Sonography in Early Diagnosis

of Chest Diseases

Gamal Rabie Agmy ,MD ,FCCP

Professor of Chest Diseases, Assiut University

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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

• X-ray beam originating anteriorly, at a shorter distance than

recommended and not tangential to the diaphragmatic cupola .

Mistaken assessment

of :

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• Pleural effusion

• Alveolar consolidation

• Alveolar-interstitial

syndrome

Bedside Chest Radiography in the Critically

ill

02 09 2012

Risk of transportation

Lung Computed Tomography in

the Critically ill

http://www.reapitie-

univparis6.aphp.fr 02 09 2012

Scanning Positions for Chest Sonography in ICU

http://radiographics.rsnajnls.org/cgi/content/full/20/3/653/F1

Normal Anatomy

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http://radiographics.rsnajnls.org/content/vol22/issue1/images/large/g02jae1g2b.jpeg

http://radiographics.rsnajnls.org/cgi/content/full/20/3/653/F6B

Tissue pattern representative of Alveolar

Consolidation

Presence of hyperechoic punctiform images representative of air bronchograms

Pleural effusion

Lower lobe

the "seashore sign" (Fig.3).

http://radiographics.rsnajnls.org/cgi/content/full/22/1/e1/F3A

http://radiographics.rsnajnls.org/cgi/content/full/22/1/e1/F3B

http://radiographics.rsnajnls.org/cgi/content/full/22/1/e1/F3C

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

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

D Lichtenstein et al AJRCCM 156 : 1640-1646 , 1997 JJR 25 05

2012

http://www.reapitie-

univparis6.aphp.fr http://www.reapitie-

univparis6.aphp.fr

02 09 2012

D Lichtenstein et al AJRCCM 156 : 1640-1646 , 1997 30 11 2011

Coalescent B lines - « comet-tails » - alveolar

edema

3 mm apart « B3 lines » ground-glass areas

http://www.reapitie-

univparis6.aphp.fr

02 09 2012

http://www.ncbi.nlm.nih.gov/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=An%20external%20file%20that%20holds%20a%20picture%2C%20illustration%2C%20etc.%0AObject%20name%20is%201476-7120-6-16-3.jpg%20%5BObject%20name%20is%201476-7120-6-16-3.jpg%5D&p=PMC3&id=2386861_1476-7120-6-16-3.jpg

http://www.ncbi.nlm.nih.gov/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=An%20external%20file%20that%20holds%20a%20picture%2C%20illustration%2C%20etc.%0AObject%20name%20is%201476-7120-6-16-4.jpg%20%5BObject%20name%20is%201476-7120-6-16-4.jpg%5D&p=PMC3&id=2386861_1476-7120-6-16-4.jpg

http://www.ncbi.nlm.nih.gov/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=An%20external%20file%20that%20holds%20a%20picture%2C%20illustration%2C%20etc.%0AObject%20name%20is%201476-7120-6-16-5.jpg%20%5BObject%20name%20is%201476-7120-6-16-5.jpg%5D&p=PMC3&id=2386861_1476-7120-6-16-5.jpg

http://www.ncbi.nlm.nih.gov/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=An%20external%20file%20that%20holds%20a%20picture%2C%20illustration%2C%20etc.%0AObject%20name%20is%201476-7120-6-16-7.jpg%20%5BObject%20name%20is%201476-7120-6-16-7.jpg%5D&p=PMC3&id=2386861_1476-7120-6-16-7.jpg

(Chest. 2008; 133:836-837)

© 2008 American College of Chest Physicians

Ultrasound: The Pulmonologist’s New Best

Friend

Momen M. Wahidi, MD, FCCP