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Background: Lung ultrasound can evaluate for pneumothorax but the accuracy of diagnosis depends on experience among physicians. This study aimed to investigate the sensitivity and specificity of intelligent lung ultrasound in comparison with chest x‐ray, employing chest computed tomography (CT) as the gold standard for diagnosis of pneumothorax in critical ill patients. Methods: This prospective, observational study included 75 dyspnea patients admitted to the Intensive Care Unit of the Fourth Affiliated Hospital of Soochow University from January 2021 to April 2023. Lung ultrasound images were collected using BLUE‐plus protocol and analyzed by artificial intelligence software to identify the pleural line, with CT results serving as the gold standard for diagnosis. Pneumothorax was diagnosed based on either the disappearance of pleural slip sign or identification of lung point. Additionally, chest x‐ray images and diagnostic results were also obtained during the same period for comparison. Results: The sensitivity and specificity of intelligent lung ultrasound in diagnosing pneumothorax were 79.4% and 85.4%, respectively. The sensitivity and specificity of x‐ray diagnosis were 82.4% and 80.5%. Additionally, the diagnostic time for lung ultrasound was significantly shorter than that for x‐ray examination. Conclusion: Intelligent lung ultrasound has diagnostic efficiency comparable to that of x‐ray examination but offers advantages in terms of speed. [ABSTRACT FROM AUTHOR]

Background: Lung ultrasonography (LUS) is a valuable diagnostic tool, but there is a shortage of LUS experts with extensive knowledge and significant experience in the field. Convolutional neural networks (CNNs) have the potential to mitigate this issue by facilitating computer-aided diagnosis. Methods: We propose computer-aided system by a CNN-based method for LUS diagnosis. As the first consideration, we investigated pleural line and lung sliding. The pleural line indicates the position of pleura in an ultrasound image, and LUS is performed after first confirming the position of pleural line. Lung sliding defined as the movement of the pleural line, and the absence of this feature is associated with pneumothorax. Results: Our proposed method accurately detected pleural line and lung sliding, demonstrating its potential to provide valuable diagnostic information on lung lesions.

The aim of the work described here was to determine the effects of imaging protocol, technique and pleural line depth on measured pleural line thickness (PLT). Sonograms were performed on a phantom and healthy volunteers. In vitro , pleural line depth, transducer type (5–1 MHz phased array vs. 13–6 MHz linear array), angle of the pleural line relative to the transducer and distance between the pleural line and focal length were explicitly modified. PLT was measured using electronic calipers. Regression equations described the effects of independent variables on PLT. Factors influencing PLT in vitr o were tested in vivo. In vitro (n = 250 sonograms), PLT was 3.8 (standard error: ±0.24) mm greater when using the phased array compared with the linear transducer (p < 0.001). For every additional centimeter of pleural line depth, PLT increased by 0.96 (±0.081) mm for the phased array (p < 0.001) and 0.26 (±0.019) mm for the linear transducer (p < 0.001). Neither pleural angle nor focal length altered PLT. In vivo (n = 160 sonograms), PLT was 2.56 (±0.06) mm greater when using the phased array (p < 0.001) compared with the linear transducer. PLT increased by 0.67 (±0.060) mm with the phased array (p < 0.001) and 0.25 mm (±0.019) with the linear transducer (p < 0.001) for every additional centimeter between the transducer and the pleura. Together the variables explained 93% of PLT variance in vivo (p < 0.001). PLT measurements are affected by transducer type and pleural line depth. Future studies evaluating PLT as a disease marker should account for confounding by these variables. [ABSTRACT FROM AUTHOR]

Background Transthoracic ultrasound (TUS) can potentially give important complementary information in particular conditions like bedside rapid diagnostic evaluation of dyspneic patients who commonly present to emergency (ER) units. Objective Assessing the significance and diagnostic utility of B-lines and pleural line abnormalities detected on TUS among patients presented to the ER unit for the assessment of dyspnea against high-resolution computed tomography findings. Patients and methods A prospective observational study including 240 consecutive patients was conducted. TUS was done for patients presenting to the ER for the assessment of dyspnea. B-lines and the pleural line were evaluated by a linear and convex transducers. Sonographic findings were reported against high-resolution computed tomography findings, which was considered the gold standard. Results Slightly rough, fringed, irregular, interrupted, wavy, coexistence of more than one abnormal type of pleural line were detected in 30.8%, 35.4%, 19.2%, 17.9%, and 30% of cases, respectively. Warrick score classified patients with interstitial lung disease to mild (44.6%), moderate (36.3%), and severe (19.2%). Diffusing capacity for carbon monoxide (DLCO% predicted) and total lung capacity (TLC% predicted) predicted showed negative correlation with Warrick score (r=−0.66, r=−0.48 respectively, P≤0.001 for both) and positive correlation with distance between B lines (r=0.31 and 0.30 respectively, P≤0.001 for both). Warrick score at a cutoff more than 7 showed 96.3% sensitivity and 64.3% specificity. Distance between B lines at cutoff more than 3 mm had 100% sensitivity and 40.4% specificity. Cutoff more than 3 for B lines number/scan showed 92.6% sensitivity and 31% specificity. Pleural thickness at cutoff more than 2 mm showed 100% sensitivity and 34% specificity. Abolished lung sliding showed 96.3% sensitivity and 50% specificity. Conclusion TUS is an important tool for the diagnosis and assessment of pulmonary disorders. B-lines number and distance, pleural line abnormalities, lung sliding, and pleural thickness added diagnostic value for the ER assessment of dyspneic patients.

