Reply to letter to the editor: ‘Evaluating imaging modalities for pulmonary congestion: Beyond chest X-ray and LDCT’

We were pleased to receive the attached manuscript as a Letter to the Editor, which directly references our recently published article: ‘Computed tomography or chest X-ray to assess pulmonary congestion in dyspnoeic patients with acute heart failure’. We welcome and appreciate the interest shown and acknowledge the reasonings by the authors.

The letter raises several important points, and we would gladly like to provide our comments. First, of the 262 patients who presented to the emergency department, we included the 228 patients who underwent all protocolled examinations and excluded those who did not have all examinations done.

Lung ultrasound was not the scope for the present paper, but we agree that lung ultrasound and chest X-ray could provide additional information, including details about differential diagnostics. Therefore, we have submitted another article, which is currently under review, where we directly compare the diagnostic accuracy of lung ultrasound, chest X-ray, ReDS, and low-dose chest CT (LDCT) for consecutive acute dyspnoeic patients, both with and without a history of heart failure. Obviously, we cannot disclose detailed results at this time but can say that lung ultrasound do not appear superior to the chest X-ray.

We concur with the authors regarding the significant advantages of lung ultrasound, particularly its lack of ionizing radiation. We believe that chest X-ray and, more specifically LDCT, should be reserved and considered for patients whose lung imaging remains inconclusive after initial assessment with lung ultrasound and chest X-ray (1). The development of ultra-low-dose CT protocols further enhances the utility of chest CT, offering significant diagnostic benefits without substantial radiation exposure in elderly, co-morbid patients.

Furthermore, many previous studies of lung ultrasound were focused on patients without concomitant pulmonary disease, but mainly included those with advanced stages of pulmonary congestion, as seen in patients with a known history of heart failure. Therefore, such studies are bound to report high sensitivities and specificities. However, much less is known of the diagnostic value in truly undifferentiated dyspnoeic patients including early stages of pulmonary congestion.

In conclusion, we appreciate the valuable points raised in the letter and welcome further discussion on this important topic. Continued research and discussions are essential for advancing our understanding and improving diagnostic strategies for patients with dyspnoea and suspected acute heart failure.

Best regards,

There is no conflict of interest in the current reply.