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Abstract
Can ultrasound be of any help in the diagnosis of alveolar-interstitial syndrome?
In a prospective study, we examined 250 consecutive patients in a medical intensive
care unit: 121 patients with radiologic alveolar-interstitial syndrome (disseminated
to the whole lung, n = 92; localized, n = 29) and 129 patients without radiologic
evidence of alveolar-interstitial syndrome. The antero-lateral chest wall was examined
using ultrasound. The ultrasonic feature of multiple comet-tail artifacts fanning
out from the lung surface was investigated. This pattern was present all over the
lung surface in 86 of 92 patients with diffuse alveolar-interstitial syndrome (sensitivity
of 93.4%). It was absent or confined to the last lateral intercostal space in 120
of 129 patients with normal chest X-ray (specificity of 93.0%). Tomodensitometric
correlations showed that the thickened sub-pleural interlobular septa, as well as
ground-glass areas, two lesions present in acute pulmonary edema, were associated
with the presence of the comet-tail artifact. In conclusion, presence of the comet-tail
artifact allowed diagnosis of alveolar-interstitial syndrome.
A new sonographic pattern of pulmonary consolidation associated with air-filled bronchi in children is presented. The consolidated area of the lung is usually hypoechoic, poorly defined, and wedge-shaped. The air-filled bronchi produce linear, high-amplitude branching echoes that converge toward the lung root. Posterior acoustic shadowing and reverberation artifacts are seen accompanying the proximal large bronchi. A comparative study is presented in which 30 pediatric patients with clinical and radiographic evidence of pneumonia were sonographically evaluated. Twenty-eight patients were successfully examined with sonography. The cases were divided into three groups: (1) consolidated lung without pleural effusion (19 patients); (2) consolidated lung with small pleural effusion (five patients); and (3) consolidated lung with partial compression atelectasis due to large pleural effusion (four patients).
Title:
American Journal of Respiratory and Critical Care Medicine
Abbreviated Title:
Am J Respir Crit Care Med
Publisher:
American Thoracic Society
ISSN
(Print):
1073-449X
ISSN
(Electronic):
1535-4970
Publication date Created:
November
01 1997
Publication date
(Print):
November
01 1997
Volume: 156
Issue: 5
Pages: 1640-1646
Affiliations
[1
]Service de Réanimation Médicale and Service de Radiologie, Hôpital Ambroise-Paré,
Boulogne (Paris), and Service de Réanimation Polyvalente, Centre Hospitalier Général,
Saint-Cloud (Paris), France