Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Memorial Hospital of Rhode Island, The Warrant Alpert Medical School of Brown University, Pawtucket, RI, USAUnited States
Department of Medicine, Memorial Hospital of Rhode Island, The Warren Alpert Medical School of Brown University, Pawtucket, RI, USAUnited States
Department of Respiratory Medicine, Kyorin University School of Medicine, Tokyo, Japan The year 2016 marks the 200
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The year 2016 marks the 200th anniversary of the invention of the stethoscope by Dr. Réne Théophile Hyacinthe Laennec. He was first inspired in September 1816 when he observed 2 children playing with a long piece of solid wood and a pin. He later made the very first stethoscope when he rolled a paper to listen to the heart sounds of a young woman. He further refined the instrument by constructing it with a hollow tube of wood.
PULMONARY RESEARCH AND RESPIRATORY MEDICINE ISSN 2377-1658 http://dx.doi.org/10.17140/PRRMOJ-4-133 Open Journal Commentary Modern Technology in Respiratory * *Corresponding author Medicine: Lung Ultrasonography–Is it Time Taro Minami, MD Assistant Professor of Medicine for the Stethoscope to Give Up its Throne?
Department of Medicine Division of Pulmonary Critical Care and Sleep Medicine Memorial Hospital of Rhode Island 1* 2 1 3 Taro Minami, MD ; Akiko Minami, MD ; Kamran Manzoor, MD ; Takeshi Saraya, MD, PhD The Warren Alpert Medical School of Brown University Pawtucket, RI, USA 1 Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Tel. +1-401-729-2635 Memorial Hospital of Rhode Island, The Warrant Alpert Medical School of Brown University, Fax: +1-401-729-2157 Pawtucket, RI, USA E-mail: nantaro@gmail.com 2Department of Medicine, Memorial Hospital of Rhode Island, The Warren Alpert Medical School of Brown University, Pawtucket, RI, USA Volume 4 : Issue 1 3 Department of Respiratory Medicine, Kyorin University School of Medicine, Tokyo, Japan Article Ref. #: 1000PRRMOJ4133 th Article History The year 2016 marks the 200th anniversary of the invention of the stethoscope by th Received: August 16th, 2016 Dr. Réne Théophile Hyacinthe Laennec. He was first inspired in September 1816 when he th Accepted: September 29th, 2016 observed 2 children playing with a long piece of solid wood and a pin. He later made the very th first stethoscope when he rolled a paper to listen to the heart sounds of a young woman. He Published: September 29 , 2016 further refined the instrument by constructing it with a hollow tube of wood.1 Three years later, in 1819, he published a textbook, which has been the foundation of respiratory medicine. In Citation his textbook titled “De l’Auscultation Médiate ou Traité du Diagnostic des Maladies des Pou- Minami T, Minami A, Manzoor K, Sa- monset du Coeur (On Mediate Auscultation or Treatise on the Diagnosis of the Diseases of the raya T. Modern technology in respi- ratory medicine: Lung ultrasonogra- Lungs and Heart)”, he introduced the terms that we still use in respiratory medicine, such as phy–Is it time for the stethoscope to “rale”, “rhonchi,” or “egophony”. Laennec founded the basis of modern respiratory medicine give up its throne? Pulm Res Respir with the invention of this remarkable tool. The stethoscope remains an indispensable tool for Med Open J. 2016; 4(1): 19-20.
physicians, and not a single day passes without it being used to examine a patient. However, doi: 10.17140/PRRMOJ-4-133 in the last decade, notable controversies have emerged regarding the utilization of the stetho- scope.2 It is interesting to learn how this new technology was perceived when Laennec first introduced the stethoscope. While this diagnostic tool was generally well received, as reported by the New England Journal of Medicine in 1821,3 Simmons described in his book that some th physicians rejected this instrument in the 20th century and preferred to apply their ears to their patients.4 The history of lung ultrasonography, on the other hand, is relatively new. Lichten- stein published a paper in 1995 that assessed movement of the lung surface to demonstrate the absence of pneumothorax, which has been termed as “lung sliding”.5 He also proposed to as- sess lung parenchyma itself by utilizing artifacts, such as reverberation artifact and ring-down artifact, which he named A-line and B-line.6 Given its relatively new history, it may not be surprising that the utilization of lung ultrasonography has not been fully appreciated in the field of internal medicine.7 Lung ultrasonography is unique in the utilization of artifacts that were often considered to impede the analysis of images.
