Usefulness of a hand-carried cardiac ultrasound device for bedside examination of pericardial effusion in patients after cardiac surgery

To identify the incidence of pericardial effusion in patients after cardiac surgery using a hand-carried cardiac ultrasound device, 200 patients were assessed on postoperative day 3. If a pericardial effusion was found, patients were monitored for 3 consecutive days with a hand-carried cardiac ultrasound device. Within 72 hours after surgery, 43 patients (21.5%) had developed an effusion, of whom 2 patients had cardiac tamponade and 41 patients (21%) had a small pericardial effusion. No difference was found in the incidence of effusion based on the type of cardiac surgery. Of patients with a small pericardial effusion on day 3 after surgery, an additional 2 of 41 (5%) developed cardiac tamponade.     

Screening for left ventricular dysfunction using a hand-carried cardiac ultrasound device

BACKGROUND: The hand-carried cardiac ultrasound (HCU) device is a recently introduced imaging device, which may be potentially useful in the primary care setting. AIM: To test the screening potential of a HCU for the detection of left ventricular (LV) dysfunction by evaluating LV ejection fraction (LVEF) and inferior vena cava (IVC) collapse. Standard echocardiographic system (SE) and plasma brain natriuretic peptide (BNP) measurements were used as a reference. METHODS: Eighty-eight consecutive patients (56 male, aged 59+/-12 years) with suspected LV dysfunction were enrolled in the study. The HCU-LVEF was visually estimated and the SE-LVEF was derived by the Simpson's biplane method. A LVEF <40% represented LV dysfunction. An IVC collapse of <50% and BNP levels > or =15 pmol/l were considered abnormal. The correlation of HCU-LVEF, HCU-IVC and BNP to the SE-LVEF and SE-IVC was analysed independently using 2x2 tables. RESULTS: Six patients were excluded because of poor echo images. 19/82 patients had LV dysfunction. The HCU and BNP could identify 17 and 18 out of these 19 patients, respectively. The agreement for LVEF and IVC collapse between SE and HCU was 96% for both parameters. The sensitivity of IVC collapse, HCU-LVEF and BNP in identifying patients with LV dysfunction was 26, 89 and 94%, respectively. CONCLUSION: A HCU device can reliably be used as a screening tool for LV dysfunction.     

Usefulness of a hand-carried cardiac ultrasound device to detect clinically significant valvular regurgitation in hospitalized patients

The accuracy of a hand-carried cardiac ultrasound (HCCU) device for the diagnosis of valvular regurgitations using color-flow Doppler was assessed. One hundred twenty hospitalized patients with at least mild valvular regurgitation by standard echocardiography were evaluated by 2 cardiologists using HCCU. The HCCU operator identified 99% of clinically significant valvular regurgitations and assessed the severity correctly in 83% of cases. For mild regurgitation, the HCCU sensitivity and specificity were 82% and 93%, respectively, resulting in correct assessments of severity in 71% of cases. HCCU used by trained cardiologists has high sensitivity for the detection and accurate assessment of the severity of clinically relevant valvular regurgitation.     

Hospitalist performance of cardiac hand-carried ultrasound after focused training

Purpose

Because the training that noncardiologists require to perform cardiac hand-carried ultrasound has not been defined, we studied how well hospitalists perform hand-carried echocardiography after limited training.

Methods

Ten hospitalists completed a focused training program that included performing an average of 35 hand-carried echocardiograms. Hospitalists’ echocardiograms were compared with gold-standard conventional echocardiograms, and hospitalists were compared with 5 certified echocardiography technicians in their ability to acquire, measure, and interpret hand-carried ultrasound images and with 6 senior cardiology fellows in their ability to interpret echocardiograms.

Results

Echocardiography technicians had significantly higher performance scores for image acquisition, measurement, and interpretation than hospitalists. Senior cardiology fellows outperformed hospitalists in most aspects of image interpretation. For hospitalists, learning image acquisition was more difficult than image interpretation.

Conclusions

Hospitalists can learn aspects of hand-carried echocardiography, but after 35 training echocardiograms cannot replicate the quality of conventional echocardiography. Whether the lower performance skills are important will depend on the clinical context of hand-carried echocardiography performed by hospitalists.     

