Sonography in Critical Ill Patients

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Sonography in Critical Ill Patients

  1. 1. Chest Sonography in Critically Ill Patients Gamal Rabie Agmy ,MD ,FCCP Professor of Chest Diseases, Assiut University
  2. 2. A common language: Color Coding Black Grey White
  3. 3. Ultrasound profiles. Lichtenstein D A , Mezière G A Chest 2008;134:117-125
  4. 4. Tissue pattern representative of Alveolar Consolidation Presence of hyperechoic punctiform imagesrepresentative of air bronchograms Pleural effusion Lower lobe
  5. 5. Scanning Positions for Chest Sonography in ICU
  6. 6. Normal Anatomy
  7. 7. Tissue pattern representative of Alveolar Consolidation Presence of hyperechoic punctiform imagesrepresentative of air bronchograms Pleural effusion Lower lobe
  8. 8. the "seashore sign" (Fig.3).
  9. 9. Clinical applications of lung ultrasonography in the intensive care unit 1. Diagnosis of pulmonary consolidation. 2. Diagnosis of atelectasis 3. Diagnosis of alveolar-interstitialsyndrome 4. Differentiating between pulmonary oedema and ARDS 5. Differentiating between pulmonary oedema and COPD 6. Diagnosis of pulmonary embolism 7. Diagnosis of pneumothorax 8. Diagnosis and estimation of volume and nature of pleural effusion. 9. Diagnostic and therapeutic ultrasound-guided thoracentesis.
  10. 10. 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
  11. 11. the "seashore sign" (Fig.3).
  12. 12. Pulmonary Embolism
  13. 13. Schematic representation of the parenchymal, pleural and vascular features associated with pulmonary embolism.(Angelika Reissig, Claus Kroegel. Respiration2003;70:441-452)
  14. 14. Alveolar-interstitial syndrome
  15. 15. Multiple B-lines - « comet-tails » - interstitial edema (B1) 7 mm apart « B lines » thickened interlobular septa D Lichtenstein et al AJRCCM 156 : 1640-1646 , 1997JJR 25 05http://www.reapitie- http://www.reapitie- 02 09 2012
  16. 16. D Lichtenstein et al AJRCCM 156 : 1640-1646 , 199730 11 2011 Coalescent B lines - « comet-tails » - alveolar edema 3 mm apart « B lines » ground-glass areas http://www.reapitie- 02 09 2012
  17. 17. (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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