الفهرس 
Aim Of WorkOnly 14 pages are availabe for public view
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Abstract
This is a prospective randomized experimental study which aims to assess the effectiveness of chest sonography as a diagnostic and a differentiating modality in cases of pneumonia and pulmonary edema. This study was conducted at Chest Medicine Department, Mansoura University Hospitals during the period from January 2017 to February 2018. It was carried on 45 patients; 30 patients with clinical findings consistent with pneumonia and 15 patients with clinical findings consistent with pulmonary edema with their age ranged from 20 to 90 years with a mean age of 57.15 years as soon their arrival at the emergency department or out-patient clinic. Patients with interstitial lung diseases were excluded. Patients were divided in two groups; group 1 ,included 30 Patients clinically consistent with pneumonia based on respiratory signs and symptoms in accordance with American Thoracic Society guidelines 2016 (cough, pleuritic pain, sputum production, fever or dyspnea), typical auscultation findings (crackles or bronchial breath sounds) and group2, included 15 Patients clinically consistent with pulmonary edema (cough ,dyspnea , hemoptysis , crackles , Wheezing or gasping for breath, orthopnea) . Results: Assessment of pneumonia patients (30 patients) by ultrasound showed that all patients (100%) had positive ultrasound findings of pneumonia with sensitivity and PPV of 100%, 43.3% of patients had bilateral consolidation while 56.7% had unilateral consolidation. Posterior zones (zone 5,6,7) were the most affected in 80% of patients . C lines were found in all patients. Air bronchograms were detected in all patients. Lung rockets (B lines) were detected in 10 patients (33.3%) with no cases were detected with interstitial syndrome. Pleural effusion was detected in 13 (43.3%) patients, 10 patients of them had free effusion. On assessment by chest x-ray, we found that alveolar shadowing was detected in all patients. 43.3% of patients had bilateral consolidation while 56.7% had unilateral consolidation. Lower zones were the most affected. Pleural effusion was detected in 15 (50%) patients, this difference refers to falsely obliterated costophrenic angles in AP film chest x. Conclusions: Chest ultrasound is a reliable tool for diagnosing and following pneumonia. It allows a faster diagnosis, rapid therapeutic decisions and follow up. CT chest is considered the gold standard for pneumonia diagnosis. Lung ultrasound with color Doppler imaging helps in identifying necrotizing changes of pneumonia and predicting poor outcome. The presence of pulmonary arteries flow pattern is an indicative of good outcome.