Impact of hand-carried cardiac ultrasound on diagnosis and management during cardiac consultation rounds.

AIM: To evaluate the impact of hand-carried cardiac ultrasound (HCU) on the diagnosis and management of patients during cardiac consultation rounds. METHODS AND RESULTS: One hundred and fifty patients hospitalized in non-cardiac units were included after the consulting cardiologist felt that an echocardiographic examination was indicated as part of his work-up. They were randomly allocated to echocardiography with an HCU device (SonoHeart, SonoSite, Inc.) (75 patients) or with a full-featured standard echo (FE) system (75 patients). The consulting cardiologist noted whether a definitive diagnosis was made or further study was necessary. Diagnosis and change in management were noted. In the HCU patient group there were 103 clinical questions. Seventy-two percent of the referral questions required no comprehensive echocardiographic evaluation. For questions of left ventricular function, valve abnormalities and pericardial effusion this was 98%. In 48% there was an immediate change in clinical management. In the FE patient group there were 94 clinical questions. In 32% the FE examination led to change in clinical management. CONCLUSION: HCU echocardiography provides clinically worthwhile assessment of left ventricular function, valve abnormalities and pericardial effusion in 98% of the cases. A direct assessment of cardiac function and anatomy at the bedside by an experienced cardiologist results in a significant immediate change in clinical management during consultation.     

胸水N-末端脑钠肽前体在胸腔积液患者中的诊断价值

目的 探讨检测胸液中N-末端脑钠肽前体(NT-proBNP)对于胸腔积液的鉴别诊断价值.方法 选取在本院因胸腔积液而进行诊断性胸腔穿刺的患者126例,根据临床表现、胸液常规检验结果及细胞学分为充血性心力衰竭胸腔积液33例(心源性组)和非心源性组93例(恶性胸腔积液18例、结核性胸腔积液22例、肾功能衰竭性胸腔积液19例、肝硬化腹水伴胸腔积液15例、肺炎性胸腔积液19例).检测2组患者胸水及血浆中NT proBNP水平,分析血浆NT proBNP水平与胸水NT-proBNP的相关性,并采用受试者工作曲线(ROC)计算用于判别胸水性质的最佳界值.结果 心源性组胸水及血浆中的NT-proBNP水平显著高于非心源性组、恶性组、结核组、肾功能衰竭组、肝硬化组和炎症组,且差异均具有统计学意义(P＜0.05);恶性组、结核组、肾功能衰竭组、肝硬化组和炎症组胸水及血浆中NT proBNP水平差异均无统计学意义(P＞0 05);胸水中NT proBNP水平与血浆中NT-proBNP水平呈显著正相关(r=0.894,P＜0.01).绘制ROC曲线结果显示,当胸水中NT-proBNP水平为1 500 ng/L时,鉴别心源性和非心源性胸水具有最大诊断指数(1.757 3),此时敏感度为89.19％、特异度为86.54％.结论 心源性胸腔积液患者胸水中NT-proBNP水平显著升高,与血浆水平呈显著正相关,以1 500 ng/L为界值时,具有鉴别诊断心源性胸水的最高价值.     

Rapid assessment of cardiac anatomy and function with a new hand-carried ultrasound device (OptiGo): a comparison with standard echocardiography.

AIMS: The aim of this study was to evaluate image quality and accuracy of a new hand-carried ultrasound device, OptiGo (Agilent Technologies) when compared to standard echocardiography in the setting of a focused examination in the assessment of cardiac anatomy and function. METHODS AND RESULTS:One-hundred and twenty-one patients were prospectively enrolled. Image quality and accuracy in assessment of chamber sizes, left ventricular (LV) wall thickness and contractility, right ventricular (RV) function, mitral and aortic leaflet thickening, mitral annular calcification, pericardial effusion and valvular regurgitation were assessed. Two-dimensional (2D) findings were graded on a four-point scale, except for LV function (six-point) and valvular leaflet opening (two-point). Colour Doppler assessment of valvular regurgitation was graded on a seven-point scale. A one-point difference was considered minor; a two or more point difference was considered major. There was no statistically significant difference in image quality between the two devices. For 2D data, the number of total (minor and major) differences between the hand-carried and standard echocardiograph examinations was significantly greater than the inter-observer variability (14.3% vs 10.7%, P< 0.05), however, major differences alone were not statistically different. For the colour Doppler assessment of regurgitation there was a significant difference between the devices for total (minor and major) differences, (40.0% vs 31.8%,P < 0.007) however, the number of major differences is explained by inter-observer variability. CONCLUSIONS: Image quality and diagnostic accuracy of the hand-carried device, OptiGo, was adequate for the purpose of performing a focused assessment of a limited number of 2D and Doppler parameters for the evaluation of cardiac anatomy and function.     

