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Background Although conventional chest radiography remains the first routine radiologic examination in mechanically ventilated patients, chest ultrasound provides more accurate information, with less ionizing radiation and less time delay. Objective To compare between sensitivity of chest ultrasound and routine daily chest X-ray in diagnosis and follow up of diseases in mechanically ventilated patients admitted at Respiratory ICU of the Ain Shams University Hospital. Design The study was carried out as a prospective analytical study. Patients and methods The study was conducted upon twenty-five mechanically ventilated patients (16 male patients and 9 female patients), with a mean age of 58.8 years (SD ± 15.64) who were admitted at the Respiratory Intensive Care Unit of the Ain Shams University Hospital during the period from October 2012 to May 2013. Chest ultrasound examination was done for patients on mechanical ventilation on the first day of enrollment prior to seeing their chest X-ray, then follow up daily chest ultrasound examination was done over the entire period of mechanical ventilation with comparison of examination results with that of chest X-ray. Results Initial chest ultrasound was more sensitive in the detection of pleural effusion (40% of cases) than chest X-ray (8% of cases). This superiority of chest ultrasound over chest X-ray persisted in follow up studies (44%, 8% respectively). As regards consolidation, there was no statistically significant difference between chest ultrasound (consolidation was detected in 16 out of 25 cases) and chest X-ray (consolidation was detected in 15 out of 25 cases) in the initial studies, and also along the follow up period, chest ultrasound detected consolidation in 17/25 patients, while CXR detected consolidation in 18/25 patients. In the follow up of five mechanically ventilated patients with no obvious radiologic abnormalities on chest X-ray, initial and follow-up ultrasound was also free and detected no localized abnormality. There was a statistically significant relationship between chest ultrasound findings in cases with pleural effusion and in cases with consolidation and clinical progress. Conclusion Chest ultrasound is a reliable tool for evaluation of mechanically ventilated patients.

A method of localizing and evacuating pleural effusions under visual control is described which in the author's opinion is an improvement and enhancement over current procedures. This method is easy, rapid, safe and causes no distress to the patient. On many occasions, failures at puncture of loculated fluid by conventional methods can successfully be accomplished under ultrasonic guidance.

Summary The aetiology of the acute chest syndrome in sickle cell disease includes: cardiopathy, lung infection, rib infarct and fat or venous embolism. We report a case where a chest bidimensional ultrasonography coupled to Doppler velocimetry, has helped to relate a chest pain to a pulmonary vaso-occlusive crisis, sometimes evocated rarely proved.

Extracardiac chest ultrasonography was performed in 51 children for characterization and localization of pleural disease (29 children), for evaluation of chest and mediastinal masses (12), and for determining the cause of unilateral chest radiographic opacification (10). Ultrasonography clearly differentiated drainable fluid from pleural thickening, accurately characterized chest and mediastinal masses, guided aspiration and drainage procedures, and allowed rapid diagnosis of causes of unilateral opaque hemithorax.

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 I is focused on basic knowledge of chest ultrasonography technique, physical basis, aims and characteristics, fields of application. Document I shows how chest ultrasonography can be useful to detect and monitor pleural diseases, pleural effusions and pneumothorax and how it can assess diaphragmatic kinetics and pathologies.