usg lung usg lung radiology

1. Lung Ultrasound

2. Agenda
• Evidence
• Technical requirements
• Indications
• The procedure
• Different clinical entities
• sumary

4. Comment(s)
• The sensitivity of transthoracic ultrasound
for the diagnosis of pneumothorax varied
between 58.9% and 100%
• and specificity varied between 94% and
100%.

5. Clinical Bottom Line
• ED transthoracic ultrasound is better than
plain x ray in the diagnosis of pneumothorax
in the supine patient.
CT thorax is the gold standard for diagnosis.

6. ADVANTAGES
• absence of radiation,
• better portability,
• real-time imaging,
• and the ability to perform dynamic imaging.

7. USG
• Compared with computed tomography (CT),
pleural ultrasound has a 95 percent sensitivity
for detection of pleural disease, but is slightly
less sensitive in detecting small amounts of
fluid
• Compared with CT scanning, ultrasound may
better differentiate pleural fluid from pleural
thickening and pleural masses .

8. • Thoracic ultrasound is also faster and less
resource-demanding than transporting a
critically-ill patient to the CT scanner

9. DISADVANTAGES — Thoracic ultrasound is an operator dependent technology. Focused,
supervised training is needed to ensure that the operator correctly interprets the
sonographic findings [6-8]. Inadequate training may increase the risk of complications.
Ultrasound is not as good as CT imaging for evaluation of the underlying lung
parenchyma in the setting of complex pleural and lung parenchymal disease. Ultrasound
guidance is not as good as guidance by CT imaging for complicated interventional
procedures, such as empyema drainage with a pigtail catheter or biopsy of pleural
masses. (

10. Disadvantages
• Operator dependent
• Training needed
• CT is better for parenchymal disease
• In complicated cases of empyema – CT would
be better

11. INDICATIONS
• Pleural fluid
• Guidance for diagnostic and therapeutic
thoracentesis
• Guidance for placement of thoracostomy tubes
• pneumothorax
• Consolidation
• Pulmonary edema
• Diaphragm movements
• Localisation of Mass

12. MACHINE REQUIREMENTS
• The usual general purpose USG machine
• 3.5 – 10 MHz probes

15. Position of patient
• Sitting
• Supine
• Semi recumbent
• Lateral decubitus

16. BLUE points

18. Zones

20. Bat sign

22. A lines

24. B-Lines

26. Pleural sliding

28. Lung pulse

29. Seashore sign

31. Pneumothorax

32. Bar code sign

33. Lung point

35. pneumothorax
• Absence of lung sliding
• Lung point
• Bar code sign

36. Lung sliding may be absent
• Large bulla
• Large cnsolidation
• Collapse
• Severe emphysema
• Main bronchus intubation

37. Landmarks

38. Pleural effusion

45. Pleual efusion
• Anechoic area
• Margins of diaphragm, lung, pleura,
• Sinusoid sign
• Particles- Plankton sign
• Septations
• Floating lung – Gelly fish sign

46. Consolidation

48. Shred

49. Pneumonia
• B lines- Localised
• Hypoechoic
• Air bronchogram Static or dynamic
• Fluid bronchogram
• Pleural effusion

50. Alveolar interstitial syndome

51. Pulmonary Edema
• B lines anteriorly
• >3 in a field
• 7 mm apart
• > 2 zones
• Both sides

52. Pulmonary edema

53. Pulmonary Edema

55. BLUE protocol

58. Pulmonary embolism
• Break in Pleural line
• Mostly in posterior inferior region
• Periperal consolidation
• 0.5 sm – 3 cm
• < 0.5 cm Viral pneumonia/ atelectasis
• >3 cm Pneumonia/ mass

59. Summerise..
• Transthoracic Ultrasound is easy and cheep
invetigation
• Especially in critically ill
• Definitly will improve the clinical skills
• More physicians to be trained in USG