Lung ultrasound in the critically ill (LUCI) and the lung point: a sign specific to pneumothorax which cannot be mimicked

Moreno-Aguilar, German; Lichtenstein, Daniel A.

doi:10.1186/s13054-015-1030-6

Cited by 21 publications

(13 citation statements)

References 3 publications

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“…Concerning the detection of pneumothorax, previous studies have already shown the advantages of US in comparison to CXR [ 36 – 38 ]. Furthermore, due to clear advantages, US has an increasing role in the critical care setting and ICU physicians are often trained in various US techniques [ 7 , 39 – 42 ].…”

Section: Discussionmentioning

confidence: 99%

Bedside ultrasound to detect central venous catheter misplacement and associated iatrogenic complications: a systematic review and meta-analysis

et al. 2018

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BackgroundInsertion of a central venous catheter (CVC) is common practice in critical care medicine. Complications arising from CVC placement are mostly due to a pneumothorax or malposition. Correct position is currently confirmed by chest x-ray, while ultrasonography might be a more suitable option. We performed a meta-analysis of the available studies with the primary aim of synthesizing information regarding detection of CVC-related complications and misplacement using ultrasound (US).MethodsThis is a systematic review and meta-analysis registered at PROSPERO (CRD42016050698). PubMed, EMBASE, the Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials were searched. Articles which reported the diagnostic accuracy of US in detecting the position of CVCs and the mechanical complications associated with insertion were included. Primary outcomes were specificity and sensitivity of US. Secondary outcomes included prevalence of malposition and pneumothorax, feasibility of US examination, and time to perform and interpret both US and chest x-ray. A qualitative assessment was performed using the QUADAS-2 tool.ResultsWe included 25 studies with a total of 2548 patients and 2602 CVC placements. Analysis yielded a pooled specificity of 98.9 (95% confidence interval (CI): 97.8–99.5) and sensitivity of 68.2 (95% CI: 54.4–79.4). US examination was feasible in 96.8% of the cases. The prevalence of CVC malposition and pneumothorax was 6.8% and 1.1%, respectively. The mean time for US performance was 2.83 min (95% CI: 2.77–2.89 min) min, while chest x-ray performance took 34.7 min (95% CI: 32.6–36.7 min). US was feasible in 97%. Further analyses were performed by defining subgroups based on the different utilized US protocols and on intra-atrial and extra-atrial misplacement. Vascular US combined with transthoracic echocardiography was most accurate.ConclusionsUS is an accurate and feasible diagnostic modality to detect CVC malposition and iatrogenic pneumothorax. Advantages of US over chest x-ray are that it can be performed faster and does not subject patients to radiation. Vascular US combined with transthoracic echocardiography is advised. However, the results need to be interpreted with caution since included studies were often underpowered and had methodological limitations. A large multicenter study investigating optimal US protocol, among other things, is needed.Electronic supplementary materialThe online version of this article (10.1186/s13054-018-1989-x) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Bedside ultrasound to detect central venous catheter misplacement and associated iatrogenic complications: a systematic review and meta-analysis

et al. 2018

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“…Air inside the pleural cavity completely reflects the ultrasound waves at the pleural line with no available imaging data from the visceral pleura and deeper [3]. Lung sliding/pleural sliding therefore cannot be observed.…”

Section: Pneumothoraxmentioning

confidence: 99%

“…For documentation, M-mode images may be helpful: The static pattern of the stratosphere sign with parallel horizontal lines (as they result from air inside the pleural space) changes into the granular "seashore sign" once the lung tissue comes into contact with the chest wall as an "on/off" pattern. It has an overall sensitivity of 66 % (75 % in the case of radio-occult pneumothorax alone) and a specificity of 100 % [3,22]. In the presence of an air-fluid level (hydro-pneumothorax), the interface between the pleural effusion (usually anechoic) and the pneumothorax component (absence of sliding or pulse and absence of B-lines) is called the "hydro point" [21].…”

Section: Pneumothoraxmentioning

confidence: 99%

“…Nevertheless, it is well acknowledged that diaphragmatic paralysis or any pathologic fluid accumulation in the pleura and/or lung can be easily visualized with conventional US imaging [2]. Furthermore, air filling of the pleural cavity results in a drastic change in impedance from tissue to air with no available imaging data from behind the visceral pleura [3], which makes ultrasound highly sensitive for the detection of even subtle pneumothorax [4]. Due to its excellent diagnostic accuracy for pleural effusion and pneumothorax, ultrasonography is implemented in the algorithms for severely injured/critically ill patients [4 -6].…”

