POCUS for EPTB Among people who develop TB, EPTB is more common in PLHIV than in those without HIV and is more common in children than in adults [61]. In 2012, a protocol was developed for focused assessment with sonography for HIV-associated TB (FASH), a triaging ultrasound scan comprising six probe positions on the thorax and abdomen that aims to identify signs consistent with EPTB that should prompt further investigation [62]. A 2019 Cochrane Review found that the use of FASH or similar abdominal ultrasound scans had a pooled sensitivity and specificity of 63% and 68%, respectively [63], and can be used in combination with other diagnostic strategies for EPTB, although the data were limited and of low certainty [63]. A randomised controlled trial of the use of an extended version of FASH, known as eFASH, in Tanzania found that eFASH did not increase the proportion of patients who were correctly managed at 6 months (the study’s primary outcome), but it did increase the proportion of patients diagnosed with definite TB [64]. POCUS for PTB For the diagnosis of adult pneumonia, lung ultrasound has at least equivalent sensitivity and specificity to CXR [65]. A finding that POCUS has similar diagnostic accuracy to CXR for PTB would be an important development. However, the current evidence base is limited and of poor quality. A 2021 systematic review found few studies and could not produce pooled FIGURE 3 Ultrasound machine in use in a tertiary care centre in India. Image provided by and reproduced with the kind permission of Stefan Weber (Division of Infectious Disease and Tropical Medicine, Department of Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany). https://doi.org/10.1183/2312508X.10024322 85 IMAGING AND DIAGNOSIS |J. BIGIO ET AL.