Usefulness of ultrasound lung comets as a nonradiologic sign of extravascular lung water

Abstract

The "comet-tail" is an ultrasound sign detectable with ultrasound chest instruments; this sign consists of multiple comet-tails fanning out from the lung surface. They originate from water-thickened interlobular septa and would be ideal for nonradiologic bedside assessment of extravascular lung water. To assess the feasibility and value of ultrasonic comet signs, we studied 121 consecutive hospitalized patients (43 women and 78 men; aged 67 ؎ 12 years) admitted to our combined cardiology-pneumology department (including cardiac intensive care unit); the study was conducted with commercially available echocardiographic systems including a portable unit. Transducer frequencies (range 2.5 to 3.5 MHz) were used. In each patient, the right and left chest was scanned by examining predefined locations in multiple intercostal spaces. Examiners blinded to clinical diagnoses noted the presence and numbers of lung comets at each examining site. A patient lung comet score was obtained by summing the number of comets in each of the scanning spaces. Within a few minutes, patients underwent chest x-ray, with specific assessment of extravascular lung water score by 2 pneumologist-radiologists blinded to clinical and echo findings. The chest ultrasound scan was obtained in all patients (feasibility 100%). The imaging time per examination was always <3 minutes. There was a linear correlation between echocardiographic comet score and radiologic lung water score (r ‫؍‬ 0.78, p <0.01). Intrapatient variations (n ‫؍‬ 15) showed an even stronger correlation between changes in echocardiographic lung comet and radiologic lung water scores (r ‫؍‬ 0.89; p <0.01). In 121 consecutive hospitalized patients, we found a linear correlation between echocardiographic comet scores and radiologic extravascular lung water scores. Thus, the comet-tail is a simple, non-time-consuming, and reasonably accurate chest ultrasound sign of extravascular lung water that can be obtained at bedside (also with portable echocardiographic equipment) and is not restricted by cardiac acoustic window limitations.

Lung ultrasound characteristics of community‐acquired pneumonia in hospitalized children

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Diagnostic accuracy of basic lung ultrasound in breathless patients over 60 years of age; stressing the protocol

“…The demonstrated drop in sensitivity was expected, as prior studies have shown that the absolute number of B lines correlates strongly with the volume of extravascular lung water 5 20 , 27 , 28 Subclinical disease might be expected to manifest fewer B lines. Using alternative strategies, groups report mixed success using fewer B lines or pleural effusions to identify pulmonary oedema 2 …”

Comparison of a basic lung scanning protocol against formally reported chest x‐ray in the diagnosis of pulmonary oedema

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