Background: Lung ultrasonography (LUS) is a valuable diagnostic tool, but there is a shortage of LUS experts with extensive knowledge and significant experience in the field. Convolutional neural networks (CNNs) have the potential to mitigate this issue by facilitating computer-aided diagnosis., Methods: We propose computer-aided system by a CNN-based method for LUS diagnosis. As the first consideration, we investigated pleural line and lung sliding. The pleural line indicates the position of pleura in an ultrasound image, and LUS is performed after first confirming the position of pleural line. Lung sliding defined as the movement of the pleural line, and the absence of this feature is associated with pneumothorax., Results: Our proposed method accurately detected pleural line and lung sliding, demonstrating its potential to provide valuable diagnostic information on lung lesions., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Abstract Background and objective Lung ultrasound is an inherently user‐dependent modality that could benefit from quantitative image analysis. In this pilot study we evaluate the use of computer‐based pleural line (p‐line) ultrasound features in comparison to traditional lung texture (TLT) features to test the hypothesis that p‐line thickening and irregularity are highly suggestive of coronavirus disease 2019 (COVID‐19) and can be used to improve the disease diagnosis on lung ultrasound. Methods Twenty lung ultrasound images, including normal and COVID‐19 cases, were used for quantitative analysis. P‐lines were detected by a semiautomated segmentation method. Seven quantitative features describing thickness, margin morphology, and echo intensity were extracted. TLT lines were outlined, and texture features based on run‐length and gray‐level co‐occurrence matrix were extracted. The diagnostic performance of the 2 feature sets was measured and compared using receiver operating characteristics curve analysis. Observer agreements were evaluated by measuring interclass correlation coefficients (ICC) for each feature. Results Six of 7 p‐line features showed a significant difference between normal and COVID‐19 cases. Thickness of p‐lines was larger in COVID‐19 cases (6.27 ± 1.45 mm) compared to normal (1.00 ± 0.19 mm), P

Objectives: Over the last years ultrasound has shown to be an important tool for evaluating lung involvement, including interstitial lung disease (ILD) a potentially severe systemic involvement in many rheumatic and musculoskeletal diseases (RMD). Despite the potential sensitivity of the technique the actual use is hampered by the lack of consensual definitions of elementary lesions to be assessed and of the scanning protocol to apply. Within the Outcome Measures in Rheumatology (OMERACT) Ultrasound Working Group we aimed at developing consensus-based definitions for ultrasound detected ILD findings in RMDs and assessing their reliability in dynamic images., Methods: Based on the results from a systematic literature review, several findings were identified for defining the presence of ILD by ultrasound (i.e., Am-lines, B-lines, pleural cysts and pleural line irregularity). Therefore, a Delphi survey was conducted among 23 experts in sonography to agree on which findings should be included and on their definitions. Subsequently, a web-reliability exercise was performed to test the reliability of the agreed definitions on video-clips, by using kappa statistics., Results: After three rounds of Delphi an agreement >75 % was obtained to include and define B-lines and pleural line irregularity as elementary lesions to assess. The reliability in the web-based exercise, consisting of 80 video-clips (30 for pleural line irregularity, 50 for B-lines), showed moderate inter-reader reliability for both B-lines (kappa = 0.51) and pleural line irregularity (kappa = 0.58), while intra-reader reliability was good for both B-lines (kappa = 0.72) and pleural line irregularity (kappa = 0.75)., Conclusion: Consensus-based ultrasound definitions for B-lines and pleural line irregularity were obtained, with moderate to good reliability to detect these lesions using video-clips. The next step will be testing the reliability in patients with ILD linked to RMDs and to propose a consensual and standardized protocol to scan such patients., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Inc.)

