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

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.