Updates in Chest Sonography

Updates in Chest

Sonography

By

Gamal Rabie Agmy , MD , FCCP Professor of Chest Diseases ,Assiut University

• Diagnostic ultrasonography

is the only clinical imaging

technology currently in use

that does not depend on

electromagnetic radiation.

Ultrasound Transducer

Speaker

transmits sound pulses

Microphone

receives echoes

• Acts as both speaker & microphone Emits very short sound pulse

Listens a very long time for returning echoes

• Can only do one at a time

High Frequency

• High frequency (5-10 MHz)

greater resolution

less penetration

• Shallow structures

vascular, abscess, t/v gyn,

testicular

Low Frequency

• Low frequency (2-3.5 MHz)

greater penetration

less resolution

• Deep structures

Aorta, t/a gyn, card, gb, renal

Probes

A common language: Color Coding

Black Grey White

Hyperechoic

Hypoechoic

Anechoic

Scanning Positions for Chest Sonography

Normal Anatomy

Normal lung surface

Left panel: Pleural line and A line (real-time). The pleural line is located 0.5 cm below the rib line in the adult. Its visible length between two ribs in the longitudinal scan is approximately 2 cm. The upper rib, pleural line, and lower rib (vertical arrows) outline a characteristic pattern called the bat sign.

the "seashore sign" (Fig.3).

Absent lung sliding

Exaggerated horizontal artifacts

Loss of comet-tail artifacts

Broadening of the pleural line to a band

Lung point

Loss of lung impulse

The key sonographic signs of

Pneumothorax

Pulmonary Embolism

Schematic representation of the parenchymal, pleural and vascular

features associated with pulmonary embolism.(Angelika Reissig, Claus

Kroegel. Respiration 2003;70:441-452 )

Duplex Doppler sonogram of a 5 x 3 cm hypoechoic mass

(adenocarcinoma) in upper lobe of left lung shows blood flow

at margin of tumor near pleura. Spectral waveform reveals

arteriovenous shunting: low-impedance flow with high

systolic and diastolic velocities. Pulsatility index = 0.90,

resistive index = 0.51, peak systolic velocity = 0.47 m/sec, end

diastolic velocity =0.23 m/sec, peak frequency shift = 3.8 kHz,

Duplex Doppler sonogram in 67-year-old man with pulmonary

tuberculosis in lower lobe of left lung shows several blue and

red flow signals in massiike lesion. Spectral waveform reveals

high-impedance flow. Pulsetility index = 4.20, resistive index =

0.93, peak systolic velocity = 0.45 m/sec, end diastolic

velocity = 0.03 m/sec, Doppler angle = 21#{

Alveolar-interstitial

syndrome

Contrast-enhanced ultrasonography

of pneumonia

A: Baseline scan shows

a hypoechoic

consolidated area

B: Seven seconds after

iv bolus of contrast

agent, the lesion shows

marked and

homogeneous

enhancement

C: The lesion remains

substantially unmodified

after 90 s.

Lung abscess at CEUS

.A: An anechoic oval

lesion is surrounded

by an echodense

capsule;

B: After iv bolus of

contrast agent, the

lesion shows no

contrast agent uptake,

whereas the capsule is

strongly enhanced

Contrast-enhanced

ultrasonography of

pulmonary infarction

After iv bolus of

contrast agent, the

lesion shows no

contrast agent

uptake in the

arterial phase,

which suggests

the absence of

blood supply.

Bronchial carcinoma infiltrating the pleural wall.

A: Posterior intercostal scan shows a

hypoechoic lesion accompanied by rib

destruction (arrows);

B: Twenty-four seconds after iv bolus of contrast agent, the lesion appears inhomogeneously enhanced; the disrupted rib appears more echogenic than the tumor (arrowheads), as a consequence of the incomplete tissue suppression due to the strong echogenicity of bone tissue.

Contrast-enhanced ultrasonography of bronchial

carcinoma

A: Baseline scan shows a hypoechoic

lesion with irregular borders

Ten seconds after iv bolus of contrast agent, the pulmonary parenchyma near the lesion is already enhanced (arrows), whereas the lesions is still unenhanced

B: Twenty seconds later, the lesion shows delayed inhomogeneous enhancement, which indicates a preferential bronchial arterial supply

Ultrasound-Guided Peripheral

IV Placement

Ultrasound evaluation of

diaphragm

(Chest. 2008; 133:836-837)

© 2008 American College of Chest

Physicians

Ultrasound: The Pulmonologist’s New

Best Friend

Momen M. Wahidi, MD, FCCP

Durham, NC

Director, Interventional Pulmonology, Duke

University Medical Center, Box 3683,

Durham, NC 27710