Point-of-Care Ultrasound in the Diagnostic Evaluation of Acute Dyspnea in the Emergency Department

Acute dyspnea is one of the most frequent and clinically challenging presentations in the emergency department, as it may originate from a broad spectrum of respiratory, cardiovascular, mixed, and systemic conditions with overlapping clinical manifestations. Rapid and accurate identification of the underlying etiology is essential to guide timely and appropriate management. Point-of-care ultrasound has emerged as a valuable diagnostic tool in this context, enabling real-time bedside assessment of cardiopulmonary structures and intravascular volume status. Lung ultrasound allows reliable identification of normal aeration patterns, interstitial syndromes, alveolar consolidation, pleural effusion, and pneumothorax, often demonstrating superior diagnostic performance compared with chest radiography and accuracy comparable to computed tomography for selected conditions. Focused cardiac ultrasound further enhances diagnostic capability by providing immediate evaluation of ventricular function, pulmonary edema, pericardial effusion, and indirect signs of acute pulmonary embolism. Assessment of the inferior vena cava complements cardiac and lung findings by offering insights into volume status and right atrial pressure, supporting differentiation between cardiogenic and non-cardiogenic causes of dyspnea. The integration of these modalities within structured multi-organ ultrasound protocols, such as EMERALD-US, BLUE, eFAST, and FATE, facilitates a systematic and efficient diagnostic approach. Evidence consistently demonstrates that PoCUS reduces time to diagnosis and treatment initiation, increases diagnostic confidence, and improves the likelihood of appropriate, etiology-directed therapy. Although its use has not been associated with significant reductions in mortality or readmission rates, it contributes to improved acute management and shorter intensive care unit stays. Despite these benefits, PoCUS remains limited by operator dependency, technical challenges, and overlapping sonographic findings across different pathologies, which may lead to misinterpretation. These limitations highlight the importance of standardized training, structured diagnostic algorithms, and continuous quality assurance to ensure safe and effective application of PoCUS in the evaluation of acute dyspnea.