Point-of-Care Ultrasound Diagnosis of Community-Acquired Pneumonia in a High-Altitude, Resource-Poor Setting

Objective: Point-of-care ultrasound (POCUS) for the evaluation of patients with suspected high-altitude pulmonary edema can be a useful tool in remote, high-altitude areas. The same technique can also yield high differential diagnostic accuracy for other relevant causes of acute respiratory distress at high altitude. With the recent development of high-quality, hand-held ultrasound devices, POCUS can be used with increasing reliability in such environments. We present a case of severe respiratory disease in a young, otherwise healthy patient during a trek at high altitude in the Khumbu valley of Nepal. Methods: By using POCUS, we were able to exclude several important differential diagnoses and diagnose the patient with community-acquired pneumonia. Results: Our findings allowed us to start early on-site treatment and positively influenced shared decision-making with the patient, which led to a helicopter evacuation. Conclusions: This case illustrates that POCUS can be a valuable tool in remote, high-altitude regions and could allow healthcare providers to diagnose and follow-up with patients exhibiting acute respiratory symptoms when other radiological imaging modalities are not available.研究目标：床旁超声（Point-of-care ultrasound, POCUS）用于评估疑似高原肺水肿（high-altitude pulmonary edema）患者，在偏远高海拔地区是一项实用的诊疗工具。该技术同样可对高海拔地区急性呼吸窘迫的其他相关病因提供较高的鉴别诊断准确率。随着近年来高质量手持式超声设备的发展，床旁超声在这类环境中的应用可靠性正不断提升。本文报告1例在尼泊尔昆布山谷高海拔徒步期间发病的年轻健康重症呼吸道疾病病例。 研究方法：通过使用床旁超声，我们得以排除多项重要鉴别诊断，并确诊患者为社区获得性肺炎（community-acquired pneumonia）。 研究结果：本次检查结果支持我们启动早期现场治疗，并对与患者的共同决策产生积极影响，最终促成直升机转运（helicopter evacuation）。 研究结论：本病例表明，床旁超声在偏远高海拔地区是一项极具价值的诊疗工具，可帮助医疗人员在缺乏其他放射影像检查手段（radiological imaging modalities）的情况下，对出现急性呼吸道症状的患者进行诊断与随访。