Emergency ultrasound identification of a lung mass
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CASE REPORT
Emergency ultrasound identification of a lung mass Mikaela Chilstrom • Michael B. Stone
Received: 3 June 2010 / Accepted: 23 October 2010 / Published online: 16 November 2010 Ó Springer-Verlag 2010
Abstract Introduction A 49-year-old woman with HIV and remote tobacco use presented with fever and 2 months of progressive dyspnea. A chest radiograph showed a right upper lobe pneumonia and treatment for community-acquired pneumonia was initiated. Materials and methods The emergency physician performed a bedside lung ultrasound that suggested a more complicated process and prompted computed tomography of the chest. This revealed a right upper lobe mass and lymphadenopathy consistent with neoplasm which was subsequently confirmed on bronchoscopy. Conclusions The role of lung ultrasound in the Emergency Department is reviewed and a new potential application of identifying patients in whom further diagnostic testing may be indicated is described. Keywords Chest ultrasonography Chest imaging Lung cancer Emergency ultrasound
Case report A 49-year-old woman with a history of hypertension, HIV on HAART (last CD4 count 449 cells/lL and viral load 50 copies/mL), and remote tobacco use (15-pack-years) presented to the emergency department (ED) with 2 months Electronic supplementary material The online version of this article (doi:10.1007/s13089-010-0041-4) contains supplementary material, which is available to authorized users. M. Chilstrom (&) M. B. Stone Department of Emergency Medicine, SUNY Downstate/Kings County Hospital Center, Brooklyn, NY 11203, USA e-mail: [email protected]
of progressive shortness of breath. During this time, she reported having a cough productive of yellow sputum with associated pleuritic chest pain, fever, night sweats, and weight loss of more than 10 pounds. She was treated with azithromycin as an outpatient 6 weeks prior to presentation without improvement in her symptoms. One month prior, she was diagnosed with bronchitis and treated with moxifloxacin, again with no improvement. A few days prior to ED presentation she noticed her sputum was blood tinged. Her vital signs were temperature 101.4 degrees Fahrenheit, heart rate 110/min, respiratory rate 22/min, blood pressure 120/76 mmHg, and oxygen saturation 97% on 2 L/min nasal canula. She had rhonchi in the right mid and upper lung fields and her left lung was clear to auscultation. Her heart was regular, tachycardic, and without murmurs. The rest of her physical exam was otherwise unremarkable and non-contributory. PA and lateral chest radiographs (Fig. 1) showed diffuse reticular opacities in the right upper lobe that were interpreted by radiology as a developing right upper lobe consolidation. The patient was placed in respiratory isolation and was started on ceftriaxone and azithromycin for suspected community-acquired pneumonia. To further evaluate the right upper lobe, a bedside lung ultrasound was performed by the emergency physician using a 5-2 MHz curvilinear transducer (General Electric Logiq P5, Wauwatosa, WI, US
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