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2011, Number 1

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Med Crit 2011; 25 (1)

Ultrasound pulmonary patterns in seriously ill patients

Carrillo ER, Carrillo CJR, Carrillo CLD

Language: Spanish
References: 35
Page: 24-32
PDF size: 374.96 Kb.


ABSTRACT

Introduction: Pulmonary ultrasonography (PUS) is a new diagnostic tool for pleuropulmonar disease in the critically ill patient. Images obtained in this study results from the interaction between the ultrasound waves with the pleura, the pulmonary parenchyma and the air-liquid interface.
Objective: To describe the lung ultrasonographic patterns of patients hospitalized in the intensive care unit with diagnosis of pneumotórax, pleural effusion, alveolar-interstitial syndrome (pulmonary edema and interstitial lung disease) and Acute Respiratory Distress Syndrome (ARDS, and review the principles of lung ultrasonography.
Patients and methods: 60 patients were included. 40 male and 20 female. Of the total group, 20 were carriers of pleural effusion, 10 pneumothorax, 15 Acute Respiratory Distress Syndrome and 15 alveolar-interstitial syndrome. In these patients the clinical diagnosis was confirmed with chest radiography and computed axial tomography. Patients underwent sequential lung ultrasound in real time and M-mode using a 10 MHz convex transducer. The pneumothorax pattern is characterized by loss of pleural undulating movement, the presence of «stratosphere sign», characterized by loss of the sign from the beach and its replacement by horizontal lines and the presence of lung point sign and line A. The pattern of pleural effusion is characterized by loss of chest movement, hydro-air level, and the curtain sign. The pattern of alveolar-interstitial syndrome is characterized by loss of pleural line movement and «rockets», characterized by the presence of multiple thin B lines. The pattern of Acute Respiratory Distress Syndrome is characterized by the combination of pleural effusion, alveolar-interstitial syndrome and condensation.
Conclusion: PUS practiced in the Intensive Care Unit is one of the most promising diagnostic procedures in the Intensive Care Medicine. Based on scientific evidence the sensibility and specificity of lung ultrasound is high for the diagnosis of pneumothorax, alveolar-interstitial syndrome, ARDS, and pleural effusion. The practice and indications of this tool will surely extend in the coming years.


REFERENCES

  1. Scalea TM, Rodríguez A, Chic WC. Consensus Conference Committee. Focused assessment with sonography for trauma (FAST): results from an international consensus conference. J Trauma 1999;46:466-480.

  2. Dubs-Kunz B. Sonography of the chest wall. Eur J Ultrasound 1996;3:103-111.

  3. Mathis G. Thorax sonography: Part I. Chest wall and pleura. Ultrasound Med Biol 1997;23:1131-1139.

  4. Rantanen NW. Diseases of the Thorax. Vet Clin North Am 1986;2:49-66.

  5. Wernecke K, Galanski M, Peters PE, Hansen J. Pneumothorax: evaluation by ultrasound preliminary results. J Thorac Imag 1987;2:76-78.

  6. Lichtenstein D. General ultrasound in the critically ill. 2nd ed. Berlin, Germany: Springer-Verlag 2005:55-75.

  7. Soldati G, Testa A, Silva F, Carbone L, Portale G, Silveri N. Chest Ultrasonography in Lung Contusion. Chest 2006;130:533-538.

  8. Soldati G. Lung sonography: artifact, movement or echotexture. G Ital Ecografia 2001;4:329-338.

  9. Lichtenstein D, Meziere G, Biderman P, Gepner A, Barre O. The comet- tail artifact: an ultrasound sign of alveolar-intersticial syndrome. Am J Respir Crit Care Med 1997;156:1640-1646.

  10. Lichtenstein D, Meziere G: Ultrasound diagnosis of an acute dyspnea. Crit Care 2003;7:93-97.

  11. Kollef MH. Risk factors for the misdiagnosis of pneumothorax in the intensive care unit 1991;19:906-910.

  12. Chiles C, Ravin CE. Radiographic recognition of pneumothorax in the Intensive Care Unit. Crit Care Med 1986;14:677-680.

  13. Hill SL, Edmisten T, Holtzman G. The occult pneumothorax: an increasing diagnostic entity in trauma. Am Surg 1999;65:254-258.

  14. Gobien RP, Reines HD, Schabel SI. Localized tension pneumothorax: unrecognized form of barotrauma in ARDS. Radiology 1982;142:15-19.

