POSSIBILITIES OF PLEURAL LINE ULTRASOUND - ORIGINAL WORK
Abstract
Introduction: Ultrasonography is an accurate and reproducible tool for assessing the pleura. It represents a critical point, as the chest wall can be assessed directly, while the underlying lungs are only assessed through specific artifacts.
Methods: The work is based on our many years of experience in pleural line ultrasound and is additionally compared with literature information. We reviewed our patient databases and analyzed the ultrasound examinations performed.
Results: Imaging the pleural line provides valuable information for diagnosing and monitoring various disease entities. Importantly, it can be successfully used in virtually any patient group, without the exposure to harmful radiation used in conventional radiology. It is also a key component of a broader examination, namely chest ultrasonography, and is a crucial element assessed in emergency ultrasound protocols.
Conclusions: Pleural line ultrasound is an important and safe diagnostic tool worth using in clinical practice. Its safety and highly detailed imaging are key considerations. It's worth comparing this method with other imaging techniques.
References
Soldati G, Demi M, Smargiassi A, Inchingolo R, Demi L. The role of ultrasound lung artifacts in the diagnosis of respiratory diseases. Expert Rev Respir Med. 2019 Feb;13(2):163-172. doi: 10.1080/17476348.2019.1565997. Epub 2019 Jan 10. PMID: 30616416.
Soldati G, Smargiassi A, Inchingolo R, Buonsenso D, Perrone T, Briganti DF, Perlini S, Torri E, Mariani A, Mossolani EE, Tursi F, Mento F, Demi L. Is There a Role for Lung Ultrasound During the COVID-19 Pandemic? J Ultrasound Med. 2020 Jul;39(7):1459-1462. doi: 10.1002/jum.15284. Epub 2020 Apr 7. PMID: 32198775; PMCID: PMC7228238.
El Sayed MJ, Zaghrini E. Prehospital emergency ultrasound: a review of current clinical applications, challenges, and future implications. Emerg Med Int. 2013;2013:531674. doi: 10.1155/2013/531674. Epub 2013 Sep 19. PMID: 24171113; PMCID: PMC3792527.
El Sayed MJ, Zaghrini E. Prehospital emergency ultrasound: a review of current clinical applications, challenges, and future implications. Emerg Med Int. 2013;2013:531674. doi: 10.1155/2013/531674. Epub 2013 Sep 19. PMID: 24171113; PMCID: PMC3792527.
Gargani L, Volpicelli G. How I do it: lung ultrasound. Cardiovasc Ultrasound. 2014 Jul 4;12:25. doi: 10.1186/1476-7120-12-25. PMID: 24993976; PMCID: PMC4098927.
Volpicelli G, Elbarbary M, Blaivas M, Lichtenstein DA, Mathis G, Kirkpatrick AW, Melniker L, Gargani L, Noble VE, Via G, Dean A, Tsung JW, Soldati G, Copetti R, Bouhemad B, Reissig A, Agricola E, Rouby JJ, Arbelot C, Liteplo A, Sargsyan A, Silva F, Hoppmann R, Breitkreutz R, Seibel A, Neri L, Storti E, Petrovic T; International Liaison Committee on Lung Ultrasound (ILC-LUS) for International Consensus Conference on Lung Ultrasound (ICC-LUS). International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med. 2012 Apr;38(4):577-91. doi: 10.1007/s00134-012-2513-4. Epub 2012 Mar 6. PMID: 22392031.
Dexheimer Neto FL, Dalcin Pde T, Teixeira C, Beltrami FG. Lung ultrasound in critically ill patients: a new diagnostic tool. J Bras Pneumol. 2012 Mar-Apr;38(2):246-56. English, Portuguese. doi: 10.1590/s1806-37132012000200015. PMID: 22576434.
Mojoli F, Bouhemad B, Mongodi S, Lichtenstein D. Lung Ultrasound for Critically Ill Patients. Am J Respir Crit Care Med. 2019 Mar 15;199(6):701-714. doi: 10.1164/rccm.201802-0236CI. Erratum in: Am J Respir Crit Care Med. 2020 Apr 15;201(8):1015. doi: 10.1164/rccm.v201erratum4. Erratum in: Am J Respir Crit Care Med. 2020 Jun 1;201(11):1454. doi: 10.1164/rccm.v201erratum5. PMID: 30372119.
