Chest Imaging in the Diagnosis and Management of Pulmonary Tuberculosis: The Complementary Role of Thoraci Ultrasound

Our plain-English summary of Chest Imaging in the Diagnosis and Management of Pulmonary Tuberculosis: The Complementary Role of Thoraci Ultrasound, by G. Rea, M. Sperandeo, R. Lieto, et al (Frontiers in Medicine, 2021).

The study

• Authors: G. Rea, M. Sperandeo, R. Lieto, M. Bocchino, C.M.I. Quarato, B. Feragalli, T. Valente, G. Scioscia, E. Giuffreda, M.P. Foschino Barbaro, D. Lacedonia
• Journal: Frontiers in Medicine
• Published: 2021;8:753821
• Cited by: 16 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Tuberculosis (TB) is a severe infectious disease that still represents a major cause of mortality and morbidity worldwide. For these reasons, clinicians and radiologists should use all the available diagnostic tools in the assessment of the disease in order to provide precise indications about starting an anti-tubercular treatment and reduce risk of TB transmission and complications especially in developing countries where the disease is still endemic. As TB mycobacteria are mainly transmitted through respiratory droplets, the pulmonary parenchyma is usually the first site of infection. As a result, chest imaging plays a central role in the diagnostic process. Thoracic ultrasound (TUS) is a portable, non-invasive, radiation-free, and cost-contained technology which could be easily available in resource-limited settings. This perspective article focuses on the potential role of TUS in the diagnosis and management of patients with pulmonary TB. Unfortunately, there are still insufficient evidence and too contrasting data to judge TUS as an appropriate diagnostic method for the screening of the disease. Despite this, TUS may have a useful role in identifying pleural and anterior pericardial effusions or in the identification of abscesses of the anterior chest wall and paraspinal collections in low- and middle-income settings. In addition, TUS seems to have a milestone role in guiding minimally invasive interventional procedures, such as placement of chest tubes, drainage of loculated collections, thoracentesis and pericardiocentesis, and percutaneous biopsy of subpleural pulmonary consolidations or pleural plaques.

Copyright © 2021 Rea, Sperandeo, Lieto, Bocchino, Quarato, Feragalli, Valente, Scioscia, Giuffreda, Foschino Barbaro and Lacedonia.

In plain English

This was a perspective article, not an original study. The authors discussed published research on thoracic ultrasound (an ultrasound scan of the chest) for diagnosing and managing pulmonary tuberculosis (TB). The article does not concern asbestos. The authors noted that the WHO recommends at least 90% sensitivity and 70% specificity for a TB screening method. They wrote that the evidence was still insufficient to judge chest ultrasound as a screening test, because sensitivity varied too much between studies. They cited a systematic review that reported sensitivity of 4.0 to 30.0% for detecting cavities in the lung. They stated that ultrasound cannot tell active from inactive TB. In their view, it may help detect fluid around the lungs (pleural effusion) and around the heart (pericardial effusion), especially in low- and middle-income settings. They saw its main role as guiding procedures such as draining fluid and taking biopsies, including biopsies of pleural plaques. The authors stated that this guidance role is supported only by small case series, single case reports and their own clinical experience.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Perspective article (narrative discussion of published literature); no original study data
• Who was studied: No study population of the authors' own. The article discussed published studies of adults and children with pulmonary TB. Its illustrative images came from the authors' routine practice.
• Exposure: Not applicable. The article concerns thoracic ultrasound imaging in tuberculosis; no asbestos or fiber exposure is studied.
• Main results:
  • The authors wrote that the WHO recommends a minimum of 90% sensitivity and 70% specificity for a TB screening method. They judged the available evidence insufficient to assess thoracic ultrasound for TB screening.
  • A systematic review cited by the authors (reference 41) reported thoracic ultrasound sensitivity of 72.5 to 100.0% for subpleural nodules and 46.7 to 80.4% for consolidations in the lung.
  • The same cited systematic review reported thoracic ultrasound sensitivity of 4.0 to 30.0% for cavitations.
  • The authors stated that ultrasound cannot distinguish active from inactive TB.
  • The authors stated that, because of scarce and contradictory data, no conclusions can be drawn on the accuracy of thoracic ultrasound for mediastinal lymph nodes in children with suspected pulmonary TB.
  • The authors stated that thoracic ultrasound showed good sensitivity for pleural effusion and can guide thoracentesis, drainage of loculated effusions and transthoracic biopsy of pleural plaques.
  • In miliary TB, the authors wrote that ultrasound findings are non-specific and that ultrasound examination alone may be confounding.
• The authors' conclusion: The authors concluded that active TB is diagnosed by clinical context, laboratory and microbiological tests, and standard chest X-ray and CT. In their view, thoracic ultrasound may be useful where radiation should be avoided or costs contained, and its main role appears to be guiding minimally invasive procedures.
• Limitations the authors state:
  • There are no controlled studies on large series of TB patients. Even the usefulness of ultrasound for guiding procedures rests on small case series, single case reports and the authors' clinical experience.
  • The authors noted that the variability in reported sensitivity may reflect differing scanner settings and image-acquisition protocols, or operator dependence.
  • The authors noted that, even under optimal conditions, ultrasound can show only about 70% of the pleural surface.

Topics

Medical terms in this study, explained in our Lexicon: Ultrasound, Endemic, Parenchyma, Pericardial Effusion, Thoracentesis, Pericardiocentesis, Biopsy, Consolidation.

Related studies

• Comments and Illustrations of the European Federation of Societies for Ultrasound in Medicine (EFSUMB) Guidelines: Rare Malignant Pulmonal and Pleural Tumors: Primary Pulmonary Sarcoma and Mesothelioma, Imaging Features on Transthoracic Ultrasound — K. Möller, F. Dietz, et al. (2024)
• Ultrasound guided continuous erector spinae plane block for pain management in pulmonary malignancy — T. Aydın, O. Balaban, et al. (2018)
• Evaluation of ALS assay of TB-SA for diagnosis of pulmonary tuberculosis — J. Jiao, M.S. Wang, et al. (2015)
• The Use of Chest Magnetic Resonance Imaging in Malignant Pleural Mesothelioma Diagnosis — F. Volpi, C.A. D'Amore, et al. (2022)
• Diagnostic surgical pathology in lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines — A.M. Schwartz, M.K. Rezaei (2013)
• Imaging in idiopathic pulmonary fibrosis: diagnosis and mimics — B. Hochhegger, E. Marchiori, et al. (2019)

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