiographs revealed the formation of a potential acoustic window. The objectives were to demonstrate the advantages and limitations of each technique and to determine whether the additional information influenced the differential diagnosis as well as the outcome of each case. The advantages of B-mode ultrasonography included: better qualitative and quantitative evaluation of pleural effusions, an improved ability to determine whether a nodule was solid or cystic and easier determination of the location in the pulmonary parenchyma. The Power Doppler ultrasound evaluated the blood supply pattern of the nodules and masses and differentiated between vessels and fluid bronchogram. A limitation of the ultrasound examination was the need to be guided by the previous radiography. The advantages of the radiographic examination included the possibility of localizing pulmonary lesions at any depth in the absence of a pleural effusion and providing a panoramic view of the extent of the thoracic disease. The ultrasound examination influenced the differential diagnosis in 18 (62.06%) cases and influenced the outcome of 8 (27.58%) cases.(AU)

Este estudo comparou os exames radiográficos e ultrassonográficos modo-B e Doppler da cavidade torácica, excluindo o coração, em animais da espécie canina e felina, nos casos em que as radiografias torácicas revelaram formação de janela acústica em potencial. O objetivo foi demonstrar as vantagens e limitações de cada técnica e determinar se as informações adicionais influenciaram o diagnóstico diferencial, bem como no desfecho de cada caso. As vantagens do modo B incluíram: melhor avaliação qualitativa e quantitativa de efusão pleural; determinação da natureza sólida ou cística de nódulos, bem como a definição de sua localização no parênquima pulmonar. O ultrassom Doppler de Amplitude permitiu a avaliação do padrão de irrigação sanguínea de nódulos e massas e a diferenciação entre vasos e broncogramas fluidos. Uma limitação do exame de ultrassom foi a necessidade de se guiar pela radiografia prévia. As vantagens do exame radiográfico foram: possibilidade de localização de lesões pulmonares em qualquer profundidade na ausência de efusão pleural e proporcionar uma visão panorâmica do acometimento da cavidade torácica. O exame ultrassonográfico proporcionou impacto no diagnóstico diferencial de 18 (62,06%) dos casos e influiu no desfecho de 8 (27,58%).(AU)

Comparative study between radiology and ultrasound in the evaluation of extracardiac thoracic diseases in dogs and cats / Estudo comparativo entre radiologia e ultrassonografia na avaliação de doenças torácicas extracardíacas em cães e gatos

ABSTRACT:This study compared radiographic and B-mode and Doppler ultrasound exams of the thoracic cavity, excluding the heart, in canine and feline species, in which the radiographs revealed the formation of a potential acoustic window. The objectives were to demonstrate the advantages and limitations of each technique and to determine whether the additional information influenced the differential diagnosis as well as the outcome of each case. The advantages of B-mode ultrasonography included: better qualitative and quantitative evaluation of pleural effusions, an improved ability to determine whether a nodule was solid or cystic and easier determination of the location in the pulmonary parenchyma. The Power Doppler ultrasound evaluated the blood supply pattern of the nodules and masses and differentiated between vessels and fluid bronchogram. A limitation of the ultrasound examination was the need to be guided by the previous radiography. The advantages of the radiographic examination included the possibility of localizing pulmonary lesions at any depth in the absence of a pleural effusion and providing a panoramic view of the extent of the thoracic disease. The ultrasound examination influenced the differential diagnosis in 18 (62.06%) cases and influenced the outcome of 8 (27.58%) cases.

RESUMO:Este estudo comparou os exames radiográficos e ultrassonográficos modo-B e Doppler da cavidade torácica, excluindo o coração, em animais da espécie canina e felina, nos casos em que as radiografias torácicas revelaram formação de janela acústica em potencial. O objetivo foi demonstrar as vantagens e limitações de cada técnica e determinar se as informações adicionais influenciaram o diagnóstico diferencial, bem como no desfecho de cada caso. As vantagens do modo B incluíram: melhor avaliação qualitativa e quantitativa de efusão pleural; determinação da natureza sólida ou cística de nódulos, bem como a definição de sua localização no parênquima pulmonar. O ultrassom Doppler de Amplitude permitiu a avaliação do padrão de irrigação sanguínea de nódulos e massas e a diferenciação entre vasos e broncogramas fluidos. Uma limitação do exame de ultrassom foi a necessidade de se guiar pela radiografia prévia. As vantagens do exame radiográfico foram: possibilidade de localização de lesões pulmonares em qualquer profundidade na ausência de efusão pleural e proporcionar uma visão panorâmica do acometimento da cavidade torácica. O exame ultrassonográfico proporcionou impacto no diagnóstico diferencial de 18 (62,06%) dos casos e influiu no desfecho de 8 (27,58%).