Volpicelli G, Silva F, Radeos M. Real-time lung ultrasound for the diagnosis of alveolar consolidation and interstitial syndrome in the emergency department. Eur J Emerg Med. 2010 Apr;17(2):63-72. doi: 10.1097/mej.0b013e3283101685. PMID: 20945542.
Lichtenstein DA. Lung ultrasound in the critically ill. Ann Intensive Care. 2014 Jan 9;4(1):1. doi: 10.1186/2110-5820-4-1. PMID: 24401163; PMCID: PMC3895677.
Volpicelli G. Sonographic diagnosis of pneumothorax. Intensive Care Med. 2011 Feb;37(2):224-32. doi: 10.1007/s00134-010-2079-y. Epub 2010 Nov 20. PMID: 21103861.
Lichtenstein DA, Mezière G, Lascols N, Biderman P, Courret JP, Gepner A, Goldstein I, Tenoudji-Cohen M. Ultrasound diagnosis of occult pneumothorax. Crit Care Med. 2005 Jun;33(6):1231-8. doi: 10.1097/01.ccm.0000164542.86954.b4. PMID: 15942336.
Hwang TS, Yoon YM, Jung DI, Yeon SC, Lee HC. Usefulness of transthoracic lung ultrasound for the diagnosis of mild pneumothorax. J Vet Sci. 2018 Sep 30;19(5):660-666. doi: 10.4142/jvs.2018.19.5.660. PMID: 30041286; PMCID: PMC6167337.
Lichtenstein D, Mezière G, Biderman P, Gepner A. The "lung point": an ultrasound sign specific to pneumothorax. Intensive Care Med. 2000 Oct;26(10):1434-40. doi: 10.1007/s001340000627. PMID: 11126253.
Prina E, Torres A, Carvalho CR. Lung ultrasound in the evaluation of pleural effusion. J Bras Pneumol. 2014 Jan-Feb;40(1):1-5. doi: 10.1590/S1806-37132014000100001. PMID: 24626263; PMCID: PMC4075927.
Joyner CR Jr, Herman RJ, Reid JM. Reflected ultrasound in the detection and localization of pleural effusion. JAMA. 1967 May 1;200(5):399-402. PMID: 6071511.
Bhatnagar R, Maskell N. The modern diagnosis and management of pleural effusions. BMJ. 2015 Sep 8;351:h4520. doi: 10.1136/bmj.h4520. PMID: 26350935.
Gryminski J, Krakówka P, Lypacewicz G. The diagnosis of pleural effusion by ultrasonic and radiologic techniques. Chest. 1976 Jul;70(1):33-7. doi: 10.1378/chest.70.1.33. PMID: 1277928.
Chen HJ, Hsu WH, Tu CY, Yu YH, Chiu KL, Hang LW, Hsia TC, Shih CM. Sonographic septation in lymphocyte-rich exudative pleural effusions: a useful diagnostic predictor for tuberculosis. J Ultrasound Med. 2006 Jul;25(7):857-63. doi: 10.7863/jum.2006.25.7.857. PMID: 16798896.
Qureshi NR, Rahman NM, Gleeson FV. Thoracic ultrasound in the diagnosis of malignant pleural effusion. Thorax. 2009 Feb;64(2):139-43. doi: 10.1136/thx.2008.100545. Epub 2008 Oct 13. PMID: 18852159.
Kocijancic I, Vidmar K, Ivanovi-Herceg Z. Chest sonography versus lateral decubitus radiography in the diagnosis of small pleural effusions. J Clin Ultrasound. 2003 Feb;31(2):69-74. doi: 10.1002/jcu.10141. PMID: 12539247.
Newhouse SM, Effing TW, Dougherty BD, D'Costa JA, Rose AR. Is Bigger Really Better? Comparison of Ultraportable Handheld Ultrasound with Standard Point-of-Care Ultrasound for Evaluating Safe Site Identification and Image Quality prior to Pleurocentesis. Respiration. 2020;99(4):325-332. doi: 10.1159/000505698. Epub 2020 Mar 24. PMID: 32208396.
Thurlbeck WM, Müller NL. Emphysema: definition, imaging, and quantification. AJR Am J Roentgenol. 1994 Nov;163(5):1017-25. doi: 10.2214/ajr.163.5.7976869. PMID: 7976869.