Section: Introductionmentioning

confidence: 99%

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Ultrasonography of the Lung

Radziņa

Biederer

2019

Fortschr Röntgenstr

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ABSTR AC T Background High diagnostic accuracy, increasing clinical experience and technical improvements are good reasons to consider lung ultrasound (US) for the assessment of pleural and pulmonary diseases. In the emergency room and in intensive care, it is well acknowledged, but application in other settings is rare. The aim of this review is to update potential users in general radiology about the diagnostic scope of lung US and to encourage more frequent use of this generally underestimated lung imaging modality.Method Literature review was done independently by the two authors in MEDLINE (via PubMed) covering a time span from 2002 until 2017 using free text and Medical Subject Headings/MeSH. Article selection for the bibliography was based on consensus according to relevance and evidence. Results and ConclusionThe technical prerequisites include a standard ultrasound unit with a suitable transducer. Pleural effusion and pneumothorax, atelectasis, interstitial edema, pneumonia, exacerbated chronic obstructive pulmonary disease/asthma and pulmonary embolism can be distinguished by particular ultrasound signs, artifacts and their combinations. A highly standardized selection of access points and terminology for the description of imaging findings contributes to high diagnostic accuracy even in challenging patients and settings. Besides the assessment of acute respiratory failure in the emergency room, lung US may be used for monitoring interstitial fluid accumulation in volume therapy and for the diagnosis of pneumonia or the assessment of pleural effusion and pleurisy in a routine outpatient setting. Last but not least, the increasing concerns about medical radiation exposure warrant a more extensive use of this sometimes underestimated modality as a cost-, time-and radiation-saving alternative or valuable adjunct to the standard imaging modalities. Key Points:▪ Lung US is a safe, quick and readily available method with options for dynamic imaging of respiratory function. ▪ Proper selection of technical parameters customized to the clinical question and standardized terminology for the precise description and interpretation of the imaging signs regarding patient history determine its diagnostic accuracy. ▪ In dyspnea lung US differentiates pneumothorax, lung edema, pneumonia, pulmonary embolism, atelectasis and pleural effusion. ▪ In intensive care, lung US allows monitoring of lung ventilation and fluid administration. ▪ It saves radiation exposure in serial follow-up, in pregnancy and pediatric radiology. Citation Format ▪ Radzina M, Biederer J, Ultrasonography of the Lung. Fortschr Röntgenstr 2019; 191: 909-923

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“…However, some normal physiological conditions can be misdiagnosed for false lung points [30, 31]. The requirement necessary to define the real lung point is an absent lung sliding with absent subpleural parenchymal ultrasound signals (B-lines or consolidations) and the lung point as the contact between the aforementioned region and the sliding lung (or pleural fluid as in hydro-pneumothorax) [32]. Indeed, some similar ultrasound patterns representing the interphases between the expanding lung and the diaphragm (Additional file 4: Video S4) and between the expanding lung and the heart (Additional file 5: Video S5), may be misdiagnosed for false lung points, especially when observed with high frequency probes, sometimes inducing the operator to wrong conclusions.…”

Section: Introductionmentioning

confidence: 99%

Common pitfalls in point-of-care ultrasound: a practical guide for emergency and critical care physicians

2016

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BackgroundPoint-of-care ultrasonography (POCUS) is a widely used tool in emergency and critical care settings, useful in the decision-making process as well as in interventional guidance. While having an impressive diagnostic accuracy in the hands of highly skilled operators, inexperienced practitioners must be aware of some common misinterpretations that may lead to wrong decisions at the bedside.ObjectivesThis article provides a revision list of common POCUS misdiagnoses usually found in practice and offers useful tips to recognize and avoid them.DiscussionThe following aspects were selected and reviewed: pericardial effusion vs. pleural vs. ascites vs. epicardial fat; right ventricle dilation in acute pulmonary embolism and inferior vena cava for volume status assessment in cardiac ultrasound; lung point and lung pulse misinterpretations and mirror artifacts vs. lung consolidations in lung ultrasound; peritoneal fluid vs. the stomach and a critical appraisal of gallbladder signs of acute cholecystitis in abdominal ultrasound; the rouleaux phenomenon vs. deep vein thrombosis or acute right strain in vascular ultrasound.ConclusionsFollowing some rules in technique and interpretation, and always integrating POCUS findings into the broader clinical context, most POCUS misdiagnosis can be avoided, and thus patients’ safety can be enhanced. Being aware of a list of common pitfalls may help to avoid misdiagnoses.Electronic supplementary materialThe online version of this article (doi:10.1186/s13089-016-0052-x) contains supplementary material, which is available to authorized users.

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Lung ultrasound in the critically ill (LUCI) and the lung point: a sign specific to pneumothorax which cannot be mimicked

Cited by 21 publications

References 3 publications

Bedside ultrasound to detect central venous catheter misplacement and associated iatrogenic complications: a systematic review and meta-analysis

Bedside ultrasound to detect central venous catheter misplacement and associated iatrogenic complications: a systematic review and meta-analysis

Ultrasonography of the Lung

Common pitfalls in point-of-care ultrasound: a practical guide for emergency and critical care physicians

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