Sonography in early diagnosis of chest diseases

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Sonography in early diagnosis of chest diseases

  1. 1. Sonography in Early Diagnosis of Chest Diseases Gamal Rabie Agmy ,MD ,FCCP Professor of Chest Diseases, Assiut University
  2. 2. Bedside Chest Radiography in the Critically ill 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 c • X-ray beam originating anteriorly, at a shorter distance than recommended and not tangential to the diaphragmatic cupola . Mistaken assessment of : • • • Pleural effusion Alveolar consolidation c Alveolar-interstitial syndrome 02 09 2012
  3. 3. Lung Computed Tomography in the Critically ill Risk of transportation http://www.reapitie- 02 09 2012
  4. 4. Scanning Positions for Chest Sonography in ICU
  5. 5. Normal Anatomy
  6. 6. Tissue pattern representative of Alveolar Consolidation Presence of hyperechoic punctiform images representative of air bronchograms Pleural effusion Lower lobe
  7. 7. the "seashore sign" (Fig.3).
  8. 8. The key sonographic signs of Pneumothorax Absent lung sliding Exaggerated horizontal artifacts Loss of comet-tail artifacts Broadening of the pleural line to a band
  9. 9. the "seashore sign" (Fig.3).
  10. 10. Pulmonary Embolism
  11. 11. Schematic representation of the parenchymal, pleural and vascular features associated with pulmonary embolism.(Angelika Reissig, Claus Kroegel. Respiration 2003;70:441-452 )
  12. 12. Alveolar-interstitial syndrome
  13. 13. Multiple B-lines - « comet-tails » - interstitial edema (B7) 7 mm apart « B lines » thickened interlobular septa http://www.reapitiehttp://www.reapitie- JJR 25 05 D Lichtenstein et al AJRCCM 156 : 1640-1646 ,09 2012 02 1997
  14. 14. Coalescent B lines - « comet-tails » - alveolar edema 3 mm apart « B3 lines » glass areas 30 11 2011 http://www.reapitie- 02 09 2012 ground- D Lichtenstein et al AJRCCM 156 : 1640-1646 , 1997
  15. 15. (Chest. 2008; 133:836-837) © 2008 American College of Chest Physicians Ultrasound: The Pulmonologist’s New Best Friend Momen M. Wahidi, MD, FCCP

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