Ultrasound is the most disruptive innovation in intensive care life, above all in this time, with a high diagnostic value when applied appropriately. In recent years, point-of-care lung ultrasound has gained significant popularity as a diagnostic tool in the acutely dyspnoeic patients. In the era of Sars-CoV-2 outbreak, lung ultrasound seems to be strongly adapting to the follow-up for lung involvement of patients with ascertaining infections, till to be used, in our opinion emblematically, as a screening test in suspected patients at the emergency triage or at home medical visit. In this brief review, we discuss the lung ultrasound dichotomy, certainties and uncertainties, describing its potential role in validated clinical contexts, as a clinicaldependent exam, its limits and pitfalls in a generic and off-label clinical context, as a virtual anatomical-dependent exam, and its effects on the clinical management of patients with COVID-19. Keywords Lung ultrasound • Point of care ultrasound • Dyspnoea • COVID-19 • Sars-CoV-2 Abbreviations ARDS Acute respiratory distress syndrome BLUE Bedside lung ultrasonography in emergency CAUSE Cardiac arrest ultrasound exam CHP Chronic hypersensitivity pneumonia COPD Chronic obstructive pulmonary disease CT Computed tomography CXR Chest X-ray COVID-19 Coronavirus disease 19 ECMO Extra-corporeal membrane oxygenation EVD Ebola virus disease FALLS Fluid administration limited by lung sonography LUS
Ultrasound examination of the thorax (TUS) can be quite suitable for children because their unique thoracic anatomy provides many acoustic windows into the chest. This review article covers techniques, indications, and applications of TUS in neonates, infants, and children, including common aspects and applications, like pulmonary consolidation and atelectasis, pleural effusion and pneumothorax and main neonatal pathologies such as respiratory distress syndrome (RDS) and transitory tachypnea of the newborn (TTN).
Bilateral adrenal hemorrhage is a rare condition, which is burdened by potentially life-threatening consequences related to the development of acute adrenal insufficiency. Despite treatment with stress-dose glucocorticoids, a mortality rate of 15% has been reported, which varies according to the severity of underlying predisposing illness and could be much more higher if the adrenal insufficiency is not promptly recognized. An early diagnosis is crucial, though, because of nonspecific clinical and laboratory findings, adrenal hemorrhage is rarely suspected. Therefore, imaging has a pivotal role for the diagnosis of this uncommon condition but, despite adrenal hematomas characteristically appear round or oval with peripheral fat stranding, their initial presentation could be ambiguous. The authors describe a case of postoperative bilateral adrenal hemorrhage initially presenting at computed tomography scan as thickening of both glands surrounded by fat stranding, which led to close monitoring of adrenal function before unequivocal hemorrhage developed.
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