Role of chest ultrasonography in the prognostic evaluation of patients with community acquired pneumonia: a prospective study

Kizhakkepeedika Davis Rennis, Muhammed Anaz, Easwaramangalath Venugopal Krishnakumar, Vadakkan Thomas, Ambooken Poulose Robert


Background: Chest ultrasonography (USG) has shown a growing interest during the last few years in the diagnosis of pneumothorax, pneumonia, or pulmonary contusions. This study was aimed to assess the ability of bedside chest USG in the prognosis of community-acquired pneumonia (CAP) patients and to compare USG with pneumonia severity index (PSI) score and conventional chest radiograph (CXR).

Methods: This prospective study was done in patients who get admitted with history and examination findings suggestive of community-acquired pneumonia were included in the study, PSI scoring and CXR were evaluated at the time of presentation. Chest physician performed the thoracic USG. PSI scoring, CXR and USG were repeated on third day and at the time of final outcome. Diagnosis at hospital discharge was taken as the reference standard.

Results: Total 100 patients (57±17 years) were included in the study. Correlation between USG, CXR and PSI score were analysed using Spearman's correlation (r). A significant (p = 0.001) correlation between USG and PSI score was found on day 1 (r=0.35), on day 3 (r=0.43) and on the final day (r=0.25). Similarly a significant correlation (p=0.001) was also found between USG and CXR (on day1(r=0.81), on day 3 (r=0.81) and on final day (r=0.74).

Conclusions: The chest-ultrasound as a bedside real time, reliable, rapid and non-invasive technique is useful in the prognostic evaluation of pneumonia patients.


Chest X-ray, Community-acquired pneumonia, Pneumonia, PSI score, Ultrasonography

Full Text:



World Health Organization. The global burden of disease: 2004. Geneva:WHO. 2008.

Ruuskanen O, Lahti E, Jennings LC, Murdoch. Viral pneumonia. Lancet. 2011;377:1264-75.

CP Heussel, HU Kauczor, AJ Ullmann. Pneumonia in neutropenic patients. Eur Radiol. 2004;14:256-71.

Blaivas M. Lung ultrasound in evaluation of pneumonia. J Ultrasound Med. 2012;31:823-6.

DJ Brenner, E J Hall. Computed tomography – an increasing source of radiation exposure. N Engl J Med. 2007;375:2277-84.

Esayag Y, Nikitin I, Bar-ZIv J. Diagnostic value of chest radiographs in bedridden patients suspected of having pneumonia. Am J Med. 2010;123(88):1-6.

BTS. BTS guidelines for the management of community acquired pneumonia in adults. Thorax. 2001;56:1-64.

Espana PP, Capelastegui A, Gorordo I, Esteban C, Oribe M, Ortega M et al. Development and validation of a clinical prediction rule for severe community-acquired pneumonia. Am J RespirCrit Care Med. 2006;174:1249-56.

Benci A, Caremani M, Menchetti D. Sonographic diagnosis of pneumonia and bronchopneumonia. Eur J Ultrasound. 1996;4:169-76.

Bourcier JE, Paquet J, Seinger M, Gallard E, Redonnet JP, Cheddadi F, et al. Performance comparison of lung ultrasound and chest x-ray for the diagnosis of pneumonia in the ED. Am J Emerg Med. 2014;32:115-8.

Cortellaro F, Colombo S, Coen D, Duca PG. Lung ultrasound is an accurate diagnostic tool for the diagnosis of pneumonia in the emergency department. Emerg Med J. 2012;29:19-23.

Volpicelli G, Mussa A, Garofalo G. Bedside lung ultrasound in the assessment of alveolar interstitial syndrome. Am J Emerg Med. 2006;24:689-96.

Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell JD, Dean NC, et al. Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults. Clinical Infectious Diseases. 2007;44:S27-72.

Lim WS, Baudouin SV, George RC, Hill AT, Jamieson C, Jeune IL et al. Pneumonia Guidelines Committee of the BTS Standards of Care Committee. BTS guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax. 2009;64 S3:iii1–ii55.

Gupta D, Agarwal R, Aggarwal AN, Singh N, Mishra N, Khilnani GC, et al. Guidelines for diagnosis and management of community-and hospital-acquired pneumonia in adults: Joint ICS/NCCP(I) recommendations. Lung India. 2012;29:S27-62.

Lichtenstein DA, Mezière GA. Relevance of lung ultrasound in the diagnosis of acute respiratory failure: the BLUE protocol. Chest. 2008;134:117-25.

Parlamento S, Copetti R, Di Bartolomeo S. Evaluation of lung ultrasound for the diagnosis of pneumonia in the ED. Am J Emerg Med. 2009;27:379-84.

Cortellaro F, Colombo S , Coen D, Duca PG. Lung ultrasound is an accurate diagnostic tool for the diagnosis of pneumonia in the emergency department, Emerg. Med. J. 2012;29:19-23.

Lichtenstein DA, Lascols N, Meziere G, Gepner A. Ultrasound diagnosis of alveolar consolidation in the critically ill. Intensive Care Med. 2004;30:276-81.

Beckh S. Real-time chest ultrasonography: a comprehensive review for the pulmonologist. Chest 2002;122:1759-73.

Woodhead M. Community-acquired pneumonia guidelines: much guidance, but not much evidence. Eur Respir J. 2002;20:1-3.

Shah BA, Singh G, Naik MA, Dhobi GN. Bacteriological and clinical profile of Community acquired pneumonia in hospitalized patients. Lung India. 2010;27:54-7.

Dey AB, Chaudhry R, Kumar P, Nisar N, Nagarkar KM. Mycoplasma pneumoniae and community-acquired pneumonia. Natl Med J India. 2000;13:66-70.

Koregel C, Reissing A. Sonographic diagnosis and follow-up of pneumonia: a prospective study. Respiration. 2007;74:537-47.

Angelika R, Roberto C, Geebhard M. Lung ultrasound in the diagnosis and follow-up of community-acquired pneumonia. Chest. 2012;142:965-72.

Alkhayat KF, Alam-Eldeen MH. Value of chest ultrasound in diagnosis of community acquired pneumonia. Egyp J Chest Diseases and Tuberculosis. 2014;63:1047-51.