Comparison of thoracic ultrasonography and thoracic radiography between healthy adult horses and horses with bacterial pneumonia using a novel, objective ultrasonographic scoring system.
Authors: Hepworth-Warren Kate L, Nelson Nathan, Dembek Katarzyna A, Young Kimberly A S
Journal: Frontiers in veterinary science
Summary
# Editorial Summary: Ultrasonographic Assessment of Equine Pneumonia Thoracic ultrasonography is increasingly accessible in equine practice, yet evidence validating its diagnostic utility against the gold standard of radiography remains sparse. Hepworth-Warren and colleagues prospectively evaluated 22 adult horses (13 healthy controls and 9 with bacterially-confirmed pneumonia) using a novel objective ultrasonographic scoring system that quantified comet tail artefacts, pleural effusion, and pulmonary consolidation across intercostal spaces, comparing results with radiographic assessment in 18 of these animals. The diseased group demonstrated significantly elevated ultrasonographic scores (median 126 versus 20 in controls; p=0.01), with the scoring system achieving 66.7% sensitivity and 92.3% specificity at a cutoff threshold of 37 for identifying bacterial pneumonia. These findings suggest that whilst thoracic ultrasonography shows high specificity—making it a reliable rule-in test—its moderate sensitivity means normal or borderline scans cannot definitively exclude pneumonia and should be interpreted alongside clinical findings. For practitioners in remote locations or field settings where portable ultrasound is more readily available than radiography, this modality offers a practical standalone diagnostic option, though radiographic confirmation may still be warranted in ambiguous cases or when clinical suspicion remains high despite borderline ultrasonographic findings.
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Practical Takeaways
- •Thoracic ultrasonography can serve as a reliable standalone diagnostic tool for bacterial pneumonia in horses when radiography is unavailable or impractical, particularly given its high specificity (92%)
- •Use a TUS score cutoff of 37 to distinguish diseased from healthy horses; scores above this threshold warrant investigation for pneumonia
- •The high specificity means positive ultrasonographic findings are likely true positives, reducing false diagnoses and unnecessary treatment
Key Findings
- •Ultrasonographic scores were significantly higher in horses with bacterial pneumonia (median 126) compared to healthy controls (median 20, p=0.01)
- •Thoracic ultrasonography demonstrated 66.7% sensitivity and 92.3% specificity for identifying bacterial pneumonia using a TUS score cutoff of 37
- •A novel objective ultrasonographic scoring system evaluating comet tail lesions, pleural effusion, and pulmonary consolidation was successfully validated for equine thoracic imaging