Objective: To explore the reliability and accuracy of lung ultrasound for diagnosing neonatal pneumothorax.Methods: This study was divided into two phases. (1) In the first phase, from January 2013 to June 2015, 40 patients with confirmed pneumothorax had lung ultrasound examinations performed to identify the sonographic characteristics of neonatal pneumothorax. (2) In the second phase, from July 2015 to August 2016, lung ultrasound was undertaken on 50 newborn infants with severe lung disease who were suspected of having pneumothorax, to evaluate the sonographic accuracy and reliability to diagnose pneumothorax.Results: (1) The main ultrasonic manifestations of pneumothorax are as follows: ① lung sliding disappearance, which was observed in all patients (100%); ② the existence of the pleural line and the A-line, which was also observed in all patients (100%); ③ the lung point, which was found in 75% of the infants with mild-moderate pneumothorax but not found to exist in 25% of the severe pneumothorax patients; ④ the absence of B-lines in the area of the pneumothorax (100% of the pneumothorax patients); and ⑤ no lung consolidation existed in the area of the pneumothorax (100% of the pneumothorax patients). (2) The accuracy and reliability of the lung sonographic signs of lung sliding disappearance as well as the existence of the pleural line and the A-line in diagnosing pneumothorax were as follows: 100% sensitivity, 100% specificity, 100% positive predictive value, and 100% negative predictive value. When the lung point exists, the diagnosis is mild-moderate pneumothorax, whereas if no lung point exists, the diagnosis is severe pneumothorax.Conclusion: Lung ultrasound is accurate and reliable in diagnosing and ruling out neonatal pneumothorax and, in our study, was found to be as accurate as chest X-ray. [ABSTRACT FROM AUTHOR]

Objectives: Detection of B ‐ line in dyspneic patients is often accompanied by abnormal changes of pleural line on transthoracic ultrasonography (TUS). The aim of the study was to evaluate the relevance and diagnostic performance of pleural line abnormalities and B ‐ lines detected on high ‐ resolution TUS against the computed tomography (CT) findings. Methods: Transthoracic ultrasonography was performed in patients admitted to the emergency department with dyspnea. The pleural line and accompanying B ‐ line were assessed using a linear transducer. The TUS findings were assessed against the corresponding high ‐ resolution CT findings in the same location, which were considered to be the gold standard. Results: Out of a total of 116 patients, 68.1% had changes of the pleural line on TUS. The characteristic changes of the pleural line were classified into four types: slightly rough pleural line with confluent B ‐ lines on TUS corresponded with CT findings of ground ‐ glass opacity; irregular and interrupted pleural line with confluent B ‐ lines corresponded with parenchymal infiltration; fringed pleural line with confluent B ‐ lines corresponded with superimposed ground ‐ glass and irregular reticular opacities; and fringed pleural line with scattered B ‐ lines corresponded with irregularly thickened interlobular septa. Wavy pleural line indicated subpleural emphysema. The coexistence of more than one abnormal pleural line was also found in 31 cases (26.7%). Conclusions: High ‐ resolution TUS may help in the initial assessment of lung pathology by its ability to identify pleural line abnormalities and B ‐ lines that are shown to be associated with CT, which could add diagnostic value in the emergency evaluation of dyspneic patients. [ABSTRACT FROM AUTHOR]

Background: To evaluate the value of the pulmonary ultrasound for the diagnosis of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in emergency departments (EDs)., Materials and Methods: Between January 2018 and December 2019, patients admitted to the ED of Shanxi Provincial People's Hospital for suspected AECOPD were prospectively included in this study. Pulmonary ultrasound was performed using a linear transducer. The pulmonary ultrasound findings were evaluated for further discrimination for patients with AECOPD. Then, the diagnostic performance of pulmonary ultrasound was estimated and calculated. The clinical characteristics between groups with and without pneumonia were compared., Results: A total of 53 patients with AECOPD were included in the final analysis. For diagnosis of AECOPD due to pneumonia, ultrasound findings, such as consolidation, slightly rough pleural line, or irregular and interrupted pleural line had a sensitivity of 92.3% and a specificity of 86.7%. For diagnosis of AECOPD complicating pulmonary fibrosis, fringed pleural line had a sensitivity of 100% and a specificity of 97.5%. In addition, patients with pleural effusion (n=19) or pneumothorax (n=1) were correctly identified and wavy or bulging pleural lines were common in patients with AECOPD (58.5%, 31/53)., Conclusion: Ultrasound findings could offer further discrimination for AECOPD complications and other pathological conditions, such as pneumonia, pulmonary fibrosis, pleural effusion, and pneumothorax in EDs., (Copyright © 2022. Published by Elsevier España, S.L.U.)

Diagnosis of a pneumothorax in the perioperative area can be difficult. Traditional gold-standard modalities may not be available or feasible to institute. Ultrasound guidance allows the anesthesia provider a method of quickly ruling out this potentially life-threatening complication. In this article we detail the use of sonography for fast and accurate diagnosis of pneumothorax. The essential terms relative to the use of ultrasonography to detect pneumothorax are also defined. [ABSTRACT FROM AUTHOR]