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Imaging of pulmonary vascular lesions
The document discusses pulmonary embolism (PE) and its diagnosis using lung ultrasound (LUS). It provides details on the diagnostic criteria for PE using LUS, including findings of typical lung lesions that indicate confirmed or probable PE. It also summarizes the sensitivity and specificity reported in studies on using LUS to diagnose PE. The document further discusses non-thrombotic causes of pulmonary embolism and the ultrasound appearance of various lung pathologies.
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Imaging of pulmonary vascular lesions
- 2. Gamal Rabie Agmy,MD, FCCP Professor of Chest Diseases, Assiut University
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- 4. Pulmonary embolism. A1.2 – 1.5 mm triangular subpleural lung consolidation. B. Vascular sign at the margin, not central Gamal Agmy
- 5. • On colorDoppler sonography, PE-based peripheral lesions do not show flow signals inside, a phenomenon defined as “consolidation with little perfusion” Gamal Agmy
- 6. Schematic representation ofthe parenchymal, pleural and vascular features associated with pulmonary embolism.(Angelika Reissig, Claus Kroegel. Respiration 2003;70:441-452) Gamal Agmy
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- 8. PE DIAGNOSTIC CRITERIA PEconfirmed Two or more typical lesions Sensi.: 44.4% Speci.: 98.7% PPV: 97.4% NPV: 62.1% PE probable One typical lesion and low grade pleural effusion Sensi.: 71.0% Speci.: 94.9% PPV: 93.8% NPV: 75.1% Mathis G et al. Thoracic Ultrasound for Diagnosing Pulmonary Embolism: A Prospective Multicenter Study of 352 Patients. Chest 2005;128:1531-1538 Gamal Agmy
- 9. PE DIAGNOSTIC ACCURACY LUSfor diagnosis of PE Metaanalysis: - Sens.: 80% (75-83%) - Spec.: 93% (89-96%) Niemann T et al. Transthoracic sonography for the detection of pulmonary embolism–a meta-analysis. Ultraschall Med 2009 30:150–156 Gamal Agmy
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- 51. CTEPH = Chronic thrombembolic pulmonaryhypertension Gamal Agmy
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- 53. Where is thepathology ??????? in the areas with increased density meaning there is ground glass in the areas with decreased density meaning there is air trapping Gamal Agmy
- 54. Pathology in blackareas Airtrapping: Airway Disease Bronchiolitis obliterans (constrictive bronchiolitis) idiopathic, connective tissue diseases, drug reaction, after transplantation, after infection Hypersensitivity pneumonitis granulomatous inflammation of bronchiolar wall Sarcoidosis granulomatous inflammation of bronchiolar wall Asthma / Bronchiectasis / Airway diseases Gamal Agmy
- 55. Airway Disease what yousee…… In inspiration sharply demarcated areas of seemingly increased density (normal) and decreased density demarcation by interlobular septa In expiration ‘black’ areas remain in volume and density ‘white’ areas decrease in volume and increase in density INCREASE IN CONTRAST DIFFERENCES AIRTRAPPING Gamal Agmy
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- 57. Pathology in whiteAreas Alveolitis / Pneumonitis Ground glass desquamative intertitial pneumoinia (DIP) nonspecific interstitial pneumonia (NSIP) organizing pneumonia In expiration both areas (white and black) decrease in volume and increase in density DECREASE IN CONTRAST DIFFERENCES Gamal Agmy
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- 60. Mosaic Perfusion Chronic pulmonaryembolism LOOK FOR Pulmonary hypertension idiopathic, cardiac disease, pulmonary disease Gamal Agmy
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- 69. Aortic Aneurysms • Location –Ascending / Anterior mediastinum – Arch / Middle mediastinum – Descending / Posterior mediastinum • Characteristics – Mediastinal "mass" density – Extrapleural – Calcification of wall • Dissecting – Inward displacement of calcified intima – Wavy margin – Inlet to outlet shadow – Left pleural effusion Gamal Agmy
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- 73. Dissecting Aneurysm Mediastinal widening Inletto outlet shadow on left side Retrocardiac: Intact silhouette of left heart margin Pulmonary artery overlay sign: Density behind left lower lobe Wavy margin Gamal Agmy