Aug 23, 2014
Sonography in Early Diagnosis
of Chest Diseases
Gamal Rabie Agmy ,MD ,FCCP
Professor of Chest Diseases, Assiut University
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At the bedside, chest radiography remains the reference for lung imaging in
critically ill patients. However, radiographical images are often of
limited quality
• Movements of the chest wall
• Film cassette posterior to the thorax
• X-ray beam originating anteriorly, at a shorter distance than
recommended and not tangential to the diaphragmatic cupola .
Mistaken assessment
of :
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• Pleural effusion
• Alveolar consolidation
• Alveolar-interstitial
syndrome
Bedside Chest Radiography in the Critically
ill
02 09 2012
Risk of transportation
Lung Computed Tomography in
the Critically ill
http://www.reapitie-
univparis6.aphp.fr 02 09 2012
Scanning Positions for Chest Sonography in ICU
Normal Anatomy
Tissue pattern representative of Alveolar
Consolidation
Presence of hyperechoic punctiform images representative of air bronchograms
Pleural effusion
Lower lobe
the "seashore sign" (Fig.3).
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
(B7)
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 « B3 lines » ground-glass areas
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univparis6.aphp.fr
02 09 2012
(Chest. 2008; 133:836-837)
© 2008 American College of Chest Physicians
Ultrasound: The Pulmonologist’s New Best
Friend
Momen M. Wahidi, MD, FCCP