196 diagnostic ultrasound respiratory ultrasound

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196 Diagnostic ultrasound Respiratory ultrasound
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extravascular lung water, but the concept and the correlation of B-lines with interstitial edema has been well established. Scanning tips Trouble with the airway images Unable to see the tracheal ring ? ± Try sliding or fanning the probe to the left or right. Sometimes the trachea (especially in emergent airway situations) is not midline. ± Adjust the depth (increase). If the depth is too shallow it can sometimes be hard to get a handle on the anatomy. Trouble with the chest images No A-lines or B-lines ? ± Try imaging in different planes or segments of the chest wall. It is important to at least look in anterior and lateral segments. Some machines use significant “post processing” to help clarify anatomic images and erase artifacts. This can cause significant degredation in the ability to use ultrasound for thoracic applications, and so asking if Figure 9.7 Volpicelli’s sonography zones. Diagnostic ultrasound 197 Respiratory ultrasound
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post-processing techniques can be turned off or minimized may be important when picking a machine if you plan to use it for thoracic imaging. Unclear image? ± If the patient has a pneumothorax with subcutaneous air, images can be difficult to obtain, so attempt to circumvent the subcutaneous air with different patient and probe positioning if possible. Normal images Figures 9.1 –9.4 are examples of normal airway and lung ultrasound scans. Abnormal images Figure 9.5 shows the appearance of B-lines. Ultrasound can also be useful to assess lung water in a dynamic fashion [ 5 , 9 , 10 ]. Figure 9.8 demonstrates Figure 9.8 These images are from the same patient. The first image was taken when the patient was suffering from high- altitude pulmonary edema and was symptomatic with hypoxia. The second image was taken after treatment and after symptoms had resolved. When the second image was obtained, the patient had normal oxygenation. Courtesy of Dr. Peter Fagenholz, Massachusetts General Hospital, Boston, MA. 198 Diagnostic ultrasound Respiratory ultrasound
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the appearance (top) and resolution (bottom) of B-lines in high-altitude pulmonary edema. Figure 9.9 shows a similar pattern in a patient with acute heart failure. Literature review Figure 9.9 These images were taken from the same patient before ( left ) and after ( right ) using continuous positive airway pressure to treat acute decompensated heart failure. The second group of eight images were obtained about one hour after the first. Courtesy of Dr. Andrew Liteplo, Massachusetts General Hospital, Boston, MA. Reference Methods Results Notes Lichtenstein & Meziere 1998 [ 3 ] 66 patients with dyspnea evaluated for multiple comet tail artifacts (B-lines) as sign of pulmonary edema. Sensitivity of 100% and specificity of 92% in the diagnosis of pulmonary edema when compared to COPD.
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