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Background Congestion score index (CSI), a semiquantitative evaluation of congestion on chest radiography (CXR), is associated with outcome in patients with heart failure (HF). However, its diagnostic value in patients admitted for acute dyspnea has yet to be evaluated. Methods and findings The diagnostic value of CSI for acute HF (AHF; adjudicated from patients' discharge files) was studied in the Pathway of dyspneic patients in Emergency (PARADISE) cohort, including patients aged 18 years or older admitted for acute dyspnea in the emergency department (ED) of the Nancy University Hospital (France) between January 1, 2015 and December 31, 2015. CSI (ranging from 0 to 3) was evaluated using a semiquantitative method on CXR in consecutive patients admitted for acute dyspnea in the ED. Results were validated in independent cohorts (N = 224). Of 1,333 patients, mean (standard deviation [SD]) age was 72.0 (18.5) years, 686 (51.5%) were men, and mean (SD) CSI was 1.42 (0.79). Patients with higher CSI had more cardiovascular comorbidities, more severe congestion, higher b-type natriuretic peptide (BNP), poorer renal function, and more respiratory acidosis. AHF was diagnosed in 289 (21.7%) patients. CSI was significantly associated with AHF diagnosis (adjusted odds ratio [OR] for 0.1 unit CSI increase 1.19, 95% CI 1.16-1.22, p 0.80, whether alone (area under the receiver operating characteristic curve [AUROC] 0.84, 95% CI 0.82-0.86) or in addition to the clinical model (AUROC 0.87, 95% CI 0.85-0.90). CSI improved diagnostic accuracy on top of clinical variables (net reclassification improvement [NRI] = 94.9%) and clinical variables plus BNP (NRI = 55.0%). Similar diagnostic accuracy was observed in the validation cohorts (AUROC 0.75, 95% CI 0.68-0.82). The key limitation of our derivation cohort was its single-center and retrospective nature, which was counterbalanced by the validation in the independent cohorts. Conclusions In this study, we observed that a systematic semiquantified assessment of radiographic pulmonary congestion showed high diagnostic value for AHF in dyspneic patients. Better use of CXR may provide an inexpensive, widely, and readily available method for AHF triage in the ED., Author(s): Masatake Kobayashi 1, Amine Douair 2, Kevin Duarte 1, Déborah Jaeger 1,2, Gaetan Giacomin 2, Adrien Bassand 2, Victor Jeangeorges 2, Laure Abensur Vuillaume 3, Gregoire Preud'homme 1, Olivier [...]

A 51-year-old man presented to the internal medicine clinic for a Department of Transportation medical examination to renew his commercial motor vehicle license. He denied any symptoms at the time [...]

A case study of a 44-year-old man with dyspnea and new atrial fibrillation who received diagnosis of mild mitral regurgitation at 28 years of age but has not visited a physician in many years is presented. Physical examination of the patient which revealed a holosystolic murmur and a soft [S.sub.3] and repeat echocardiography showed a flail posterior leaflet and moderate-to-severe mitral regurgitation suggested surgery at a center experienced in mitral-valve repair on the basis of symptoms and atrial fibrillation.

A 68-year-old woman with a history of hypertension, paroxysmal atrial fibrillation, and liver transplant for primary sclerosing cholangitis (PSC) presented with a 2-month history of cough and shortness of breath. [...]

The case of an 89-year-old man with progressive dyspnea is discussed to better understand acute exacerbation of pulmonary asbestosis. The different diagnostic procedures, treatment methodologies and management regimes for the disease are highlighted.

The case of a 67-year-old man with a history of dyspnea is discussed to better understand the causes, diagnosis and treatment of severe chronic obstructive pulmonary disease (COPD). The different treatment methodologies and management regimes for COPD are also highlighted.

A 38-year-old woman presented to the emergency department because of increasing fatigue and shortness of breath, worsening during the past 2 months. At the time of presentation, even minimal exertion [...]

The case of a 25-year-old woman admitted to hospital with dyspnea is discussed to better understand pulmonary hypertension. The causes, symptoms, diagnosis, treatment methodologies and management of the disease are highlighted.

The case of a 27-year-old man with progressive dyspnea is discussed to better understand the Hermansky-Pudlak syndrome (HPS). The clinical manifestations of HPS, as well as treatment and management strategies are highlighted.

A 25-year-old woman presented to her local emergency department with symptoms of increasing abdominal girth and shortness of breath during the previous week. Her clothes no longer fit at her [...]

