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Jugular vein ultrasound and pulmonary oedema in patients with suspected congestive heart failure

Jang, Timothya,b,c,d; Aubin, Chandrab; Naunheim, Rosanneb; Lewis, Lawrence M.b; Kaji, Amy H.a,c,d

European Journal of Emergency Medicine: February 2011 - Volume 18 - Issue 1 - p 41–45
doi: 10.1097/MEJ.0b013e32833b2566
Original Articles

Background The diagnosis of patients with acute dyspnoea is challenging, as clinical history and physical examination are often nondiagnostic and inaccurate. Consequently, clinicians often rely on the results of chest radiography (CXR) to determine the initial intervention and guide further treatment.

Objective The purpose of this study was to prospectively assess the sensitivity and specificity of ultrasonographic assessment of jugular venous distension (US-JVD) for identifying pulmonary oedema on CXR in dyspnoeic patients with suspected congestive heart failure.

Measurements US-JVD was compared with initial CXR findings of pulmonary oedema as determined by radiology consultants blinded to all clinical information and US-JVD measurements.

Results US-JVD had a sensitivity of 98.2% [95% confidence interval (CI), 89.2–99.9] and a specificity of 42.9% (95% CI, 30.7–55.9), a likelihood ratio positive of 1.7 (95% CI, 1.4–2.1), and likelihood ratio negative of 0.04 (95% CI, 0.006–0.3), for identifying dyspnoeic patients with pulmonary oedema on initial CXR.

Conclusion US-JVD is a sensitive test for identifying pulmonary oedema on CXR in dyspnoeic patients with suspected congestive heart failure.

aDavid Geffen School of Medicine at UCLA

bDivision of Emergency Medicine, Washington University School of Medicine, St Louis, Missouri

cHarbor-UCLA Medical Center, Department of Emergency Medicine

dLA Biomed Research Institute, Carson St Torrance, California, USA

Correspondence to Dr Timothy Jang, MD, David Geffen School of Medicine at UCLA and Harbor-UCLA Medical Center, 1000 W. Carson St, D-9A, Torrance, CA 90502, USA Tel: +1 310 222 3500; fax: +1 310 212 6101; e-mail: tbj@ucla.edu

Received November 19, 2009

Accepted April 19, 2010

© 2011 Lippincott Williams & Wilkins, Inc.