Search

When performing chest sonography of patients with symptoms such as respiratory infection, dyspnea and chest pain, the primary goal is to find or exclude significant diagnoses such as pneumothorax, pleural effusion, pulmonary edema, tumors, pulmonary emboli, etc. as the cause of the symptoms. If infection with SARS-CoV-2 is present, COVID-19 pneumonia can be confirmed or excluded as the cause of the symptoms with a high degree of probability based on the sonographic signs. COVID-19 pneumonia shows typical changes in the lungs, which are easily accessible to ultrasound due to their usually peripheral location. These are ubiquitous signs, such as a thickened, fragmented pleura with subpleural consolidations, multiple comet tail artifacts of varying size and thickness, some of which are coascent, broad bright light beams, and possibly small encapsulated pleural effusions. The more of these sonographic signs are present and the more pronounced they are, the sooner the patient must be hospitalized and possibly intubated. Ultrasound is also useful as a follow-up tool, together with clinical and laboratory findings. [ABSTRACT FROM AUTHOR]

Due to the COVID-19 pandemic, lung ultrasound is experiencing a tremendous upswing and rapid diffusion. This affects both publications and clinical use. The typical changes are described here, also for lung consolidations of other genesis and in interstitial lung diseases. Comparisons with other imaging techniques and indications of the accuracy of lung ultrasound are also presented hereafter. [ABSTRACT FROM AUTHOR]

The analysis of vertical reverberation artefacts is an essential component of the differential diagnosis in pulmonary ultra-sound. Traditionally, they are often, but not exclusively, called B-line artefacts (BLA) and/or comet tail artefacts (CTA), but this view is misleading. In this position paper we clarify the terminology and relation of the two lung reverberation artefacts BLA and CTA to spe-cific clinical scenarios. BLA are defined by a normal pleura line and are a typical hallmark of cardiogenic pulmonary edema after exclusion of certain pathologies including pneumonia or lung contusion, whereas CTAs show an irregular pleura line representing a variety of parenchymal lung diseases. The dual approach using low frequency transducers to determine BLA and high frequency transducer to determine the pleural surface is recommended. [ABSTRACT FROM AUTHOR]

Lung ultrasound offers an immediate diagnosis in accordance with the clinical examination in many causes of dyspnea: pleural effusion, pulmonary edema, pneumonia, pulmonary embolism and interstitial lung diseases. At first level exam, CXR, despite its intrinsic limitations and low accuracy, may still play a relevant role. CT scan remains the gold standard, but it requires patient transportation and use of radiation, which precludes an extensive use especially within the same patient. Lung ultrasound, after proper training of the physician, is able to provide greater accuracy than CXR and similar accuracy to the CT scan. [ABSTRACT FROM AUTHOR]

Pneumonie lung consolidations are characterized by typical changes in terms of sonomorphology: echopoor lesions with blurred margins, bronchoaerograms, regular vascularization, and parapneumonic effusions. Pneumonias may be first discovered at bedside. Reventilation is well correlated with clinical progression. Compared with CT in four metaanalyses, lung ultrasound shows accuracy with a sensitivity of 88-97% and a specificity of 90-96%. Chest x-ray on the other hand has a pooled sensitivity of 77% and a specificity of 91 %.Thus, lung ultrasound should replace chest x-ray in the diagnosis of pneumonia acquired by out-patients. [ABSTRACT FROM AUTHOR]

Infected and septated pleural effusions are referred to as complicated. Ultrasound is the best method to detect septations. Inadequately treated parapneumonic effusions have a high risk of prolonged hospitalization and increased mortality after late or inadequate tube drainage. Pleural thickenings may occur diffuse, circumscribed, nodular, regular, irregular, hypoechoic or complexly structured. In most patients with pleuritis abnormalities of the pleura can be detected by ultrasound. The development of pleural metastases is often combined with pleural effusions. The role of ultrasound in imaging of mesotheliomas is discussed. [ABSTRACT FROM AUTHOR]

The science of lung ultrasound has grown tremendously over the last two decades and lung ultrasound has not only entered the mainstream of point of care ultrasound but has become a dominant topic. Understanding lung ultrasound signs and artifacts is critical to being able to correlate findings with actual pathology and normal anatomy and physiology. Investigators have described multiple lung ultrasound artifacts and findings and it is important to understand both the physics and anatomic basis behind them. Additionally, ultrasound machine use and transducer selection can significantly affect results obtained on patient during an examination and the provider must carefully choose the correct settings. This manuscript describes the state of the art in ultrasound artifact recognition and correlation as well as management of ultrasound technology to optimize diagnostic success. [ABSTRACT FROM AUTHOR]

Imaging of pulmonary embolism (PTE) remains a great challange. Mortality is even high. Possibilities of lung ultrasound, echocardiography, and compression leg vein sonography are discussed. Hemodynamic instable patients should achieve echocardiography at bed side with an accuracy of 90% and immeadiatly treated. In case of a suspected PTE, compression sonography of the leg veins is recommended. It can be performed within 2 min but, on average, yields a positive result in only one-half of the cases of PTE. During the last years, pulmonary sonography took root as a complementary method to MSCT either when the latter is not available or when it is contraindicated because of contrast agent allergy, renal insufficiency, or pregnancy. This method was able to provide evidence of subpleural pulmonary consolidations due to embolism in at least three-fourths of patients having a PTE. According to clinical presentation, combination of lung ultrasound, echocardiograpphy, and compression ultrasoud of the leg veins showed a sensitiviy of more than 90%. [ABSTRACT FROM AUTHOR]

A growing amount of evidence prompts us to update the first version of recommendations for lung ultrasound in internal medicine (POLLUS-IM) that was published in 2018. The recommendations were established in several stages, consisting of: literature review, assessment of literature data quality (with the application of QUADAS, QUADAS-2 and GRADE criteria) and expert evaluation carried out consistently with the modified Delphi method (three rounds of on-line discussions, followed by a secret ballot by the panel of experts after each completed discussion). Publications to be analyzed were selected from the following databases: Pubmed, Medline, OVID, and Embase. New reports published as of October 2019 were added to the existing POLLUS-IM database used for the original publication of 2018. Altogether, 528 publications were systematically reviewed, including 253 new reports published between September 2017 and October 2019. The new recommendations concern the following conditions and issues: pneumonia, heart failure, monitoring dialyzed patients' hydration status, assessment of pleural effusion, pulmonary embolism and diaphragm function assessment. POLLUS-IM 2020 recommendations were established primarily for clinicians who utilize lung ultrasound in their everyday clinical work. [ABSTRACT FROM AUTHOR]