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Chest Ultrasonograhy :Technical
Aspects and Interpretation
Gamal Rabie Agmy ,MD ,FCCP
Professor of Chest Diseases, Assiut University
ERS National Delegate of Egypt
Basics
• U/S probes emit and
receive the energy as
waves to form pictures
Ultrasound Transducer
Speaker
transmits sound pulses
Microphone
receives echoes
• 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
Physical Principles
Cycle
• 1 Cycle = 1 repetitive periodic oscillation
Cycle
Frequency
• # of cycles per second
• Measured in Hertz (Hz)
-Human Hearing 20 - 20,000 Hz
-Ultrasound > 20,000 Hz
-Diagnostic Ultrasound 2.5 to 10
MHz
(this is what we use!)
frequency
1 cycle in 1 second = 1Hz
1 second
= 1 Hertz
High Frequency
• High frequency (5-10 MHz)
greater resolution
less penetration
• Shallow structures
Low Frequency
• Low frequency (2-3.5 MHz)
greater penetration
less resolution
• Deep structures
Probes
A common language: Color Coding
Black Grey White
Ultrasound profiles.
Lichtenstein D A , Mezière G A Chest 2008;134:117-125
Normal lung surface
Left panel: Pleural line andA line (real-time).
The pleural line is located 0.5 cm below the rib line in the adult.
Its visiblelength between two ribs in the longitudinalscan is approximately 2
cm. The upper rib, pleural line, and lowerrib (verticalarrows)outlinea
characteristicpattern calledthe bat sign.
Scanning Positions for
Chest Sonography in ICU
Normal Anatomy
Tissue pattern representative of Alveolar
Consolidation
Presence of hyperechoic punctiform
imagesrepresentative of air bronchograms
Pleural
effusion
Lower lobe
the "seashore sign" (Fig.3).
Absent lung sliding
Exaggerated horizontal artifacts
Loss of comet-tail artifacts
Broadening of the pleural line to a
band
Lung point
Loss of lung pulse
The key sonographic signs
of Pneumothorax
the "seashore sign" (Fig.3).
Pulmonary Embolism
Schematic representation of the parenchymal, pleural and vascular
features associated with pulmonary embolism.(Angelika Reissig, Claus
Kroegel. Respiration2003;70:441-452)
Alveolar-interstitial syndrome
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
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
(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
Chest ultrasonograhy techanical aspects and interpretation

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Chest ultrasonograhy techanical aspects and interpretation

  • 1.
  • 2. Chest Ultrasonograhy :Technical Aspects and Interpretation Gamal Rabie Agmy ,MD ,FCCP Professor of Chest Diseases, Assiut University ERS National Delegate of Egypt
  • 3.
  • 4. Basics • U/S probes emit and receive the energy as waves to form pictures
  • 5. Ultrasound Transducer Speaker transmits sound pulses Microphone receives echoes • 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
  • 7. Cycle • 1 Cycle = 1 repetitive periodic oscillation Cycle
  • 8. Frequency • # of cycles per second • Measured in Hertz (Hz) -Human Hearing 20 - 20,000 Hz -Ultrasound > 20,000 Hz -Diagnostic Ultrasound 2.5 to 10 MHz (this is what we use!)
  • 9. frequency 1 cycle in 1 second = 1Hz 1 second = 1 Hertz
  • 10. High Frequency • High frequency (5-10 MHz) greater resolution less penetration • Shallow structures
  • 11. Low Frequency • Low frequency (2-3.5 MHz) greater penetration less resolution • Deep structures
  • 13. A common language: Color Coding Black Grey White
  • 14. Ultrasound profiles. Lichtenstein D A , Mezière G A Chest 2008;134:117-125
  • 15. Normal lung surface Left panel: Pleural line andA line (real-time). The pleural line is located 0.5 cm below the rib line in the adult. Its visiblelength between two ribs in the longitudinalscan is approximately 2 cm. The upper rib, pleural line, and lowerrib (verticalarrows)outlinea characteristicpattern calledthe bat sign.
  • 16.
  • 17. Scanning Positions for Chest Sonography in ICU
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  • 29. Tissue pattern representative of Alveolar Consolidation Presence of hyperechoic punctiform imagesrepresentative of air bronchograms Pleural effusion Lower lobe
  • 30.
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  • 42.
  • 43. Absent lung sliding Exaggerated horizontal artifacts Loss of comet-tail artifacts Broadening of the pleural line to a band Lung point Loss of lung pulse The key sonographic signs of Pneumothorax
  • 44.
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  • 57. Schematic representation of the parenchymal, pleural and vascular features associated with pulmonary embolism.(Angelika Reissig, Claus Kroegel. Respiration2003;70:441-452)
  • 58.
  • 60.
  • 61.
  • 62.
  • 63.
  • 64. 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
  • 65. 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
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  • 75. (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