Updates in Chest Sonography

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Updates in Chest Sonography

  1. 1. Updates in Chest Sonography By Gamal Rabie Agmy , MD , FCCP Professor of Chest Diseases ,Assiut University
  2. 2. • Diagnostic ultrasonography is the only clinical imaging technology currently in use that does not depend on electromagnetic radiation.
  3. 3. Ultrasound Transducer • Acts as both speaker & microphone  Emits very short sound pulse  Listens a very long time for returning echoes • Can only do one at a time Speaker Microphone transmits sound pulses receives echoes
  4. 4. High Frequency • High frequency (5-10 MHz) greater resolution less penetration • Shallow structures vascular, abscess, t/v gyn, testicular
  5. 5. Low Frequency • Low frequency (2-3.5 MHz) greater penetration less resolution • Deep structures Aorta, t/a gyn, card, gb, renal
  6. 6. Probes
  7. 7. A common language: Color Coding Black Grey White
  8. 8. Hyperechoic Hypoechoic Anechoic
  9. 9. Scanning Positions for Chest Sonography
  10. 10. Normal Anatomy
  11. 11. Normal lung surface Left panel: Pleural line and A line (real-time). The pleural line is located 0.5 cm below the rib line in the adult. Its visible length between two ribs in the longitudinal scan is approximately 2 cm. The upper rib, pleural line, and lower rib (vertical arrows) outline a characteristic pattern called the bat sign.
  12. 12. the "seashore sign" (Fig.3).
  13. 13. 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 Lung point Loss of lung impulse
  14. 14. Pulmonary Embolism
  15. 15. Schematic representation of the parenchymal, pleural and vascular features associated with pulmonary embolism.(Angelika Reissig, Claus Kroegel. Respiration 2003;70:441-452 )
  16. 16. Duplex Doppler sonogram of a 5 x 3 cm hypoechoic mass (adenocarcinoma) in upper lobe of left lung shows blood flow at margin of tumor near pleura. Spectral waveform reveals arteriovenous shunting: low-impedance flow with high systolic and diastolic velocities. Pulsatility index = 0.90, resistive index = 0.51, peak systolic velocity = 0.47 m/sec, end diastolic velocity =0.23 m/sec, peak frequency shift = 3.8 kHz,
  17. 17. Duplex Doppler sonogram in 67-year-old man with pulmonary tuberculosis in lower lobe of left lung shows several blue and red flow signals in massiike lesion. Spectral waveform reveals high-impedance flow. Pulsetility index = 4.20, resistive index = 0.93, peak systolic velocity = 0.45 m/sec, end diastolic velocity = 0.03 m/sec, Doppler angle = 21#{
  18. 18. Alveolar-interstitial syndrome
  19. 19. Contrast-enhanced ultrasonography of pneumonia A: Baseline scan shows a hypoechoic consolidated area B: Seven seconds after iv bolus of contrast agent, the lesion shows marked and homogeneous enhancement C: The lesion remains substantially unmodified after 90 s.
  20. 20. Lung abscess at CEUS .A: An anechoic oval lesion is surrounded by an echodense capsule; B: After iv bolus of contrast agent, the lesion shows no contrast agent uptake, whereas the capsule is strongly enhanced
  21. 21. Contrast-enhanced ultrasonography of pulmonary infarction After iv bolus of contrast agent, the lesion shows no contrast agent uptake in the arterial phase, which suggests the absence of blood supply.
  22. 22. Bronchial carcinoma infiltrating the pleural wall. A: Posterior intercostal scan shows a hypoechoic lesion accompanied by rib destruction (arrows); B: Twenty-four seconds after iv bolus of contrast agent, the lesion appears inhomogeneously enhanced; the disrupted rib appears more echogenic than the tumor (arrowheads), as a consequence of the incomplete tissue suppression due to the strong echogenicity of bone tissue.
  23. 23. Contrast-enhanced ultrasonography of bronchial carcinoma A: Baseline scan shows a hypoechoic lesion with irregular borders Ten seconds after iv bolus of contrast agent, the pulmonary parenchyma near the lesion is already enhanced (arrows), whereas the lesions is still unenhanced B: Twenty seconds later, the lesion shows delayed inhomogeneous enhancement, which indicates a preferential bronchial arterial supply
  24. 24. Ultrasound-Guided Peripheral IV Placement
  25. 25. Ultrasound evaluation of diaphragm
  26. 26. (Chest. 2008; 133:836-837) © 2008 American College of Chest Physicians Ultrasound: The Pulmonologist’s New Best Friend Momen M. Wahidi, MD, FCCP Durham, NC Director, Interventional Pulmonology, Duke University Medical Center, Box 3683, Durham, NC 27710

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