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Purpose: For many years the lung has been considered off-limits for ultrasound. However, it has been recently shown that lung ultrasound (LUS) may represent a useful tool for the detection of many pulmonary conditions, including the assessment of pulmonary congestion, that is obtained by the evaluation of B-lines, the sonographic sign of pulmonary interstitial syndrome. Our aim was to determine the accuracy of LUS to rule out congestive heart failure in patients with acute dyspnoea.Methods: One-hundred and three patients (56% females, mean age 61±17 years) admitted for acute dyspnoea to the Emergency Department, underwent a bedside LUS examination by a portable pocket size device with a cardiac probe, before the institution of any therapy. Right and left antero-lateral hemithoraxes were scanned, as previously described. A positive LUS test was considered when more than 3 B-lines were found on more than two scanning sites, bilaterally and/or by the presence of bilateral pleural effusion. All patients underwent a chest X-ray (CXR). Two independent physicians, blinded to LUS findings, reviewed all the medical records to establish the aetiology of the dyspnoea.Results: LUS was always performed in less than 5 minutes, with 99.5% feasibility. Dyspnoea due to pulmonary congestion was confirmed in 29 patients (Group 1) and excluded in 74 patients (Group 2). Mean B-lines number was 72±48 in Group 1 and 17±37 in Group 2 (p<.0001). A positive LUS test was found in 102/103 patients with a diagnosis of pulmonary congestion and in 8/103 patients with other diagnosis (interstitial lung disease, n=4; H1N1 influenza, n=1; lung cancer, n=2; tubercolosis, n=1). Accuracy of LUS and CXR to detect signs of pulmonary congestion is shown in the table.Conclusions: Although not specific, B-lines are more sensitive than CXR for the evaluation of pulmonary congestion. In a dyspnoic patient, the absence of bilateral B-lines can reliably exclude the presence of pulmonary congestion with a 5-minute bedside examination.