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DR MOSTAQUE AHMED BHUIYANMBBS.MD.FCPSASSISTANT PROFESSOR.DEPT OF RADIOLOGY& IMAGINGSYLHET MAG OSMANI MEDICAL COLLEGE.

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Over the last few years the use of lung ultrasound has gained in popularity in diagnosis and evaluation of critically ill patients.

It is rapid, repeatable and free of complications.

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It is common knowledge that ultrasound beam not normally passed through air filled structures making the evaluation of lung parenchyma impossible

—these does not however prevents the diagnosis of several conditions include pneumothorax. consolidation, pleural effusion etc.

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AdvantagesAdvantages

Can detect small amount of fluid in pleural cavity and location of the fluid.

Can differentiate pleural fluid from lung consolidation

Diagnosis of pleural thickening and pleural mass.

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DisadvantageDisadvantage

Thoracic ultrasound is an operator dependent technique

Is not as good as CT in evaluation of parenchymal disease.

Indications of chest sonographyIndications of chest sonography

Chest wall pathology Lipoma.hematoma.abscess. Node, rib fracture rib metastasis.rib massDiaphragm: Normal /paralysis of hemidiaphragmPleural effusion Pleural thickening

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Pleural mass like fibroma.lipoma,mesothelioma metastasis etc

Detection of pneumothorax

Consolidation

Guidence for diagnostic and therapeutic thoracocentesis

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SCANING POSITIONSCANING POSITION

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NORMAL ANATOMYNORMAL ANATOMY

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Acute Pulmonary oedema.Acute Pulmonary oedema.

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Acute pulmonary oedemaAcute pulmonary oedema

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PneumothoraxPneumothorax

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ConsolidationConsolidation Irregular hypoechic area of varying

size and shape.Echotexure can appear homogenous

or inhomogenous.The most common sonographic

feature is the air bronchogram which is characterized by lens shaped internal echoes within hypodene area or echogenic lines.

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Summarizing sonographic Summarizing sonographic finding in consolidationfinding in consolidation

Liver like in early stageAir bronchogramFluid bronchogramBlurred and serrated marginReberberation echoes in the marginHypoechoic abscess formation

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COLLASPE OF LUNGCOLLASPE OF LUNG

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Pleural effusion.Pleural effusion.

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Pleural thickening.Pleural thickening.

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Lung abscessLung abscess

They typically appear as round or oval anechoic lesions

Margin may be smooth and echodense

Microabscess are often visible as anechoic areas within the pneumonic consolidation.

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Pneumonia complicated by abscessPneumonia complicated by abscess

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Peripheral bronchial carcinomaPeripheral bronchial carcinoma

Can help to define better necrotic areas that are depicted as anehoic region inside the tumour.

The infiltrative growth of solid tissue without regard to anatomical structures is characteristic of malignancy.

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Pheripheral bronchial ca.Pheripheral bronchial ca.

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Lung ca infiltrating chest wall.Lung ca infiltrating chest wall.

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Pulmonary metastasisPulmonary metastasis

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Summary of pulmonary caSummary of pulmonary ca

Hypoechoic, inhomogenous.

Rounded, nearly rounded.

Sharp,serrated margins

Infiltration of chest wall

Irregular vascularization

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Limitation of lung ultrasoundLimitation of lung ultrasound

Require formal training ,knowledge and skills.

Obese patients are frequently difficult to examine.

The presence of subcutaneous emphysema.

Lung ultrasound cannot detect lung overinflation.

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ConclusionConclusionEasy to learn and apply It can be used quickly to rule out any

significant pneumothorax in critically ill patient.

More sensitive than cxr in pleural effusion or pleural pathology.

The routine use of lung ultrasound appears attractive alternative to bedside chest radiography

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