Incidence and significance of pleural effusion after abdominal surgery.

Two hundred patients who had undergone abdominal surgery received bilateral decubitus chest roentgenograms between 48 and 72 hours after surgery to evaluate the incidence of pleural effusion after abdominal surgery. Ninety-seven (49 percent) had some pleural fluid visible on the x-ray films. In 50 patients the thickness of the fluid was less than 4 mm on the decubitus film; in 26, it was between 4 mm and 10 mm; and in 21, it was greater than 10 mm. The incidence of pleural effusions was higher after upper-abdominal surgery, in patients with postoperative atelectasis, on the side on which the surgery was performed, and in patients with free abdominal fluid. Thoracocentesis was performed on 20 patients, and in 16 patients the effusions were exudates. All of the effusions resolved without specific therapy except one. The pleural fluid in this patient was characterized by a low pH (6.93) and positive culture for Staphylococcus aureus. Small pleural effusions are common after abdominal surgery, and most resolve spontaneously within a few days.     

Pleural fluid characteristics of patients with symptomatic pleural effusion after coronary artery bypass graft surgery

BACKGROUND: This study describes the pleural fluid characteristics of patients who develop symptomatic pleural effusions after coronary artery bypass graft surgery (CABG). METHODS: Post-CABG patients who underwent a therapeutic thoracentesis for a symptomatic pleural effusion were included unless another explanation for the pleural effusion was present. RESULTS: During the study, 71 patients (mean age, 61 years) were identified; 49 were men and 22 were women. All patients underwent internal mammary artery grafting. Early effusions (<30 days after CABG) occurred in 45 patients (63%) and late effusions (>/=30 days after CABG) developed in 26 (37%). Early effusions were bloody (median red blood cell count, 706 x 10(12)/L [706,000 mm(3)])with a high eosinophil count (median, 0.385), whereas effusions that occurred in the late period were yellow exudates with predominant lymphocytes (median, 0.68) and monocytes (median, 0.20). The mean pleural fluid level of lactate dehydrogenase was more than 3 times the upper limit of the reference range in serum in early effusions, whereas late effusions had significantly lower lactate dehydrogenase levels. CONCLUSIONS: Characteristics of early and late effusions differ significantly, suggesting a different pathogenesis of the effusions. Patients who develop a symptomatic pleural effusion after CABG should undergo a therapeutic thoracentesis; however, further investigations are warranted only in patients who have pleural fluid characteristics different from those described.     

中心静脉穿刺管在婴幼儿心脏直视术后胸腔积液引流中的应用(附19例报告)

目的 介绍一种婴幼儿心脏直视术后胸腔积液引流的新方法,并报告19例采用此方法引流的经验。方法 应用中心静脉穿刺管引流19例婴幼儿心脏直视术后的胸腔积液。结果全组19例患儿,均治愈出院。无胸腔穿刺并发症。结论 应用中心静脉穿刺管引流婴幼儿心脏直视术后的胸腔积液,副作用小,效果良好,值得介绍推广。     

Chlamydia pneumoniae pneumonia with pleural effusion: diagnosis by culture

A case of Chlamydia pneumoniae pneumonia with pleural effusion in an otherwise healthy 19-year-old man is described. Diagnosis was made by serologic means as well as by culture of both the nasopharynx and the pleural fluid.     

