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The response endorses comparable performance for key conditions and notes that lung ultrasound could be incorporated into routine assessment, while emphasizing five practical limitations related to lesion location, polytrauma-related misses, reduced acoustic penetration in obese or edematous patients, difficulty imaging posterior lung zones in noncooperative or supine ventilated patients, and constraints from bone structures and devices. The letter argues for ultrasound as a radiation-free bedside complement rather than a universal CT replacement, reserving CT for diagnostic uncertainty or when comprehensive cross-sectional evaluation is essential.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/lung-ultrasound-in-the-icu-strengths-limitations-and-the-continued-role-of-computed-tomography-letter-to-the-editor/449047/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/lung-ultrasound-in-the-icu-strengths-limitations-and-the-continued-role-of-computed-tomography-letter-to-the-editor/449047.png","ImageObject",300,407,{"name":92,"@type":93},"Stanford","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-04","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":81},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What is the main conclusion about lung ultrasound (LUS) use in the ICU?","Question",{"text":112,"@type":113},"LUS should be incorporated into regular assessment of mechanically ventilated patients, but it should not be viewed as a universal replacement for CT. CT remains important when diagnostic uncertainty exists or comprehensive cross-sectional evaluation is required.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"Which lung conditions may be missed by LUS due to lesion location?",{"text":117,"@type":113},"LUS can visualize only pathologies abutting the visceral pleura, limiting detection of deep-seated consolidation or collapse surrounded by normally aerated lung—conditions that are often evident on CT, particularly in focal pneumonia, early ARDS, or lobar collapse.",{"name":119,"@type":110,"acceptedAnswer":120},"Why might LUS be less reliable in obese or edematous patients?",{"text":121,"@type":113},"Ultrasound penetration may be impaired due to increased chest wall thickness and soft-tissue edema, reducing diagnostic accuracy for small pleural effusions, dependent atelectasis, and subtle interstitial edema, whereas CT can still provide clearer diagnostic information.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},449047,1790959610,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":81,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":14,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":24},2336477552062,"https://ap-avatar.wpscdn.com/davatar_994ba38a5ba835b3df7d355c54d3ed8d","LETTER TO THE EDITOR  \nLung Ultrasound in the ICU: Strengths, Limitations, and the Continued Role of Computed Tomography  \nKundan N Mehta1, Drashti M Otiya2  \nKeywords: Bedside ultrasound, Chest X-ray, Computed tomography.  \nIndian Journal of Critical Care Medicine (2025): 10.5005/jp-journals-10071-25106  \nDear Editor,  \nWe read with the great interest the article by Al Tayar et al.,“Comparative Analysis of Lung Ultrasound, Computed Tomography, and X-ray in the Diagnosis of Common Pathologies among Critically Ill Mechanically Ventilated Patients—A Prospective Observational Study,” which depicts that the performance between the lung ultrasound (LUS) and computed tomography (CT) of chest for pneumothorax, pleural effusion, consolidation, lung collapse, and pulmonary edema as equivalent, and clearly outperforms portable chest radiography in an intensive care setting.1 The study strongly suggests the incorporation of LUS into the regular assessment of mechanically ventilated patients.  \nThough LUS has its utility in some lung conditions, there are documented limitations of its use even in the five conditions considered in the study. This demands further discussion.  \n1. Only pathologiesabutting the visceral pleura like pneumothorax, consolidation, collapse, and edema can be visualized on LUS, restricting its use in observing deep-seated consolidation or collapse surrounded by normally aerated lung, despite being clearly evident on a CT chest, which is particularly important in focal pneumonia, early acute respiratory distress syndrome (ARDS), or lobar collapse.  \n2. Among the polytrauma patients included in this cohort, the possibility of LUS (and related FAST protocols) missing out on detecting small or deeply located solid organ contusions ofthe liver, spleen, or kidneys, as well as limited lung contusions that do not reach the pleural surface, is quite high.  \n3. Ultrasound penetration may often be impaired in obese or edematous patients.2 Increased chest wall thickness and softtissue edema may show acoustic limitations in the diagnosis of small pleural effusions, dependent atelectasis, or subtle interstitial edema, whereas CT chest can still provide clear diagnostic information.  \n4. In intubated or otherwise noncooperative patients, access to posterior lung zones is frequently compromised. Posterior views are pivotal for identifying small loculated effusions, dependent collapse, and posterior consolidations. In supine ventilated patients, obtaining these windows are often challenging, potentially leading to poor diagnostic accuracy compared to the controlled conditions ofa prospective imaging protocol.  \n5. Bone structures and medical devices may restrict acquiring an accurate LUS. Scapulae, ribs, chest wall dressings, drains,  \n1Department of Respiratory Medicine, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pune, Maharashtra, India 2Department of Pulmonary Medicine, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pune, Maharashtra, India Corresponding Author: Drashti M Otiya, Department of Pulmonary Medicine, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pune, Maharashtra, India, Phone: +91 9979151210, e-mail: [otiyadrashti@gmail.com](otiyadrashti@gmail.com)  \nHow to cite this article: Mehta KN, Otiya DM. Lung Ultrasound in the ICU: Strengths, Limitations, and the Continued Role of Computed Tomography. Indian J Crit Care Med 2025;29(12):1054–1055 .  \nSource of support: Nil  \nConflict of interest: None  \nand monitoring equipment commonly restrict ultrasound capabilities, particularly for posterior-lateral pneumothoraxes or retro-scapular consolidations, and may limit the detection of clinically important but anatomically “hidden” lesions.3  \nRecognizing these limitations does not diminish the value of the authors’ findings; instead, it reinforces the view that LUS should be considered a powerful, radiation-free, bedside complement rather than a universal replacement for CT. When","cbCaijml5PUWmHe3","https://ap.wps.com/l/cbCaijml5PUWmHe3","pdf",166583,"English","# Introduction\n## Incorporation of LUS into routine ICU assessment\n# Limitations of LUS vs CT\n## Lesions not abutting the visceral pleura\n## Potential misses in polytrauma\n## Acoustic impairment in obese or edematous patients\n## Limited access to posterior lung zones\n## Obstruction from bone structures and medical devices\n# Clinical implications for using CT","[{\"question\":\"What is the main conclusion about lung ultrasound (LUS) use in the ICU?\",\"answer\":\"LUS should be incorporated into regular assessment of mechanically ventilated patients, but it should not be viewed as a universal replacement for CT. CT remains important when diagnostic uncertainty exists or comprehensive cross-sectional evaluation is required.\"},{\"question\":\"Which lung conditions may be missed by LUS due to lesion location?\",\"answer\":\"LUS can visualize only pathologies abutting the visceral pleura, limiting detection of deep-seated consolidation or collapse surrounded by normally aerated lung—conditions that are often evident on CT, particularly in focal pneumonia, early ARDS, or lobar collapse.\"},{\"question\":\"Why might LUS be less reliable in obese or edematous patients?\",\"answer\":\"Ultrasound penetration may be impaired due to increased chest wall thickness and soft-tissue edema, reducing diagnostic accuracy for small pleural effusions, dependent atelectasis, and subtle interstitial edema, whereas CT can still provide clearer diagnostic information.\"}]","Lung Ultrasound in the ICU - Strengths, Limitations, and the Continued Role of Computed Tomography - Letter to the Editor | PDF",1790729278]