The use of lung ultrasound, echocardiography and vena cava inferior measurements for differentiating pulmonary edema caused by heart failure and pulmonary diseases as a cause of acute dyspnea in patients admitted to the emergency department due to shortness of breath

Introduction and Purpose: Dyspnea is one of the most common reasons for admission to the emergency department and differential diagnosis of dyspnea can be challenging for emergency physicians. The aim of this study was to investigate the diagnostic value of Lung USG, Echocardiography and IVC measurements in the differentiation of pulmonary edema and pulmonary diseases in patients admitted to the emergency department with dyspnea. Materials and Methods: In our study, 96 patients who presented to the emergency department with dyspnea were evaluated. USG was performed by the researcher at the time of first admission so that the acute diagnosis and treatment of the patients could not be interrupted. Lung USG was performed at a total of six points in both lungs in accordance with the BLUE protocol. After that, cardiac functions were evaluated by echocardiography. Finally, the caval index was calculated by measuring the maximum diameter of the IVC in inspiration and expiration. Results: A total of 96 patients participated in the study. 42 (43.8 %) patients were female, 54 (56.3 %) were male, and the mean age was 69.8. When the lung USG results were evaluated, A profile, B' profile, consolidation and air bronchogram were found to be significantly higher in patients with pneumonia (p = 0.026, p <0.001, p <0.001, p <0.001, respectively). B profile and pleural effusion were statistically higher in patients with pulmonary edema (p<0,001 for both). A profile was significantly higher in asthma / COPD patients (p=0,025). When the echocardiography findings were evaluated, the mean EF was found to be 51.08 % in patients with pneumonia and 44.21 % in other patients. The mean EF of the patients with pneumonia was statistically significantly higher (p=0,017). The mean EF was found to be 34.47 % in patients with pulmonary edema and 52.59 % in other patients. The mean EF of the patients diagnosed with pulmonary edema was statistically lower (p<0,001). When the IVC findings were evaluated, the mean caval index of the patients diagnosed with pneumonia was 51.11 and the mean caval index of the other patients was 24.9. The caval index was significantly higher in patients with pneumonia (p<0,001). The mean caval index of the patients diagnosed with pulmonary edema was 22.07 and the mean caval index of the other patients was 41.28. The caval index was significantly lower in patients with pulmonary edema (p<0,001). Conclusion: In our study, lung USG, echocardiography and IVC findings were found to be significant in the differential diagnosis of dyspnea in accordance with the literature. Lung USG, echocardiography and IVC measurement can be used in patients presenting to the emergency department with dyspnea. In addition, we believe that a more comprehensive USG protocol can be formed by combining the protocols used in lung USG, especially BLUE protocol, with echocardiography and IVC measurements. Keywords: Dyspnea, Lung Ultrasound, Echocardiography, Vena Cava İnferior, Differential Diagnosis