Comparison between lung ultrasonography and chest X-ray in the evaluation of acute pulmonary edema and COPD exacerbation in patients with acute SOB in the emergency department

Background: Acute shortness of breath (SOB) is a common and potentially life-threatening symptom in emergency departments (ED), often indicating serious conditions such as acute pulmonary edema or COPD exacerbations. Prompt and accurate identification of the underlying cause is critical for improving patient outcomes. Objective: This study compared the diagnostic accuracy, sensitivity, specificity, and time efficiency of lung ultrasonography (LUS) and chest X-ray (CXR) in diagnosing acute pulmonary edema and COPD exacerbations in patients presenting with acute SOB. Methods: A cross-sectional study was conducted on 83 patients aged 50-70 years with a history of congestive heart failure (CHF), COPD, or both. Both LUS and CXR were performed. LUS was assessed for B-lines indicating pulmonary edema, while CXR findings were evaluated for signs of acute pulmonary edema or COPD exacerbation. Results: LUS showed a sensitivity of 93.9% and specificity of 100% for diagnosing acute pulmonary edema, outperforming CXR (sensitivity 78.6%, specificity 90%). LUS delivered results within 10 minutes, while CXR took over 30 minutes. LUS detected >3 B-lines in 51 patients, correlating with acute pulmonary edema and guiding targeted treatment. CXR identified pulmonary edema in 47 CHF patients and COPD exacerbation in 33 patients but was less effective in early-stage detection. Treatment decisions aligned closely with LUS findings (κ = 0.976), whereas CXR showed low agreement (κ = 0.047). Conclusion: LUS is a superior, rapid, and non-invasive diagnostic tool for acute SOB in EDs. With higher accuracy and faster results than CXR, LUS should be adopted as the first-line modality for managing acute pulmonary edema and COPD exacerbations.