Volpicelli G, Cardinale L, Garofalo G, Veltri A. Usefulness of lung ultrasound in the bedside distinction between pulmonary edema and exacerbation of COPD. Emerg Radiol. 2008 May;15(3):145-51. doi: 10.1007/s10140-008-0701-x. Epub 2008 Jan 31. PMID: 18236088.
Lichtenstein D, Mezière G. A lung ultrasound sign allowing bedside distinction between pulmonary edema and COPD: the comet-tail artifact. Intensive Care Med. 1998 Dec;24(12):1331-4. doi: 10.1007/s001340050771. PMID: 9885889.
Lichtenstein DA. Lung ultrasound in the critically ill. Ann Intensive Care. 2014 Jan 9;4(1):1. doi: 10.1186/2110-5820-4-1. PMID: 24401163; PMCID: PMC3895677.
Davidsen JR, Laursen CB, Højlund M, Lund TK, Jeschke KN, Iversen M, Kalhauge A, Bendstrup E, Carlsen J, Perch M, Henriksen DP, Schultz HHL. Lung Ultrasound to Phenotype Chronic Lung Allograft Dysfunction in Lung Transplant Recipients. A Prospective Observational Study. J Clin Med. 2021 Mar 5;10(5):1078. doi: 10.3390/jcm10051078. PMID: 33807615; PMCID: PMC7961975.
Miyashita N. Atypical pneumonia: Pathophysiology, diagnosis, and treatment. Respir Investig. 2022 Jan;60(1):56-67. doi: 10.1016/j.resinv.2021.09.009. Epub 2021 Nov 5. PMID: 34750083.
Song G, Bae SC, Lee YH. Diagnostic accuracy of lung ultrasound for interstitial lung disease in patients with connective tissue diseases: a meta-analysis. Clin Exp Rheumatol. 2016 Jan-Feb;34(1):11-6. Epub 2016 Jan 20. PMID: 26812366.
Buda N, Piskunowicz M, Porzezińska M, Kosiak W, Zdrojewski Z. Lung Ultrasonography in the Evaluation of Interstitial Lung Disease in Systemic Connective Tissue Diseases: Criteria and Severity of Pulmonary Fibrosis - Analysis of 52 Patients. Ultraschall Med. 2016 Aug;37(4):379-85. English. doi: 10.1055/s-0041-110590. Epub 2015 Dec 29. PMID: 26713499.
Ferro F, Delle Sedie A. The use of ultrasound for assessing interstitial lung involvement in connective tissue diseases. Clin Exp Rheumatol. 2018 Sep-Oct;36 Suppl 114(5):165-170. Epub 2018 Oct 1. PMID: 30296990.
Manolescu D, Davidescu L, Traila D, Oancea C, Tudorache V. The reliability of lung ultrasound in assessment of idiopathic pulmonary fibrosis. Clin Interv Aging. 2018 Mar 22;13:437-449. doi: 10.2147/CIA.S156615. PMID: 29606857; PMCID: PMC5868611.
Xie HQ, Zhang WW, Sun S, Chen XM, Yuan SF, Gong ZH, Liu L. A simplified lung ultrasound for the diagnosis of interstitial lung disease in connective tissue disease: a meta-analysis. Arthritis Res Ther. 2019 Apr 11;21(1):93. doi: 10.1186/s13075-019-1888-9. PMID: 30975190; PMCID: PMC6460810.
Kagami K, Harada T, Yamaguchi K, Kouno S, Ikoma T, Yoshida K, Kato T, Tomono J, Wada N, Adachi T, Kurabayashi M, Obokata M. Association between lung ultrasound B-lines and exercise-induced pulmonary hypertension in patients with connective tissue disease. Echocardiography. 2021 Aug;38(8):1297-1306. doi: 10.1111/echo.15141. Epub 2021 Jun 29. PMID: 34184322.
Buda N, Wojteczek A, Masiak A, Piskunowicz M, Batko W, Zdrojewski Z. Lung Ultrasound in the Screening of Pulmonary Interstitial Involvement Secondary to Systemic Connective Tissue Disease: A Prospective Pilot Study Involving 180 Patients. J Clin Med. 2021 Sep 12;10(18):4114. doi: 10.3390/jcm10184114. PMID: 34575225; PMCID: PMC8466284.