老年人胸腔积液32例鉴别诊断分析

目的探讨老年人胸腔积液的鉴别诊断。临床资料32例胸腔积液患者,年龄55～80,平均70岁。心衰16例,肺癌2例,结核性胸膜炎9例,脓胸2例,液气胸3例。讨论老年人胸腔积液必须注意心衰、结核、肿瘤、系统性疾病的鉴别诊断。     

Validation of a new hand-carried ultrasound device equipped with directional color power Doppler and continuous wave Doppler

OBJECTIVES: This study evaluated the accuracy of the directional color power Doppler (DCPD) and continuous wave Doppler (CWD) methods incorporated in the new hand-carried SonoSite 180PLUS ultrasound device. METHODS: The hand-held ultrasound system with 2.5 MHz transducer and SONOS 5500 was used as a standard ultrasound system with a 2 to 4 MHz wideband transducer. The experimental study used a Doppler wire phantom to evaluate the influence of target wire speed and angle of transducer on DCPD imaging. The clinical study included 48 consecutive patients. DCPD assessment of valvular regurgitation measured the distances of DCPD signals of mitral, aortic and tricuspid valve regurgitation using the apical four-chamber view for comparison with standard echocardiography. CWD assessment measured the peak velocities of the aortic flow and tricuspid valve regurgitant flow for comparison with standard echocardiography. RESULTS: In the experimental study, DCPD signals were not influenced by target wire speed changes and transducer incident angles. In the clinical study, agreements for mitral, aortic and tricuspid regurgitation between the two methods were 89.6%, 81.8% and 78.7%, respectively. The distances of DCPD valve regurgitant signals by the hand-carried ultrasound device showed good correlation (mitral regurgitation: y = 0.84x + 0.55; r = 0.93, aortic regurgitation: y = 0.95x + 0.27; r = 0.94, tricuspid regurgitation: y = 0.86x + 0.61; r = 0.90) with those by standard echocardiography. Evaluation of CWD velocity measurements showed good agreement for the lower flow velocities (< 2.0 m/sec). However, underestimation occurred for the high flow velocities (> 2.0 m/sec) compared with those by standard echocardiography (aortic flow: y = 0.80x + 0.11; r = 0.95, tricuspid regurgitation: y = 1.00x - 0.23; r = 0.90). CONCLUSIONS: The new hand-carried ultrasound device (SonoSite 180PLUS equipped with DCPD and CWD) is clinically useful for evaluating valvular regurgitations and flow velocities. Further studies are needed to determine the mechanism of the underestimation of high flow velocities by CWD.     

Loculated pericardial effusion and cardiac tamponade late after cardiac surgery.

A case of loculated pericardial effusion diagnosed by chest roentgenogram and subsequent echocardiogram is presented. This effusion was unusual in its late appearance after thoracotomy and its discrete location which resulted in hemodynamic embarrassment. Subsequent cultures demonstrated an infected pericardial space and septicemia.     

内科胸腔镜对胸腔积液诊断和治疗的临床价值

目的：探讨内科胸腔镜对胸腔积液的诊断价值,以及应用内科胸腔镜滑石粉胸膜固定术对恶性胸腔积液的治疗价值。方法回顾性性分析2008年1月至2014年1月在郑州市第三人民医院呼吸内科接受内科胸腔镜诊断的142例胸腔积液患者的临床资料。评价内科胸腔镜对胸腔积液的诊断阳性率和分析病因。将确诊为恶性胸腔积液的患者分为胸腔镜组和对照组。胸腔镜组给予内科胸腔镜滑石粉胸膜固定术,对照组胸给予胸腔引流管内灌注滑石粉而实现胸膜固定。对两组的疗效进行对比和分析。结果在142例胸腔积液患者中,有136例经内科胸腔镜检查及病理活检明确诊断,确诊率达95.8%。其中恶性胸腔积液(含恶性胸膜间皮瘤2例)85例(59.9%),结核性胸膜炎31例(21.8%),肺炎旁积液13例(9.2%),非特异性炎症7例(4.9%),原因不明胸腔积液6例(4.2%)。确诊的85例恶性胸腔积液患者中,胸腔镜组56例,1个月后复查有效率为91.1%,完全缓解率为82.1%;对照组29例,1个月后复查有效率为69.0%,完全缓解率为48.3%,两组有效率和完全缓解率比较,差异均有统计学意义(χ2值分别为6.786、10.555,P 值分别为0.009、0.001)。结论内科胸腔镜对胸腔积液具有较好的确诊率,内科胸腔镜滑石粉胸膜固定术可以有效地治疗恶性胸腔积液。