Thoracic ultrasound in the differential diagnosis of severe dyspnea: A reappraisal

Emergency diagnosis or treatment of pulmonary edema cannot yet be based on a single specific “objective” diagnostic tool, whether US or biomarkers. In the search for useful approaches or clues, respiratory sounds were recently re-assessed and found mostly valuable for a correct diagnosis along the best established medical practice. Although TUS examination can play a valuable role in the emergency department in identifying and monitoring pleural and subpleural lesions, such as pleural effusion or pneumothorax, it has no critical role in the differential diagnosis of severe dyspnea when based exclusively on B-line assessment, i.e. on artifacts and not on imaging. Therefore great caution is necessary when using this TUS procedure, and guidelines for diagnosis and therapeutic intervention in emergency patients should be closely reappraised.