The role of chest ultrasonography in the management of respiratory diseases: document II

Abstract

Chest ultrasonography can be a useful diagnostic tool for respiratory physicians. It can be used to complete and widen the general objective examination also in emergency situations, at the patient’s bedside. The aim of this document is to promote better knowledge and more widespread use of thoracic ultrasound among respiratory physicians in Italy. This document II is focused on advanced approaches to chest ultrasonography especially in diagnosing sonographic interstitial syndrome with physical hypotheses about the genesis of vertical artifacts, differential diagnosis of cardiogenic pulmonary edema and non-cardiogenic pulmonary edema, raising diagnostic suspicion of pulmonary embolism, ultrasound characterization of lung consolidations and the use of ultrasonography to guide procedural interventions in pulmonology. Finally, document II focuses on chest ultrasonography as useful diagnostic tool in neonatal and pediatric care.

Accuracy of point-of-care lung ultrasonography for the diagnosis of cardiogenic pulmonary edema in dogs and cats with acute dyspnea

“…Sensitivity of LUS for the diagnosis of CPE in the present study was slightly lower than in human studies of the diagnostic accuracy of LUS for the same purpose, in which sensitivity ranged from 81.3% to 98.3% (mean sensitivity, 94.1%) 10 and absence of B lines in all quadrants effectively ruled out CPE. 25 In the present study, 6 patients (5 dogs and 1 cat) with a final diagnosis of CPE had no positive sites identified via LUS (ie, had false-negative results). The CPE diagnosis in these patients had been made on the basis of thoracic radiographic evidence of a very mild or focal interstitial pattern or echocardiographic evidence of severe heart disease and a positive response to diuretic treatment.…”

“…Findings in human medicine Small Animals & Exotic suggest that performance of LUS may be dependent on several equipment-related factors, including ultrasound model, probe, software, and quality of LUS training. 25 The ultrasonographic machine used in the present study was a moderately priced, small, portable laptop model. Given that LUS examination relies on identifying artifacts rather than specific structures with high resolution, this technique was useful even with less expensive equipment.…”

The use of lung ultrasound images for the differential diagnosis of pulmonary and cardiac interstitial pathology

“…1). The presence of three or more B-lines between two ribs in a single scan indicates the presence of sonographic interstitial syndrome (SIS), and the latter may be focal, multifocal, homogeneously or non-homogeneously diffuse [8][9][10]. From this classification, a rather elementary semiotics for B-lines and the related sonographic interstitial syndrome emerges without a solid physical interpretation of the acoustic signs to support it.…”

“…The B-lines, which are often observed in the areas adjacent to the pneumonic consolidations, are related to pneumogenic inflammatory changes. Unifocal or oligofocal B-lines with variable arrangements (separate, dense, or coalescent with a white lung), pure, or mixed with consolidations are indicative of pulmonary genesis (interstitial pneumonia, pleurisy, contusion) [9,27]. Recently, a B-line-based assessment of interstitial lung diseases was introduced [28].…”

A 46-Year-Old Woman With an Uncommon Case of Massive Pneumothorax

“…Sometimes diagnosing the presence of giant bullae instead of pneumothorax may be difficult and may lead to unnecessary insertions of chest tubes. 1,2 Indeed, differential diagnosis may be challenging even for expert radiologists or surgeons, despite the help of highly accurate CT, because it cannot indicate if signs of bullae, such as septa or irregular disposition of a pneumothorax, are missing or being misidentified. [3][4][5] We previously suggested the utility of CU in the differential diagnosis of pneumothorax and lung bullae, especially if there were areas of doubt, such as an uncommon disposition of the pneumothorax.…”