Gasperini ML, Gigante A, Iacolare A, Pellicano C, Lucci S, Rosato E. The predictive role of lung ultrasound in progression of scleroderma interstitial lung disease. Clin Rheumatol. 2020 Jan;39(1):119-123. doi: 10.1007/s10067-019-04686-z. Epub 2019 Jul 20. PMID: 31327084.
Blaivas M. Lung ultrasound in evaluation of pneumonia. J Ultrasound Med. 2012 Jun;31(6):823-6. doi: 10.7863/jum.2012.31.6.823. PMID: 22644677.
Cortellaro F, Colombo S, Coen D, Duca PG. Lung ultrasound is an accurate diagnostic tool for the diagnosis of pneumonia in the emergency department. Emerg Med J. 2012 Jan;29(1):19-23. doi: 10.1136/emj.2010.101584. Epub 2010 Oct 28. PMID: 21030550.
Caiulo VA, Gargani L, Caiulo S, Fisicaro A, Moramarco F, Latini G, Picano E, Mele G. Lung ultrasound characteristics of community-acquired pneumonia in hospitalized children. Pediatr Pulmonol. 2013 Mar;48(3):280-7. doi: 10.1002/ppul.22585. Epub 2012 May 2. PMID: 22553150.
Long L, Zhao HT, Zhang ZY, Wang GY, Zhao HL. Lung ultrasound for the diagnosis of pneumonia in adults: A meta-analysis. Medicine (Baltimore). 2017 Jan;96(3):e5713. doi: 10.1097/MD.0000000000005713. PMID: 28099332; PMCID: PMC5279077.
Reissig A, Copetti R. Lung ultrasound in community-acquired pneumonia and in interstitial lung diseases. Respiration. 2014;87(3):179-89. doi: 10.1159/000357449. Epub 2014 Jan 28. PMID: 24481027.
Lichtenstein D, Peyrouset O. Is lung ultrasound superior to CT? The example of a CT occult necrotizing pneumonia. Intensive Care Med. 2006 Feb;32(2):334-335. doi: 10.1007/s00134-005-0004-6. Epub 2006 Jan 27. PMID: 16468074.
Bouhemad B, Zhang M, Lu Q, Rouby JJ. Clinical review: Bedside lung ultrasound in critical care practice. Crit Care. 2007;11(1):205. doi: 10.1186/cc5668. PMID: 17316468; PMCID: PMC2151891.
Havelock T, Teoh R, Laws D, Gleeson F; BTS Pleural Disease Guideline Group. Pleural procedures and thoracic ultrasound: British Thoracic Society Pleural Disease Guideline 2010. Thorax. 2010 Aug;65 Suppl 2:ii61-76. doi: 10.1136/thx.2010.137026. PMID: 20696688.
Demi L, Wolfram F, Klersy C, De Silvestri A, Ferretti VV, Muller M, Miller D, Feletti F, Wełnicki M, Buda N, Skoczylas A, Pomiecko A, Damjanovic D, Olszewski R, Kirkpatrick AW, Breitkreutz R, Mathis G, Soldati G, Smargiassi A, Inchingolo R, Perrone T. New International Guidelines and Consensus on the Use of Lung Ultrasound. J Ultrasound Med. 2023 Feb;42(2):309-344. doi: 10.1002/jum.16088. Epub 2022 Aug 22. PMID: 35993596; PMCID: PMC10086956.
Lee FC. Lung ultrasound-a primary survey of the acutely dyspneic patient. J Intensive Care. 2016 Aug 31;4(1):57. doi: 10.1186/s40560-016-0180-1. PMID: 27588206; PMCID: PMC5007698.
Rocca E, Zanza C, Longhitano Y, Piccolella F, Romenskaya T, Racca F, Savioli G, Saviano A, Piccioni A, Mongodi S. Lung Ultrasound in Critical Care and Emergency Medicine: Clinical Review. Adv Respir Med. 2023 May 17;91(3):203-223. doi: 10.3390/arm91030017. PMID: 37218800; PMCID: PMC10204578.
Mathis G. Sonographie bei Lungenembolie: drei Fliegen auf einen Streich [Ultrasound in pulmonary embolism: killing three birds with one stone]. Pneumologie. 2006 Oct;60(10):600-6. German. doi: 10.1055/s-2006-944257. PMID: 17043975.