  15. Wernecke K, Galanski M, Peters PE, Hansen J. Pneumothorax: evaluation by ultrasound. Preliminary results. J Thorac Imaging 1987;2:79-82.

  16. Rowan KR, Kirkpatrick AW, Liu D. Traumatic pneumothorax. Detection with thoracic US: Correlation with chest radiography and CT. Radiology 2002;225:210-214.

  17. Kirkpatrick AW, Ng AK, Dulchavsky SA. Sonographic diagnosis of a pneumothorax inapparent on plain radiography: confirmation by CT. J Trauma 2001;50:750-752.

  18. Zhang M, Liu HZ, Yang XJ, Gan JX, Xu WS, You DX, Jiang YG. Rapid detection of pneumothorax by ultrasonography in patients with multiple trauma. Crit Care 2006;10:112-117.

  19. Lichtenstein DA, Meziere G, Lascols N, Biderman P, Courret JP, Gepner A, et al. Ultrasound diagnosis of occult pneumothorax. Crit Care Med 2005;33:1231-1237.

  20. Lichtenstein DA, Menu Y. A Bedside Ultrasound sign ruling out pneumothorax in the critically ill. Lung Sliding. Chest 1995;108:1345-1348.

  21. Targheta R, Bourgeois JM, Balmes P: Ultrasonographic approach to diagnosing hydropneumothorax. Chest 1992;101:931-934.

  22. Lichtenstein DA, Meziere G, Biderman P, Gepner A. The “ lung point”: an ultrasound sign specific to pneumothorax. Intensive Care Med 2000;26:1434-1440.

  23. Linchtenstein DA, Meziere G, Biderman P, Gepner A. The comet-tail artifact: an ultrasound sign rulling out pneumothorax. Intensive Care Med 1999;25:383-388.

  24. Tocino IM, Miller MH, Fairfax WR. Distribution of pneumothorax in the supine and semirecumbent critically ill adult. AJR 1985;144:901-905.

  25. Lichtenstein DA, Courret JP. Feasibility of ultrasound in the helicopter. Intensive Care Med 1998;24:1119.

  26. Yang PC, Luh DB, Chang CJ, Yu SH, Kuo D. Ultrasonographic evaluation of pulmonary consolidation. Am Rev Respir Dis 1992;146:757-762.

  27. Targhetta R, Chavagneux R, Bourgeois JM, Dauzat M, Balmes P, Pourcelot L. Sonographic approach to diagnosing pulmonary consolidation. J Ultrasound Med 1992;11:667-672.

  28. Wheeler AP, Carroll FE, Bernard GR. Radiographic issues in adult respiratory distress syndrome. New Horiz 1993;1:471-477.

  29. Puybasset L, Cluzel P, Gusman P, Grenier P, Preteux F, Rouby JJ. CT Scan ARDS Study Group: Regional distribution of gas and tissue in acute respiratory distress syndrome: Consequences on lung morphology. Intensive Care Med 2000;26:857-869.

  30. Rouby JJ, Puybasset L, Nieszkowsa A, Lu Q. Acute respiratory distress syndrome: Lessons from computed tomography of the whole lung. Crit Care Med 2003;31:285-295.

  31. Henschke CI, Yankelevitz DF, Wand A, Davis SD, Shiau M. Accuracy and efficacy of chest radiography in the intensive care unit. Radiol Clin North Am 1996;34:21-31.

  32. Lichtenstein DA, Goldstein I, Mourgeon E, Cluzel P, Grenier P, Rouby JJ. Comparative diagnostic performances of auscultation, chest radiography, and lung ultrasonography in acute respiratory distress syndrome. Anesthesiology 2004;100:9-15.

  33. Tsubo T, Sakai I, Suzuki A, Okawa H, Ishihara H, Matsuki A. Density detection in dependent left lung region using transesophageal echocardiography. Anesthesiology 2001;94:793-798.

  34. Puybasset L, Cluzel P, Chao N, Slutsky AS, Coriat P, Rouby JJ. A computed tomography scan assessment of regional lung volume in acute lung injury. Am J Respir Crit Care Med 1998;158:1644-1655.

  35. Lichtenstein AD. Ultrasound examination of the lung in the intensive care unit. Pediatr Crit Care 2009;10:693-698.




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