Sonographie der Pleura diaphragmatica bei Tumorpatienten

Görg, C; Görg, K.; Wb, Schwerk; Kleinsorge, F.

doi:10.1055/s-2007-1011643

Cited by 5 publications

(1 citation statement)

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“…The free fluid moves varying according to the decubitus of the patient, unlike the loculated effusion, which is much less modifiable, and differently from empyema, which does not change with the body position; the latter is easily distinguishable from fibrothorax which appears as a band of variable echogenicity, sometimes calcified, parallel to the coast, of uniform thickness, which does not modify with breath changes. Also sub-pulmonary effusions may be visible, if adjacent to the pleura, often in association with inflammatory or cancer processes (29). In addition, ultrasound can detect by trans-thoracic anterior left view the presence of any posterior pericardial effusion.…”

Section: © C I C E D I Z I O N I I N T E R N a Z I O N A L Imentioning

confidence: 99%

Transthoracic ultrasound for pleural effusion: traps and tricks

Sperandeo¹

2014

sob

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SummaryPleural effusion is excess fluid that accumulates between the two pleural layers. Excessive amounts of such fluid can impair breathing by limiting the expansion of the lungs during ventilation. Pleural effusion is still usually diagnosed on the basis of medical history and physical examination, and confirmed by chest x-ray. It is observed in many pulmonary and extra-pulmonary disease; its cause can be relatively benign or definitely malign (cancer), and may require drainage for treatment or for achieving a diagnosis which is available at the bedside by physical examination and Thoracic Ultrasound (TUS). Pleural effusion is detected by TUS even when its volume is very little: it is possible to perform and repeat at bedside, by sufficiently trained physicians. Diagnostic intervention procedures are safer if performed using US probes specifically designed for this use, i.e. with a central hole which allows the co-axial passage of the disposable tools for drainage or Fine Needle Aspiration Biopsy (FNAB). Over-trusting in US criteria not evidence-based and, more important, which are demonstrated to be unreliable when critically re-appraised must be discouraged; reversal of such scarcely validated but recommended practices, which could be harmful for patients, is actively in progress also in this field of medicine. No special trick is needed and no actual trap is present when the assessment of pleural effusion is performed by a sufficiently skilled MD and with a reliable and well set echo machine. Echo-assisted thoracentesis is an excellent procedure when appropriately performed in all its phases, which are: choice of the site of insertion, visualization in real-time during the drainage and serial control during lung re-expansion (so as to avoid pneumothorax). KEY WORDS: ultrasound, pleural effusion. Transthoracic ultrasound: overviewThe ultrasound examination in the study of pleuro-pulmonary disease, i.e. Thoracic Ultra-Sound (TUS), is limited by the presence of air in the lungs and by the rib cage (1). As a consequence TUS is not an all purpose tool, drawbacks and appropriate indications must be the cynosure of the pneumologist which relies on TUS for diagnosis and management of patients (2). The presence of the bony structures of the rib cage restricts the success of ultrasound imaging of the pleural surface to about 70% of the total (3). These issues, relating to limitations on the use of ultrasound in the thoracic area, have been known since the ʼ60s, a time when pioneering works were published using A-mode for exploring pleuro-pulmonary structures and, namely, pleural effusion (4), even in comparison with radiological imaging and with a greater sensitivity and specificity (5). Thereafter these advantages were established in the few subsequent years, with minimal further refinements despite the technology of ultrasound equipment has evolved considerably (6, 7): the value of ultrasound examination of the pleura and lungs remains highly underestimated to this day, and overstatements (8) and over- Mini-review...

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Section: © C I C E D I Z I O N I I N T E R N a Z I O N A L Imentioning

confidence: 99%