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Lung Ultrasound
Marek Nalos
Department of Intensive care
Nepean Hospital
Penrith, NSW
AUSTRALIA
Chest space - the final frontier
• These are the voyages of the starship Ultrasound
• Its continuing mission:
– to explore...
Normal lung - no lung image
just artifacts
just artifacts
• Soft tissue/air interface 99% of ultrasound waves is reflected...
Normal lung = air
Reverberation artifact
Reverberation artifact
QuickTime™ and a
Photo - JPEG decompressor
are needed to s...
Asthma lung - anterior
QuickTime™ and a
H.264 decompressor
are needed to see this picture.
A - line
Pleura
Normal - A profile - lung base
QuickTime™ and a
H.264 decompressor
are needed to see this picture.
Diaphragm
Liver
Lung
Sp...
Lung consolidation
Contiguous B-lines
B-lines, (lung rockets)
Daniel Lichtenstein et al. Anesthesiology 2004
QuickTime™ and a
decompressor
are needed to see this picture.
rib shadow rib shadow
Wet lung = air/fluid
interfaceReverber...
10
Non cardiogenic pulmonary oedema
QuickTime™ and a
Photo - JPEG decompressor
are needed to see this picture.
cardiogenic pulmonary oedema
anterior
QuickTime™ and a
decompressor
are needed to see this picture.
QuickTime™ and a
decom...
QuickTime™ and a
H.264 decompressor
are needed to see this picture.
lung base
QuickTime™ and a
Microsoft Video 1 decompres...
QuickTime™ and a
decompressor
are needed to see this picture.
Spleen
Consolidated lung
Vertebral column
Diaphraghm
Consolidation - solid tissue
QuickTime™ and a
decompressor
are needed to see this picture.
Right lung base
rib artifact
Consolidation - solid tissue
QuickTime™ and a
decompressor
are needed to see this picture.
Left lung base
No pleural slidi...
Lung consolidation - air bronchgrams
QuickTime™ and a
decompressor
are needed to see this picture.
• sensitivity - 93.4% (95% CI, 89.2%-96.3%)
• specificity - 97.7% (95% CI, 93.4%-99.6%)
• Positive LR - 40.5 (95% CI, 13.2...
Differentiating viral and
bacterial pneumonia in
children
Fluid bronchograms -Tracheo-
esophageal fistula
QuickTime™ and a
decompressor
are needed to see this picture.
Diseased lung
QuickTime™ and a
decompressor
are needed to see this picture.
pleural line
B-line
pleural effusion
consolida...
Pneumothorax
• Absence of lung sliding
• Absence of any B-line
• Potential presence of a lung point
Pneumothorax
Lung point
Lung point
QuickTime™ and a
decompressor
are needed to see this picture.
Curtesy of Dr. Martin Bal...
Ruling out pneumothorax after subclavian
line insertion
QuickTime™ and a
Photo - JPEG decompressor
are needed to see this ...
Pleural effusion
QuickTime™ and a
Cinepak decompressor
are needed to see this picture.
Differentiate basal lung
field opacities on
portable CXR
QuickTime™ and a
decompressor
are needed to see this picture.
Qui...
Parapneumonic effusion
QuickTime™ and a
Cinepak decompressor
are needed to see this picture.
Empyema
QuickTime™ and a
Cinepak decompressor
are needed to see this picture.
28
QuickTime™ and a
decompressor
are needed to see this picture.
QuickTime™ and a
decompressor
are needed to see this pict...
51 post Tetralogy of Fallot repair acute
on chronic respiratory failure
QuickTime™ and a
Photo - JPEG decompressor
are needed to see this picture.
QuickTime™ and a
Photo - JPEG decompressor
are ...
31
QuickTime™ and a
Photo - JPEG decompressor
are needed to see this picture.
QuickTime™ and a
Photo - JPEG decompressor
a...
74 yrs old lady - Nissen fundoplication
postoperative acute respiratory failure
33
Perforated oesophagus
QuickTime™ and a
Photo - JPEG decompressor
are needed to see this picture.
QuickTime™ and a
Photo...
Mediastinitis
QuickTime™ and a
Photo - JPEG decompressor
are needed to see this picture.
QuickTime™ and a
Photo - JPEG dec...
21 yrs old boy - dyspnoea, can’t raise left arm
QuickTime™ and a
Photo - JPEG decompressor
are needed to see this picture.
QuickTime™ and a
Photo - JPEG decompressor
are ...
37
QuickTime™ and a
Photo - JPEG decompressor
are needed to see this picture.
QuickTime™ and a
Photo - JPEG decompressor
a...
Case
• 20 y old driver, multitrauma
–mild head injury
–rib fractures, lung contusions,
haemopneumothorax,
–liver laceratio...