A 54-year-old previously healthy male farmer presented to our institution with a 2-week history of dyspnea. Notably, he had just finished working in his fields for the season and had [...]

The article discusses the symptoms, diagnosis and treatment methodologies for drug-induced lung disease caused due to either infliximab or balsalazide. A case study of a 63-year-old woman with dyspnea on exertion is highlighted to better understand the reasons behind drug-induced lung disease.

The article discusses how an array of varied and unrelated symptoms though not explained by a single diagnosis can result in a unifying cause by understanding their simultaneous development. A case study of a 57-year-old man with progressive dyspnea and exertion, edema of upper and lower legs is highlighted to understand multi-organ disease.

A 63-year-old man with cryptogenic cirrhosis who was on the orthotopic liver transplant list presented with dyspnea. During the past several months, the patient had become increasingly more short of [...]

Various patients are examined to investigate the prognostic significance of a common symptom dyspnea among patients consulting for cardiac stress check-up. The study reveals that a subgroup of otherwise asymptomatic patients who reported dyspnea were in great danger of death from cardiac or other causes, and hence testing for dyspnea is considered necessary while examining cardiac patients.

A 24-year-old sailor describes dyspnea in the setting of substantial weight gain, where the degree of weight gain and the time course suggest that this is a subacute process and the differential diagnosis is broad and includes cardiac, pulmonary, hepatic and renal dysfunction. The sailor had evidence of fluid on the pleural and peritoneal spaces and according to the results of chest radiography, pericardial effusion as well.

Byline: Patrick Ray (1), Martine Arthaud (2), Yannick Lefort (3), Sophie Birolleau (3), Catherine Beigelman (4), Bruno Riou (1) Keywords: Acute dyspnea; Elderly patients; Emergency department; Cardiogenic pulmonary edema; B-type natriuretic peptide Abstract: Objective Differentiating cardiogenic pulmonary edema (CPE) from respiratory causes of dyspnea is particularly difficult in elderly patients. The aim of our study was to evaluate B-type natriuretic peptide (BNP) in patients older than 65 years presenting with acute dyspnea. Design Prospective study. Setting Medical emergency department of a 2000-bed urban teaching hospital. Patients Patients aged over 65 years presenting with acute dyspnea and a respiratory rate more than 25/min or a PaO.sub.2 below 70 mmHg, Sp[O.sub.2 ]less than 92%, PaCO.sub.2 higher than 45 mmHg with pH less than 7.35, were included. BNP levels, measured blind at admission were compared with the final diagnosis (CPE or no CPE) as defined by experts. Intervention None. Measurements and results Three hundred eight patients (mean age of 80 years) were enrolled in the study. The median BNP was 575 pg/ml [95% confidence interval (CI): 410--898] in the CPE group (n=141) versus 75 pg/ml (95% CI: 59--98) in the no CPE group (n=167) (p Conclusion Analysis of BNP is useful in elderly patients with acute dyspnea, but the threshold value is higher than that previously determined. Author Affiliation: (1) Department of Emergency Medicine and Surgery, Centre Hospitalo-Universitaire (CHU) Pitie-Salpetriere Hospital, Assistance-Publique Hopitaux de Paris (AP-HP), Universite Pierre et Marie Curie, 47 boulevard de l'Hopital, 75013, Paris, France (2) Laboratory of Emergency Biology, Centre Hospitalo-Universitaire (CHU) Pitie-Salpetriere Hospital, Assistance-Publique Hopitaux de Paris (AP-HP), Universite Pierre et Marie Curie, 47 boulevard de l'Hopital, 75013, Paris, France (3) Department of Pneumology, Centre Hospitalo-Universitaire (CHU) Pitie-Salpetriere Hospital, Assistance-Publique Hopitaux de Paris (AP-HP), Universite Pierre et Marie Curie, 47 boulevard de l'Hopital, 75013, Paris, France (4) Department of Radiology, Centre Hospitalo-Universitaire (CHU) Pitie-Salpetriere Hospital, Assistance-Publique Hopitaux de Paris (AP-HP), Universite Pierre et Marie Curie, 47 Boulevard de l'Hopital, 75013, Paris, France Article History: Registration Date: 24/09/2004 Received Date: 07/12/2003 Accepted Date: 15/09/2004 Online Date: 22/10/2004 Article note: Presented, in part, at the 30th annual congress of the Societe de Reanimation de Langue Francaise, Paris, January 2002 (abstract no. SP 94).