EH 5_2015

Experience and explore this innovation in ultrasound www.tryarietta.com www.hitachi-medical-systems.eu A NEW GENERATION ULTRASOUND SYSTEM www.healthcare-in-europe.com 21ULTRASOUND acquired pneumonia. This is normally diagnosed with conventional X-rays taken in two positions. ‘Things are different with children. Although chest X-rays (for reasons of radiation protection taken only in one position) are also used here, there should be a discussion as to whether a suspected diagnosis should not initial- ly be confirmed via ultrasound instead. ‘There are cases of pneumonia that can be detected on a chest X-ray and CT, but not with ultrasound; these are mostly atypical changes to the lungs. Historically, chest X-rays were the first imaging procedure used to diagnose TB, which is why, in Austria, all asylum seekers still have to undergo chest X-rays. Replacing these with ultra- sound scans would make no sense in my view, because many changes caused by TB cannot be seen on an ultrasound scan. We need to indi- vidually differentiate which type of infection is likely to be present, which patient is affected and when there is a good reason to use ultrasound.’ Are there guidelines for ultrasound of the lungs? ‘As far as I’m aware there are no S3 guidelines for community acquired and/or nosocomial types of pneu- monia that stipulate the use of ultra- sound for diagnosis. Pneumonia is a common, and specifically for older patients, serious disease. If we insisted on carrying out the initial diagnosis with ultrasound for all patients affect- ed this would make no sense because there would likely be a large number of cases that we wouldn’t be able to detect. From an organisational view- point this would not be feasible either, both for in- and out-patient settings. ‘If the objective is a comprehen- sive diagnosis for a patient suffer- ing from severe pneumonia, we need to establish for prognostic reasons alone how many pulmonary lobes are affected and whether the pneumonia is necrotising or abscess forming. It isn’t always possible to determine this clearly with ultrasound. The same applies to changes to the bronchi, such as tumours or bronchiectasis, which lead to pneumonia.’ You mention X-rays, CT and ultra- sound… why not MRI? ‘There are currently several working groups looking into the use of MRI to monitor children with congenital diseases such as mucoviscidosis (cystic fibrosis), for reasons of radiation pro- tection. However, MRI does not have as good a spatial resolution as modern CT. Furthermore, the lung diagnosis is made more difficult because of move- ments caused by breathing and the beating heart. The lungs, which are mostly filled with air, appear on MRI more or less as black holes but, despite this fact, there are still concerted efforts to utilise MRI for functional diagnosis of the lungs. The results achieved by these working groups remain to be seen. n procedure for diagnosis and ctions 53-year-old male with suspected pneumonia. Chest X-ray (a) shows a consolidation bottom right and a pleural effusion on the right. The CT (b) soft tissue image shows a pleural effusion with an air pocket on the right and a thickening of the pleural layers; the consolidation shows the start of necrolysis. The CT lung image (c) shows an infected infiltration in the left lower lobe, which can hardly be seen on the X-ray (a). Diagnosis of pathogens: Pneumococci. Clinical diagnosis: abscess-forming bilateral pneumonia with pleural empyema on the right

Pages Overview