QuickTime™ and a
Microsoft Video 1 decompressor
are needed to see this picture.
• Echocardiography demonstrates normal
LV ...
In the meantime, CXR arrived...?
QuickTime™ and a
Microsoft Video 1 decompressor
are needed to see this picture.
Blunt chest trauma - sudden hypoxia.
Left ...
Failure to wean
QuickTime™ and a
H.264 decompressor
are needed to see this picture.
QuickTime™ and a
H.264 decompressor
ar...
43
H1N1 - ARDS - TOE
QuickTime™ and a
decompressor
are needed to see this picture.
You can’t hide from the frontier
The beautiful frontier is close and all you
need is to look
Lung ultrasound is feasible
• Bedside, point of care test
• Quick, easy to repeat
• No radiation exposure
• Dynamic nature...
Lung ultrasound in ICU
• Often more useful then CXR
• Steep learning curve
• Provides quick answers to
simple clinical que...
Iris Ting Daniel Lichtenstein
Thank you
Marek Nalos: Lung: The Final Frontier
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Marek Nalos: Lung: The Final Frontier

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Marek Nalos gives us the finer details of using ultrasound as a diagnostic tool for respiratory illness.

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Transcript of "Marek Nalos: Lung: The Final Frontier"

  1. 1. Lung Ultrasound Marek Nalos Department of Intensive care Nepean Hospital Penrith, NSW AUSTRALIA
  2. 2. Chest space - the final frontier • These are the voyages of the starship Ultrasound • Its continuing mission: – to explore strange new pictures – to seek out life – and new meanings • To boldly go where only horse has gone before
  3. 3. Normal lung - no lung image just artifacts just artifacts • Soft tissue/air interface 99% of ultrasound waves is reflected • Lung is full of air if normal so ultrasound cannot be used to image healthy lung, only the pleura • But... – with disease process lung loosing aeration – less US beam reflection and more penetration
  4. 4. Normal lung = air Reverberation artifact Reverberation artifact QuickTime™ and a Photo - JPEG decompressor are needed to see this picture. A - line pleural line A - line rib shadow rib shadow
  5. 5. Asthma lung - anterior QuickTime™ and a H.264 decompressor are needed to see this picture. A - line Pleura
  6. 6. Normal - A profile - lung base QuickTime™ and a H.264 decompressor are needed to see this picture. Diaphragm Liver Lung Spine Curtain sign
  7. 7. Lung consolidation Contiguous B-lines B-lines, (lung rockets) Daniel Lichtenstein et al. Anesthesiology 2004
  8. 8. QuickTime™ and a decompressor are needed to see this picture. rib shadow rib shadow Wet lung = air/fluid interfaceReverberation artifact B - line
  9. 9. 10 Non cardiogenic pulmonary oedema QuickTime™ and a Photo - JPEG decompressor are needed to see this picture.
  10. 10. cardiogenic pulmonary oedema anterior QuickTime™ and a decompressor are needed to see this picture. QuickTime™ and a decompressor are needed to see this picture. right left
  11. 11. QuickTime™ and a H.264 decompressor are needed to see this picture. lung base QuickTime™ and a Microsoft Video 1 decompressor are needed to see this picture. spleen left kidney lung lung liver right left
  12. 12. QuickTime™ and a decompressor are needed to see this picture. Spleen Consolidated lung Vertebral column Diaphraghm
  13. 13. Consolidation - solid tissue QuickTime™ and a decompressor are needed to see this picture. Right lung base rib artifact
  14. 14. Consolidation - solid tissue QuickTime™ and a decompressor are needed to see this picture. Left lung base No pleural sliding
  15. 15. Lung consolidation - air bronchgrams QuickTime™ and a decompressor are needed to see this picture.
  16. 16. • sensitivity - 93.4% (95% CI, 89.2%-96.3%) • specificity - 97.7% (95% CI, 93.4%-99.6%) • Positive LR - 40.5 (95% CI, 13.2-123.9) • Negative LR - 0.07 (95% CI, 0.04-0.11) • A combination of auscultation and LUS increased the positive LR to 42.9 (95% CI, 10.8-170.0) and decreased the negative LR to 0.04 (95% CI, 0.02-0.09) Lung Ultrasound in the Diagnosis and Follow-up of Community-Acquired Pneumonia: A Prospective, Multicenter, Diagnostic Accuracy Study Angelika Reissig, MD; Roberto Copetti, MD; Gebhard Mathis, MD; Christine Mempel; Andreas Schuler, MD; Peter Zechner, MD; Stefano Aliberti, MD; Rotraud Neumann, MD; Claus Kroegel, MD, PhD; Heike Hoyer, MSc
  17. 17. Differentiating viral and bacterial pneumonia in children
  18. 18. Fluid bronchograms -Tracheo- esophageal fistula QuickTime™ and a decompressor are needed to see this picture.
