Rple of chest sonography in management of dyspnea

2. Assessment of
dyspnea by Chest US
Gamal Rabie Agmy, MD, FCCP
Professor of chest Diseases,Assiut university

4. High Frequency
• High frequency (5-10 MHz)
greater resolution
less penetration
• Shallow structures

5. Low Frequency
• Low frequency (2-3.5 MHz)
greater penetration
less resolution
• Deep structures

6. Probes

7. A common language: Color Coding
Black Grey White

9. BLUE-Protocol and FALLS-Protocol Two
Applications of Lung Ultrasound in the Critically
Ill
(Daniel A. Lichtenstein , MD , FCCP, CHEST
2015; 147 ( 6 ): 1659 - 1670

12. THE BAT VIEW
Chest wall
Pleural line

14. 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 characteristicpattern called the bat sign.

15. A lines = default normal
 Horizontal echo
reflection at exact
multiples of intervals
from surface to
bright reflector.
 Dry lung OR PNTX
 Decay with depth
 Obliterated by B
pleura A
A
A
A
A
A

18. the "seashore sign" (Fig.3).

21. Confluent B lines = Bad Bad
 ‘White’ or ‘shining’
lung
 Means increased
severity
 Probably indicates
thicker fluid in alveoli
eg protein or
inflammatory cells
 % space / 10

22. B x 3 x 2 x 2 = CCF
Makes assumption that ‘globally’ wet
lungs are most likely to be CCF
12

23. Ultrasound profiles.
Lichtenstein D A , Mezière G A Chest 2008;134:117-125

28. Tissue pattern representative of Alveolar
Consolidation
Presence of hyperechoic punctiform
images
representative of air bronchograms
Pleural
effusion
Lower lobe

40. 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

44. the "seashore sign" (Fig.3).

53. Pulmonary Embolism

54. Schematic representation of the parenchymal, pleural and vascular
features associated with pulmonary embolism.(Angelika Reissig, Claus
Kroegel. Respiration2003;70:441-452)

56. Alveolar-interstitial syndrome

61. Multiple B-lines - « comet-tails » - interstitial edema
(B1)
7 mm apart « B lines » thickened interlobular
septa
D Lichtenstein et al AJRCCM 156 : 1640-1646 , 1997
JJR 25 05
http://www.reapitie-
http://www.reapitie- 02 09 2012

62. D Lichtenstein et al AJRCCM 156 : 1640-1646 , 1997
30 11 2011
Coalescent B lines - « comet-tails » - alveolar
edema
3 mm apart « B lines » ground-glass
areas
http://www.reapitie- 02 09 2012

75. (Chest. 2008; 133:836-837)
© 2008 American College of Chest Physicians
Ultrasound: The Pulmonologist’s New Best
Friend
Momen M. Wahidi, MD, FCCP