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Sonography in Early Diagnosis
of Chest Diseases

Gamal Rabie Agmy ,MD ,FCCP
Professor of Chest Diseases, Assiut University
Bedside Chest Radiography in the Critically
ill
At the bedside, chest radiography remains the reference for lung imaging in
critically ill patients. However, radiographical images are often of
limited quality

•

Movements of the chest wall

•

Film cassette posterior to the
thorax
c

•

X-ray beam originating anteriorly, at
a shorter distance than
recommended and not tangential to
the diaphragmatic cupola .

Mistaken assessment
of :
•
•
•

Pleural effusion
Alveolar consolidation
c
Alveolar-interstitial
syndrome

02 09 2012
Lung Computed Tomography in
the Critically ill

Risk of transportation
http://www.reapitie-

02 09 2012
Scanning Positions for
Chest Sonography in ICU
Normal Anatomy
Tissue pattern representative of Alveolar
Consolidation
Presence of hyperechoic punctiform
images
representative of air bronchograms

Pleural
effusion

Lower lobe
the "seashore sign" (Fig.3).
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
the "seashore sign" (Fig.3).
Pulmonary Embolism
Schematic representation of the parenchymal, pleural and vascular
features associated with pulmonary embolism.(Angelika Reissig, Claus
Kroegel. Respiration 2003;70:441-452 )
Alveolar-interstitial syndrome
Multiple B-lines - « comet-tails » -

interstitial edema

(B7)
7 mm apart « B lines »

thickened interlobular

septa

http://www.reapitiehttp://www.reapitie-

JJR 25 05

D Lichtenstein et al AJRCCM 156 : 1640-1646 ,09 2012
02 1997
Coalescent B lines - « comet-tails » -

alveolar

edema
3 mm apart « B3 lines »
glass areas

30 11 2011
http://www.reapitie-

02 09 2012

ground-

D Lichtenstein et al AJRCCM 156 : 1640-1646 , 1997
(Chest. 2008; 133:836-837)
© 2008 American College of Chest Physicians
Ultrasound: The Pulmonologist’s New Best
Friend
Momen M. Wahidi, MD, FCCP
Sonography in early diagnosis of chest diseases

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Sonography in early diagnosis of chest diseases

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  • 2. Sonography in Early Diagnosis of Chest Diseases Gamal Rabie Agmy ,MD ,FCCP Professor of Chest Diseases, Assiut University
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  • 4. Bedside Chest Radiography in the Critically ill At the bedside, chest radiography remains the reference for lung imaging in critically ill patients. However, radiographical images are often of limited quality • Movements of the chest wall • Film cassette posterior to the thorax c • X-ray beam originating anteriorly, at a shorter distance than recommended and not tangential to the diaphragmatic cupola . Mistaken assessment of : • • • Pleural effusion Alveolar consolidation c Alveolar-interstitial syndrome 02 09 2012
  • 5. Lung Computed Tomography in the Critically ill Risk of transportation http://www.reapitie- 02 09 2012
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  • 7. Scanning Positions for Chest Sonography in ICU
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  • 19. Tissue pattern representative of Alveolar Consolidation Presence of hyperechoic punctiform images representative of air bronchograms Pleural effusion Lower lobe
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  • 33. 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
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  • 47. Schematic representation of the parenchymal, pleural and vascular features associated with pulmonary embolism.(Angelika Reissig, Claus Kroegel. Respiration 2003;70:441-452 )
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  • 54. Multiple B-lines - « comet-tails » - interstitial edema (B7) 7 mm apart « B lines » thickened interlobular septa http://www.reapitiehttp://www.reapitie- JJR 25 05 D Lichtenstein et al AJRCCM 156 : 1640-1646 ,09 2012 02 1997
  • 55. Coalescent B lines - « comet-tails » - alveolar edema 3 mm apart « B3 lines » glass areas 30 11 2011 http://www.reapitie- 02 09 2012 ground- D Lichtenstein et al AJRCCM 156 : 1640-1646 , 1997
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  • 68. (Chest. 2008; 133:836-837) © 2008 American College of Chest Physicians Ultrasound: The Pulmonologist’s New Best Friend Momen M. Wahidi, MD, FCCP