  19. 19. Diseased lung QuickTime™ and a decompressor are needed to see this picture. pleural line B-line pleural effusion consolidation
  20. 20. Pneumothorax • Absence of lung sliding • Absence of any B-line • Potential presence of a lung point
  21. 21. Pneumothorax Lung point Lung point QuickTime™ and a decompressor are needed to see this picture. Curtesy of Dr. Martin Balik
  22. 22. Ruling out pneumothorax after subclavian line insertion QuickTime™ and a Photo - JPEG decompressor are needed to see this picture. QuickTime™ and a Photo - JPEG decompressor are needed to see this picture. Presence of pleural sliding or B-lines rules out pneumothorax with 100% accuracy pleural sliding + _
  23. 23. Pleural effusion QuickTime™ and a Cinepak decompressor are needed to see this picture.
  24. 24. Differentiate basal lung field opacities on portable CXR QuickTime™ and a decompressor are needed to see this picture. QuickTime™ and a decompressor are needed to see this picture.
  25. 25. Parapneumonic effusion QuickTime™ and a Cinepak decompressor are needed to see this picture.
  26. 26. Empyema QuickTime™ and a Cinepak decompressor are needed to see this picture.
  27. 27. 28 QuickTime™ and a decompressor are needed to see this picture. QuickTime™ and a decompressor are needed to see this picture. QuickTime™ and a decompressor are needed to see this picture. Pneumonia - legionella QuickTime™ and a decompressor are needed to see this picture. detail
  28. 28. 51 post Tetralogy of Fallot repair acute on chronic respiratory failure
  29. 29. QuickTime™ and a Photo - JPEG decompressor are needed to see this picture. QuickTime™ and a Photo - JPEG decompressor are needed to see this picture. QuickTime™ and a Photo - JPEG decompressor are needed to see this picture.
  30. 30. 31 QuickTime™ and a Photo - JPEG decompressor are needed to see this picture. QuickTime™ and a Photo - JPEG decompressor are needed to see this picture. QuickTime™ and a Photo - JPEG decompressor are needed to see this picture.
  31. 31. 74 yrs old lady - Nissen fundoplication postoperative acute respiratory failure
  32. 32. 33 Perforated oesophagus QuickTime™ and a Photo - JPEG decompressor are needed to see this picture. QuickTime™ and a Photo - JPEG decompressor are needed to see this picture.
  33. 33. Mediastinitis QuickTime™ and a Photo - JPEG decompressor are needed to see this picture. QuickTime™ and a Photo - JPEG decompressor are needed to see this picture.
  34. 34. 21 yrs old boy - dyspnoea, can’t raise left arm
  35. 35. QuickTime™ and a Photo - JPEG decompressor are needed to see this picture. QuickTime™ and a Photo - JPEG decompressor are needed to see this picture. QuickTime™ and a Photo - JPEG decompressor are needed to see this picture.
  36. 36. 37 QuickTime™ and a Photo - JPEG decompressor are needed to see this picture. QuickTime™ and a Photo - JPEG decompressor are needed to see this picture.
  37. 37. Case • 20 y old driver, multitrauma –mild head injury –rib fractures, lung contusions, haemopneumothorax, –liver laceration and ankle fractures • One week in ICU, still intubated, febrile, sudden desaturation, tachycardia, hypotension, tachypnoea
  38. 38. QuickTime™ and a Microsoft Video 1 decompressor are needed to see this picture. • Echocardiography demonstrates normal LV and RV function and size
  39. 39. In the meantime, CXR arrived...?
  40. 40. QuickTime™ and a Microsoft Video 1 decompressor are needed to see this picture. Blunt chest trauma - sudden hypoxia. Left lower lung collapse Bronchoscopy - removal of thick sputum plug from left lower lobe bronchus
  41. 41. Failure to wean QuickTime™ and a H.264 decompressor are needed to see this picture. QuickTime™ and a H.264 decompressor are needed to see this picture. QuickTime™ and a H.264 decompressor are needed to see this picture.
  42. 42. 43 H1N1 - ARDS - TOE QuickTime™ and a decompressor are needed to see this picture.
  43. 43. You can’t hide from the frontier
  44. 44. The beautiful frontier is close and all you need is to look
  45. 45. Lung ultrasound is feasible • Bedside, point of care test • Quick, easy to repeat • No radiation exposure • Dynamic nature – visualization of pleural/lung interface during inspiration and expiration
  46. 46. Lung ultrasound in ICU • Often more useful then CXR • Steep learning curve • Provides quick answers to simple clinical questions arising from history and clinical examination • - in parallel
  47. 47. Iris Ting Daniel Lichtenstein
  48. 48. Thank you
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