B-lines: Transthoracic chest ultrasound signs useful in assessment of interstitial lung diseases

Abstract

OBJECTIVE:This prospective study was conducted to evaluate the value of sonographic B-lines (previously called “comet tail artifacts”), which are long, vertical, well-defined, hyperechoic, dynamic lines originating from the pleural line in assessment of interstitial lung diseases (ILD) and compare them with the findings of chest high-resolution computed tomography (HRCT) and pulmonary function tests (PFTs).MATERIALS AND METHODS:Sixty-one patients with ILD underwent transthoracic lung ultrasound for assessment of the presence of B-lines and the distance between them. These findings were compared with that of chest HRCT (ground glass, reticular, nodular or honey combing) and PFT as forced vital capacity (FVC), total lung capacity (TLC), diffusion capacity for carbon monoxide (DLCO) and partial arterial oxygen pressure (PaO2).RESULTS:All patients had diffuse bilateral B-lines. The distance between each of the two adjacent B lines correlated with the severity of the disease on chest HRCT where B3 (the distance was 3 mm) correlated with ground glass opacity and B7 (the distance was 7 mm) correlated with extensive fibrosis and honey combing. Also, the distance between B-lines inversely correlated with FVC (r = −0.848, P < 0.001), TLC (r = −0.664, P < 0.001), DLCO (r = −0.817, P < 0.001) and PaO2 (r = −0.902, P < 0.001).CONCLUSION:B-lines that are lung Ultrasound signs seem to be useful in the assessment of ILD.

Ultrasonography for the Diagnosis of Pneumothorax after Transbronchial Lung Cryobiopsy in Diffuse Parenchymal Lung Diseases

“…To our knowledge, this is the first experience reported in the literature. In particular, the rapid bedside detection of the absence of both sliding sign and B-lines in patients who usually showed diffuse and bilateral vertical artifacts [17,18,19,20] could optimize the postprocedural management of patients with DPLD who underwent TBLC.…”

A Simplified Approach to Extravascular Lung Water Assessment Using Point-of-Care Ultrasound in Patients with End-Stage Chronic Renal Failure Undergoing Hemodialysis

“…In order to perform lung ultrasound, we used a modified protocol previously described by Jambrik et al[22], which provided analysis of 28 lung regions. B lines were defined as a hyperechoic vertical linear artefact arising from the pleural line, moving with lung sliding and spreading to the end of the screen, erasing any A line (horizontal linear artefact) that it crosses [8]. The scanning method of the right chest occurs along the parasternal, the mid-clavicular, the anterior axillary, and mid axillary line at the 2nd, 3rd, 4th, and 5th intercostal space (total of 16 regions).…”

“…While air in normal lungs is impermeable to ultrasound and therefore cannot be seen during assessment, widened alveolar septa in the context of pulmonary edema produce a linear artefact on 2D ultrasound commonly called B-line or “comet-tails” [6, 7]. The term alveolar-interstitial syndrome is preferred because they can occur in the setting of interstitial or parenchymal pulmonary disease, such as pulmonary fibrosis and acute respiratory distress syndrome [8, 9]. Nevertheless, clinical context coupled with the assessment of B-lines in multiple lung fields can provide important insights.…”

Lung ultrasound: a promising tool to monitor ventilator-associated pneumonia in critically ill patients

“…1b; Additional file 2: Video S2). B lines represent a reverberation artifact through thickened subpleural interlobular septa by deposition of fibrous tissues, inflammatory cells, or pulmonary edema [37]. Thus, a B line can be detected in cardiogenic pulmonary edema, acute respiratory distress syndrome (ARDS), interstitial lung diseases, pneumonia, etc.…”

“…Thus, a B line can be detected in cardiogenic pulmonary edema, acute respiratory distress syndrome (ARDS), interstitial lung diseases, pneumonia, etc. [37, 38]. The presence of multiple vertical B lines more than 7 mm apart (spaced B lines) indicates a moderate decrease in lung aeration due to thickened interlobular septa.…”