Lung Ultrasound in the Assessment of Pulmonary Complications After Lung Transplantation

Abstract

Introduction Lung ultrasound (LUS) has a high diagnostic accuracy for identifying frequent conditions in the post-operative phase after lung transplantation (LTx). This study aimed to investigate the feasibility and clinical ability of LUS to identify pulmonary complications such as pleural effusions and pneumonias in the early postoperative phase after LTx. Methods A prospective cohort study of lung transplant recipients who consecutively underwent single LTx (SLTx) or double LTx (DLTx) at the National Lung Transplantation Center in Denmark from May 1 to October 31, 2015 was conducted. LUS was performed at four time points corresponding to post-transplant day 3, and weeks 2, 6, and 12 (LUS #1–4) to detect and monitor variation in pathological LUS findings over time. Concurrent with LUS #4, a high-resolution computed tomography examination of the thorax (HRCT) was also performed. Results 14 patients (1 SLTx/13 DLTx, 7 (50 %) women, mean age: 50.4 years) who had undergone the four prespecified LUS examinations were included. Pleural effusion was the most common condition and most pronounced at post-LTx week 2. Findings consistent with pneumonia increased during week 2 and subsequently decreased. Corresponding to LUS #1, 2, 3, and 4, pleural effusion occurred in 85.7 %, 92.9 %, 85.7 %, and 78.6 %, and pneumonia in 21.4 %, 28.6 %, 14.3 %, and 14.3 %, respectively. HRCT findings at post-LTx week 12 were predominantly presented by unspecific ground glass opacities. Conclusion In a post-LTx setting, LUS represents a clinical novelty as a feasible diagnostic and monitoring tool to identify pathological pulmonary complications in the early post-operative phase.

Implementation of transbronchial lung cryobiopsy in a tertiary referral center for interstitial lung diseases: a cohort study on diagnostic yield, complications, and learning curves

“…We performed at least 2 biopsies from 2 ipsilateral BS and slowly deflated the Fogarty balloon to observe whether bleeding emerged [23]. A focused lung ultrasound (FLUS) examination was used to identify potential iatrogenic pneumothorax (PTX) immediately after TBLC [24,25]. The patient was observed for at least 2 h after TBLC, and a supplementary chest X-ray (CXR) was made to reveal late-onset PTX [9].…”

Implementation of Transbronchial Lung Cryobiopsy in a Tertiary Referral Center for Interstitial Lung Diseases – A Cohort Study on Diagnostic Yield, Complications, and Learning Curves

“…We performed at least 2 biopsies from 2 ipsilateral BS and slowly de ated the Fogarty balloon to observe whether bleeding emerged [23]. A focused lung ultrasound (FLUS) examination was used to identify potential iatrogenic pneumothorax (PTX) immediately after TBLC [24,25]. The patient was observed for at least 2 hours after TBLC, and a supplementary chest X-ray (CXR) was made to reveal late-onset PTX [9].…”

Lung Ultrasound to Phenotype Chronic Lung Allograft Dysfunction in Lung Transplant Recipients. A Prospective Observational Study

“…Consistent with previous studies by this research group the lung transplant recipients were examined in a sitting position, and thorax was systematically scanned in fourteen different zones (seven zones on each hemithorax (i.e., zones R (right) 1-7 and L (left) 1-7) covering the anterior, lateral and posterior thorax wall with one LUS record stored per zone (Figure 1) [19,31]. LUS was performed by three experts (J.R.D., H.H.L.S., K.N.J.)…”

“…HRCT 2.6.1. Scanning Protocol All patients had a HRCT scan performed in a supine position from apex to below the costophrenic angle in 64 (or more) slice scanners, and a standard lung algorithm was used to obtain 1 mm non-overlapping slices that were reviewed in a lung window setting (window width 1500 Hounsfield units (HU); window level−500 HU) [19].…”

“…There is only limited experience with lung ultrasound (LUS) as part of LTx followup. LUS has primarily been used in the early post-operative phase after LTx in order to diagnose and monitor acute complications such as pleural effusion, pneumonia, and atelectasis [17][18][19][20]. In interstitial lung disease (ILD), lung parenchyma and pleura possess an increased tissue density, which can be demonstrated by LUS findings as a significant number of B-line reverberation artifacts as part of the interstitial syndrome (IS), and pleural thickening [21][22][23][24][25][26][27].…”