Author Response - Lung Ultrasound in the Intensive Care Unit: Strengths, Limitations, and the Continued Role of Computed Tomography

Sep 30, 2026

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Letter to the editor providing an author response to comments on an article comparing lung ultrasound (LUS) with chest X-ray (CXR) for thoracic pathologies in critical care. The response clarifies that LUS and portable bedside CXR were performed immediately before CT thorax, using CT as the gold standard for diagnostic performance. Findings emphasize superior LUS accuracy for pleural-adjacent conditions and discuss LUS limitations in deeper lesions and restricted acoustic windows, while reaffirming CT’s indispensable role in complex or occult thoracic disease.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages2

Reading Time5 min

AccessFree to download

Letter to the Editor – Response to Comments

Methodology and comparative design

Diagnostic results and key pathologies

Limitations of LUS and practical constraints

Role of CT in complex cases

Advantages of LUS for dynamic monitoring and integration in ICU care

LETTER TO THE EDITOR – RESPONSE TO COMMENTS Author Response: Lung Ultrasound in the Intensive Care Unit: Strengths, Limitations, and the Continued Role of Computed Tomography Ashraf S Al Tayar1, Hosni A Salem2, Prashant Nasa3 Keyword: Bedside lung ultrasound, Critical care ultrasound, Lung ultrasound score, Lung ultrasound, Pneumothorax, Pulmonary edema. Indian Journal of Critical Care Medicine (2025): 10.5005/jp-journals-10071-25109 Dear Editor, We thank the authors for their thoughtful and constructive comments on our article on comparative analysis of lung ultrasound (LUS) with chest X-ray (CXR).1 We appreciate their critical appraisal of our work and appreciate the concerns highlighted regarding the optimal use of LUS and computed tomography (CT) of the thorax in critical care practice. At the outset, it is essential to emphasize a key aspect of the methodology employed in our study. The LUS and routine bedside portable CXR were directly compared with CT thorax, which served as the gold standard. As described in the methods section of the study, all LUS and CXR examinations were performed immediately before CT thorax, and the diagnostic performance metrics were calculated with respect to CT findings asthe standard of truth. This study design facilitated a rigorous and pragmatic head-to-head comparison of the two bedside modalities in the evaluation of various pulmonary pathologies under identical clinical conditions. The results of our study indicate that LUS significantly outperformed portable CXR in diagnosing five studied pathologies– pneumothorax, pleural effusion, consolidation, collapse, and pulmonary edema. However, these conditions can be accurately assessed when they are adjacent to the pleural surface.2 In various categories, including pleural effusion and consolidation, the sensitivity and positive predictive value of LUS were approximately 100%, reflecting a high-level concordance with CT. Conversely, the routine bedside CXR demonstrated a lower diagnostic accuracy, underscoring the limitations of the portable CXR, which have been widely recognized in the context of critical care imaging.2 The correspondents have appropriately highlighted several limitations of LUS. We fully concur that LUS is less sensitive for deeper parenchymal lesions surrounded by normally aerated lung. This is an inherent limitation of LUS, rooted in the physics of ultrasound rather than the proficiency of the operator.3 Similarly, in conditions with restricted acoustic windows, such as in obese or edematous patients, there can be a difficulty in accessing the dorsal zones of the lung, especially in mechanically ventilated patients. Additionally, the presence of thick dressings, drains, or medical devices can further reduce the image quality and occasionally limit the diagnostic yield. These practical considerations were acknowledged in our discussion and reflect real-world practices in the ICU, where both LUS and portable CXRs face similar constraints when compared to CT scans.1 1Department of Acute Medicine, King’s Mill Hospital, Mansfield, United Kingdom 2Department of Anaesthesia, Intensive Care and Pain, Faculty of Medicine, Al-Azhar University, Cairo, Egypt 3Anaesthesia and Critical Care Medicine, New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom Corresponding Author: Prashant Nasa, Anaesthesia and Critical Care Medicine, New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom, Phone: +447852862083, e-mail: [dr.prashantnasa@hotmail.com](dr.prashantnasa@hotmail.com) How to cite this article: AlTayarAS, Salem HA, Nasa P. Author Response: Lung Ultrasound in the Intensive Care Unit: Strengths, Limitations, and the Continued Role of Computed Tomography. Indian J Crit Care Med 2025;29(12):1056–1057 . Source of support: Nil Conflict of interest: None We also agree that in complex polytrauma patients or with suspected occult thoracic pathology, a

FAQs

How was CT used in the study design for this response?

LUS and routine portable CXR were performed immediately before CT thorax, and diagnostic metrics were calculated against CT findings as the gold standard.

Which thoracic pathologies did the authors report as better diagnosed with LUS than with portable CXR?

LUS significantly outperformed portable CXR for pneumothorax, pleural effusion, consolidation, collapse, and pulmonary edema, particularly when lesions were adjacent to the pleural surface.

What limitations of lung ultrasound does the author response emphasize?

LUS is less sensitive for deeper parenchymal lesions surrounded by normally aerated lung, and image acquisition can be difficult in patients with restricted acoustic windows such as obesity, edema, or mechanically ventilated dorsal-zone access issues, as well as when thick dressings or devices are present.

Sep 30, 2026

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