Lung ultrasound in a nutshell. Lines, signs, some applications, and misconceptions from a radiologist’s point of view

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Abstract

In recent years, lung ultrasound (LUS) has developed rapidly, and it is growing in popularity in various scenarios. It has become especially popular among clinicians. There are constant attempts to introduce it in new fields, with quite a strong resistance in the radiological community. In addition, knowledge regarding lung and LUS has been augmented by the recent COVID-19 pandemic. Unfortunately, this has led to many misconceptions. The aim of this review is to discuss lines, signs, and phenomena that can be seen in LUS in order to create a single, easily available compendium for radiologists and promote consistency in LUS nomenclature. Some simplified suggestions are presented.

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Most cited references 81

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Relevance of lung ultrasound in the diagnosis of acute respiratory failure: the BLUE protocol.

Daniel Lichtenstein, Gilbert Mezière (2008)

This study assesses the potential of lung ultrasonography to diagnose acute respiratory failure. This observational study was conducted in university-affiliated teaching-hospital ICUs. We performed ultrasonography on consecutive patients admitted to the ICU with acute respiratory failure, comparing lung ultrasonography results on initial presentation with the final diagnosis by the ICU team. Uncertain diagnoses and rare causes (frequency<2%) were excluded. We included 260 dyspneic patients with a definite diagnosis. Three items were assessed: artifacts (horizontal A lines or vertical B lines indicating interstitial syndrome), lung sliding, and alveolar consolidation and/or pleural effusion. Combined with venous analysis, these items were grouped to assess ultrasound profiles. Predominant A lines plus lung sliding indicated asthma (n=34) or COPD (n=49) with 89% sensitivity and 97% specificity. Multiple anterior diffuse B lines with lung sliding indicated pulmonary edema (n=64) with 97% sensitivity and 95% specificity. A normal anterior profile plus deep venous thrombosis indicated pulmonary embolism (n=21) with 81% sensitivity and 99% specificity. Anterior absent lung sliding plus A lines plus lung point indicated pneumothorax (n=9) with 81% sensitivity and 100% specificity. Anterior alveolar consolidations, anterior diffuse B lines with abolished lung sliding, anterior asymmetric interstitial patterns, posterior consolidations or effusions without anterior diffuse B lines indicated pneumonia (n=83) with 89% sensitivity and 94% specificity. The use of these profiles would have provided correct diagnoses in 90.5% of cases. Lung ultrasound can help the clinician make a rapid diagnosis in patients with acute respiratory failure, thus meeting the priority objective of saving time.

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The comet-tail artifact. An ultrasound sign of alveolar-interstitial syndrome.

DANIEL LICHTENSTEIN, GILBERT MÉZIÈRE, PHILIPPE BIDERMAN … (1997)

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.

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Usefulness of ultrasound lung comets as a nonradiologic sign of extravascular lung water.

Zoltán Jambrik, Simonetta Monti, Vincenzo Coppola … (2004)

The "comet-tail" is an ultrasound sign detectable with ultrasound chest instruments; this sign consists of multiple comet-tails fanning out from the lung surface. They originate from water-thickened interlobular septa and would be ideal for nonradiologic bedside assessment of extravascular lung water. To assess the feasibility and value of ultrasonic comet signs, we studied 121 consecutive hospitalized patients (43 women and 78 men; aged 67 +/- 12 years) admitted to our combined cardiology-pneumology department (including cardiac intensive care unit); the study was conducted with commercially available echocardiographic systems including a portable unit. Transducer frequencies (range 2.5 to 3.5 MHz) were used. In each patient, the right and left chest was scanned by examining predefined locations in multiple intercostal spaces. Examiners blinded to clinical diagnoses noted the presence and numbers of lung comets at each examining site. A patient lung comet score was obtained by summing the number of comets in each of the scanning spaces. Within a few minutes, patients underwent chest x-ray, with specific assessment of extravascular lung water score by 2 pneumologist-radiologists blinded to clinical and echo findings. The chest ultrasound scan was obtained in all patients (feasibility 100%). The imaging time per examination was always <3 minutes. There was a linear correlation between echocardiographic comet score and radiologic lung water score (r = 0.78, p <0.01). Intrapatient variations (n = 15) showed an even stronger correlation between changes in echocardiographic lung comet and radiologic lung water scores (r = 0.89; p <0.01). In 121 consecutive hospitalized patients, we found a linear correlation between echocardiographic comet scores and radiologic extravascular lung water scores. Thus, the comet-tail is a simple, non-time-consuming, and reasonably accurate chest ultrasound sign of extravascular lung water that can be obtained at bedside (also with portable echocardiographic equipment) and is not restricted by cardiac acoustic window limitations.

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Author and article information

Contributors

Piotr Łyźniak: Role: Manuscript preparation

Dominik Świętoń: Role: Manuscript preparation

Zbigniew Serafin: Role: Manuscript preparation

Edyta Szurowska: Role: Manuscript preparation

Journal

Journal ID (nlm-ta): Pol J Radiol

Journal ID (iso-abbrev): Pol J Radiol

Journal ID (publisher-id): PJR

Title: Polish Journal of Radiology

Publisher: Termedia Publishing House

ISSN (Print): 1733-134X

ISSN (Electronic): 1899-0967

Publication date (Electronic): 21 June 2023

Publication date Collection: 2023

Volume: 88

Pages: e294-e310

Affiliations

[1 ]2 ^nd Department of Radiology, University Clinical Centre in Gdańsk, Gdańsk, Poland

[2 ]Department and Chair of Radiology and Imaging Diagnostics, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland

Author notes

Correspondence address: Piotr Łyźniak, 2 ^nd Department of Radiology, University Clinical Centre in Gdańsk, Gdańsk, Poland, e-mail: plyzniak@ 12345610g.pl

Article

Publisher ID: 50902

DOI: 10.5114/pjr.2023.128866

PMC ID: 10317011

PubMed ID: 37404548

SO-VID: 7e225b01-2fcd-414f-986b-1855b33ae01b

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0). License ( https://creativecommons.org/licenses/by-nc-nd/4.0/)

History

Date received : 29 March 2023

Date accepted : 29 April 2023

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