Jiang L., Ma, Y., Zhao C., Shen W., Feng X., Xu Y., Zhang M. Role of transthoracic lung ultrasonography in the
Lichtenstein DA, Mezière GA. Relevance of lung ultrasound in the diagnosis of acute respiratory failure: the BLUE protocol. Chest. 2008 Jul;134(1):117-25. doi: 10.1378/chest.07-2800. Epub 2008 Apr 10. Erratum in: Chest. 2013 Aug;144(2):721. PMID: 18403664; PMCID: PMC3734893.
Yuan A, Yang PC, Lee L, Wu HD, Kuo SH, Luh KT, Chen WJ, Lin FY. Reactive pulmonary artery vasoconstriction in pulmonary consolidation evaluated by color Doppler ultrasonography. Ultrasound Med Biol. 2000 Jan;26(1):49-56. doi: 10.1016/s0301-5629(99)00118-0. PMID: 10687792.
Arbelot C, Ferrari F, Bouhemad B, Rouby JJ. Lung ultrasound in acute respiratory distress syndrome and acute lung injury. Curr Opin Crit Care. 2008 Feb;14(1):70-4. doi: 10.1097/MCC.0b013e3282f43d05. PMID: 18195629.
Dargent A, Chatelain E, Kreitmann L, Quenot JP, Cour M, Argaud L; COVID-LUS study group. Lung ultrasound score to monitor COVID-19 pneumonia progression in patients with ARDS. PLoS One. 2020 Jul 21;15(7):e0236312. doi: 10.1371/journal.pone.0236312. PMID: 32692769; PMCID: PMC7373285.
Mongodi S., Bonaiti S., Stella A., Colombo A., Santangelo E., Vaschetto R., Orlando A., Bouhemad B., Mojoli F. Lung Ultrasound for Daily Monitoring and Management of ARDS Patients. Clinical Pulmonary Medicine, 2019 26(3), s. 92-97.
Pisani L, Vercesi V, van Tongeren PSI, Lagrand WK, Leopold SJ, Huson MAM, Henwood PC, Walden A, Smit MR, Riviello ED, Pelosi P, Dondorp AM, Schultz MJ; Lung Ultrasound Consortium. The diagnostic accuracy for ARDS of global versus regional lung ultrasound scores - a post hoc analysis of an observational study in invasively ventilated ICU patients. Intensive Care Med Exp. 2019 Jul 25;7(Suppl 1):44. doi: 10.1186/s40635-019-0241-6. PMID: 31346914; PMCID: PMC6658630.
Griffin N, Khan N, Thomas JM, Fisher C, Moskovic EC. The radiological manifestations of intramuscular haemangiomas in adults: magnetic resonance imaging, computed tomography and ultrasound appearances. Skeletal Radiol. 2007 Nov;36(11):1051-9. doi: 10.1007/s00256-007-0375-6. Epub 2007 Sep 12. PMID: 17849114.
Daigeler A, Vogt PM, Busch K, Pennekamp W, Weyhe D, Lehnhardt M, Steinstraesser L, Steinau HU, Kuhnen C. Elastofibroma dorsi--differential diagnosis in chest wall tumours. World J Surg Oncol. 2007 Feb 5;5:15. doi: 10.1186/1477-7819-5-15. PMID: 17280612; PMCID: PMC1797045.
Hu X, Cai H, Zhou M, He H, Tian W, Hu Y, Chen L, Deng Y. New clinical application of high-intensity focused ultrasound: local control of synovial sarcoma. World J Surg Oncol. 2013 Oct 8;11:265. doi: 10.1186/1477-7819-11-265. PMID: 24103491; PMCID: PMC3851998.
Bandi V, Lunn W, Ernst A, Eberhardt R, Hoffmann H, Herth FJ. Ultrasound vs. CT in detecting chest wall invasion by tumor: a prospective study. Chest. 2008 Apr;133(4):881-6. doi: 10.1378/chest.07-1656. Epub 2007 Oct 20. PMID: 17951616.
Sconfienza LM, Mauri G, Grossi F, Truini M, Serafini G, Sardanelli F, Murolo C. Pleural and peripheral lung lesions: comparison of US- and CT-guided biopsy. Radiology. 2013 Mar;266(3):930-5. doi: 10.1148/radiol.12112077. Epub 2012 Nov 30. PMID: 23204543.
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