Chest Sonography in Critically

Ill Patients

Gamal Rabie Agmy ,MD ,FCCP

Professor of Chest Diseases, Assiut University

A common language: Color Coding

Black Grey White

Ultrasound profiles.

Lichtenstein D A , Mezière G A Chest 2008;134:117-125

http://radiographics.rsnajnls.org/cgi/content/full/20/3/653/F6B

Tissue pattern representative of Alveolar

Consolidation

Presence of hyperechoic punctiform images representative of air bronchograms

Pleural

effusion

Lower lobe

Scanning Positions for Chest Sonography in ICU

http://radiographics.rsnajnls.org/cgi/content/full/20/3/653/F1

Normal Anatomy

http://radiographics.rsnajnls.org/content/vol22/issue1/images/large/g02jae1g2a.jpeg

http://radiographics.rsnajnls.org/content/vol22/issue1/images/large/g02jae1g2b.jpeg

http://radiographics.rsnajnls.org/cgi/content/full/20/3/653/F6B

Tissue pattern representative of Alveolar

Consolidation

Presence of hyperechoic punctiform images representative of air bronchograms

Pleural

effusion

Lower lobe

the "seashore sign" (Fig.3).

Clinical applications of lung ultrasonography in the

intensive care unit

1. Diagnosis of pulmonary consolidation.

2. Diagnosis of atelectasis

3. Diagnosis of alveolar-interstitial syndrome

4. Differentiating between pulmonary oedema and ARDS

5. Differentiating between pulmonary oedema and COPD

6. Diagnosis of pulmonary embolism

7. Diagnosis of pneumothorax

8. Diagnosis and estimation of volume and nature of pleural effusion.

9. Diagnostic and therapeutic ultrasound-guided thoracentesis.

http://radiographics.rsnajnls.org/cgi/content/full/22/1/e1/F3A

http://radiographics.rsnajnls.org/cgi/content/full/22/1/e1/F3B

http://radiographics.rsnajnls.org/cgi/content/full/22/1/e1/F3C

Absent lung sliding

Exaggerated horizontal artifacts

Loss of comet-tail artifacts

Broadening of the pleural line to a band

The key sonographic signs of

Pneumothorax

the "seashore sign" (Fig.3).

Pulmonary Embolism

Schematic representation of the parenchymal, pleural and vascular

features associated with pulmonary embolism.(Angelika Reissig, Claus

Kroegel. Respiration 2003;70:441-452 )

Alveolar-interstitial syndrome

Multiple B-lines - « comet-tails » - interstitial edema (B1)

7 mm apart « B lines » thickened interlobular septa

D Lichtenstein et al AJRCCM 156 : 1640-1646 , 1997 JJR 25 05 2012

http://www.reapitie-

univparis6.aphp.fr http://www.reapitie-

univparis6.aphp.fr

02 09 2012

D Lichtenstein et al AJRCCM 156 : 1640-1646 , 1997 30 11 2011

Coalescent B lines - « comet-tails » - alveolar

edema

3 mm apart « B lines » ground-glass areas

http://www.reapitie-

univparis6.aphp.fr

02 09 2012

http://www.ncbi.nlm.nih.gov/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=An%20external%20file%20that%20holds%20a%20picture%2C%20illustration%2C%20etc.%0AObject%20name%20is%201476-7120-6-16-3.jpg%20%5BObject%20name%20is%201476-7120-6-16-3.jpg%5D&p=PMC3&id=2386861_1476-7120-6-16-3.jpg

http://www.ncbi.nlm.nih.gov/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=An%20external%20file%20that%20holds%20a%20picture%2C%20illustration%2C%20etc.%0AObject%20name%20is%201476-7120-6-16-4.jpg%20%5BObject%20name%20is%201476-7120-6-16-4.jpg%5D&p=PMC3&id=2386861_1476-7120-6-16-4.jpg

http://www.ncbi.nlm.nih.gov/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=An%20external%20file%20that%20holds%20a%20picture%2C%20illustration%2C%20etc.%0AObject%20name%20is%201476-7120-6-16-5.jpg%20%5BObject%20name%20is%201476-7120-6-16-5.jpg%5D&p=PMC3&id=2386861_1476-7120-6-16-5.jpg

http://www.ncbi.nlm.nih.gov/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=An%20external%20file%20that%20holds%20a%20picture%2C%20illustration%2C%20etc.%0AObject%20name%20is%201476-7120-6-16-7.jpg%20%5BObject%20name%20is%201476-7120-6-16-7.jpg%5D&p=PMC3&id=2386861_1476-7120-6-16-7.jpg

(Chest. 2008; 133:836-837)

© 2008 American College of Chest Physicians

Ultrasound: The Pulmonologist’s New Best

Friend

Momen M. Wahidi, MD, FCCP