Diaphragm ultrasonography is another example of a technology that has changed the Copyright Minami T diagnostic approach to assess diaphragmatic function. Before this imaging modality was devel- ©2016 . This is an open access article distributed under the oped, it was relatively time consuming and invasive to diagnose diaphragm dysfunction by flu- Creative Commons Attribution 4.0 oroscopy or by electromyography. McCool et al reported that with the aid of ultrasonography, International License (CC BY 4.0), the movement of the diaphragm dome and thickening of the diaphragm itself may be directly which permits unrestricted use, observed in real time. This can be performed at the bedside in the intensive care unit (ICU) or distribution, and reproduction in any medium, provided the original in the clinic for convenient identification of the presence or absence of diaphragm dysfunction. work is properly cited. Though its history is relatively new, ultrasonography is becoming a standard tool in the field of Open Journal ISSN 2377-1658 http://dx.doi.org/10.17140/PRRMOJ-4-133 pulmonary and critical care medicine. Mayo et al9 at the Ameri- 4. Simmons JG. Doctors and Discoveries: Lives that Created can College of Chest Physicians (ACCP) have already recog- Today’s Medicine. Boston, USA: Houghton Mifflin Company; nized its importance and published a statement in competencies 2002.
of ultrasonography for critical care physicians 7 years ago.
5. Lichtenstein DA, Menu Y. A bedside ultrasound sign ruling Regarding diagnostic accuracy, the stethoscope may out pneumothorax in the critically ill-lung sliding. Chest. 1995; not be as strong a tool as hoped for, especially for trainees. A 108(5): 1345-1348.
study by Mangione revealed a striking deficiency in pulmonary auscultatory skills among internal medicine and family prac- 6. Lichtenstein DA, Mezière GA. Relevance of lung ultrasound tice trainees as they recognized less than half of all respiratory in the diagnosis of acute respiratory failure: The BLUE protocol.
events.10 He also described “disturbingly low” cardiac ausculta- Chest. 2008; 134(1): 117-125. doi: 10.1378/chest.07-2800 tory skills among internal medicine and family medicine train- ees since they recognized 20% of all cardiac events.11 Lung ul- 7. Fuhlbrigge AL, Choi AMK. Diagnostic Procedures in Respi- trasonography, on the other hand, clearly gives different results.
ratory Disease in Harrison’s Principles of Internal Medicine.
th Lichtenstein described in his original article that the absence of 19th ed. McGraw-Hill, New York, USA: Elsevier; 2015.
lung sliding to detect pneumothorax has extremely high sensitiv- ity of 95.3% and specificity of 91.1% with positive predictive 8. McCool FD, Minami T. Diaphragm ultrasound in the ICU. In: value of 87% and negative predictive value of 100%.5 Jankowich M, Gartman E, ed. Ultrasound in the Intensive Care Unit. New York, NY, USA: Humana Press; 2015: 235-238.
People may have a reasonable concern regarding new technology, as the novelty of using such technology may distract 9. Mayo PH, Beaulieu Y, Doelken P, et al. American College of physicians from focusing on their patients. Criticism is often di- Chest Physicians/La Société de Réanimation de Langue Fran- rected towards physicians who tend to care less about the cru- çaise statement on competence in critical care ultrasonography.
cial part of data gathering by history and physical examination.
Chest. 2009; 135(4): 1050-1060. doi: 10.1378/chest.08-2305 While we acknowledge these potential pitfalls of new technolo- gies, we should not deny its potential to revolutionize the world 10. Mangione S, Nieman LZ. Pulmonary auscultatory skills of medicine, as seen with the stethoscope, chest radiograph, or during training in internal medicine and family practice. Am computed tomography, and the potential to create an entire new J Respir Crit Care Med. 1999; 159(4 Pt 1): 1119-1124. doi: horizon, as Laennec did with the stethoscope 200 years ago.
10.1164/ajrccm.159.4.9806083 In conclusion, the time for the stethoscope to give up its 11. Mangione S, Nieman LZ. Cardiac auscultatory skills of in- throne to lung ultrasonography may not have arrived; although ternal medicine and family practice trainees. A comparison of in the near future, such an occurrence may be likely as the use diagnostic proficiency. JAMA. 1997; 278(9): 717-722. doi: 10.
of lung ultrasonography increases in the world of respiratory 1001/jama.1997.03550090041030 medicine. Hopefully, it will follow the path of its predecessor to revolutionize the field of medicine.
CONFLICTS OF INTEREST The authors declare that they have no conflicts of interest.