Bedside lung ultrasound versus chest X-ray use in the emergency department.

Acute dyspnoea is one of the most common reasons patients present to the emergency departments (ED). In most cases, the physical examination and bedside radiographs are inconclusive, resulting in the need for more sophisticated diagnostics. These diagnostics may delay treatment or expose the patient to unnecessary radiation. Here, we present the case of a dyspnoeic patient with a normal chest X-ray. The patient was diagnosed with pneumonia by bedside lung ultrasound (BLUS). BLUS revealed bilateral pleural effusion, which was more significant on the right side of the thorax. The right lower lung lobe was consolidated and quad, sinusoid and shred signs were present on BLUS. Chest X-rays demonstrated normal findings. Based on this discrepancy, computerised tomography (CT) of the chest was ordered. A consolidated right lower lung lobe was clearly appreciated with bilateral pleural effusion. However, this finding was not observed on the chest X-ray. Because of the dynamic nature of the disease process, we were able to diagnose pathological changes in the lung earlier with the use of BLUS. In conclusion, this modality may replace the chest X-ray in the ED because it can be used bedside, has high accuracy, and minimal cost.