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

Abstract

In recent years, great advances have been made in the use of lung ultrasound to detect pulmonary edema and interstitial changes in the lung. However, it is clear that B-lines oversimplify the description of the physical phenomena associated with their presence. The artifactual images that ultrasounds provide in interstitial pulmonary pathology are merely the ultimate outcome of the complex interaction of a specific acoustic wave with a specific three-dimensional biological structure. This interaction lacks a solid physical interpretation of the acoustic signs to support it. The aim of this paper was to describe the differences between the sonographic interstitial syndrome related to lung diseases and that related to cardiogenic edema in the light of current knowledge regarding the pleural plane's response to ultrasound waves.

The sound of air: point-of-care lung ultrasound in perioperative medicine

“…They are thought to represent areas of focal increased lung density (i.e., interlobular septa, microatelectasis) and considered pathologic only when visible on the whole image, from the pleural line to the end of the screen without fading, and present in large numbers. 18,19 Finally, two normal dynamic LUS findings can be recognized: lung sliding and lung pulse. These findings are generated by the movement of the lung surface (visceral pleura) with respect to the innermost chest wall (parietal pleura), with lung sliding representing air movement during respiration and lung pulse the transmission of cardiac contractions through the lung ( Fig.…”

Thoracic ultrasound and SARS-COVID-19: a pictorial essay

“…Indeed, the presence of some B lines spread over several scans seems to be an early finding of COVID-19, even in mildly symptomatic subjects; in the most serious cases such as those that are pre-ARDS or ARDS, the B lines end up filling the ultrasound image almost completely, until they Initially, those ultrasound findings were related to cardiogenic pulmonary edema, in which the B lines are present bilaterally, with a base-apex gradient and with progressive involvement depending on the severity of the disease [7]. Moreover, B lines are also found in other diseases such as bruises, chronic fibrotic lung diseases and ARDS.…”

“…Thoracic ultrasound is an easy-to-learn and reliable method [7][8][9][10][11][12][13]. No advanced machinery or software is required.…”

“…Moreover, B lines are also found in other diseases such as bruises, chronic fibrotic lung diseases and ARDS. ARDS can be distinguished from cardiogenic pulmonary edema by the presence of multifocal and diffuse lung alterations, without a base-apex gradient, while chronic interstitial diseases differ by an extreme irregularity of the pleural line, which can be thickened and distorted, with the presence of focal subpleural interruptions (consolidations), and by the presence of uneven and irregular vertical artifacts (B lines) [7,16,17].…”

“…In the most severe and advanced forms, lung consolidations are present, representing pulmonary pathological areas that are no longer normally ventilated (Figs. 6,7,8,9).…”