Ultrasound artifacts mimicking pleural sliding after pneumonectomy

Thoracic Ultrasound Artifacts: Still a Matter of Discussion

“…Their detection can also be modified by an increase in the pleural line movement rate in dyspneic patients and by concomitant heart and lung disorders. 4 Consequently, the detection of B-lines remains largely subjective and at best semiquantitative, and it is questionable whether a firm relationship between the number of B-lines and a specific disease can be established. 5…”

Count of B-lines: A Matter with Persistent Limitations

“…In particular, B-lines, appearing as parallel hyper echogenic striae extended for the entire US image, result from different acoustic impedance between liquid film trapped in gas microbubbles and/or fibrous edema areas crossed by the US beam. That is why B-lines are also found in the bowel loops 3 and in the residual cavity of the postpneumonectomy space 4 . On the other hand, "comet tails," running out in a few mm of depth in a triangular shape, derive from solid structures such as crystals (e.g., cholesterin, calcium) or pleural thickenings.…”

Response

“…2 OSA has also been associated with worsened control of asthma symptoms. 3 Weight loss leads to improvement or resolution of OSA 4 ; hence, it is possible that at least part of the benefit of bariatric surgery is via a reduction in the severity of sleep-disordered breathing. OSA is also associated with metabolic syndrome, has a pro-inflammatory effect, increases susceptibility to infection, and seems to alter the gut microbiome, 5 all mechanisms cited by Goto et al 1 as possible explanations for the effect of obesity on the risk of AECOPD.…”