Clinical application of lung ultrasound in patients with acute dyspnoea: differential diagnosis between cardiogenic and pulmonary causes

Abstract

This review discusses the usefulness of bedside lung ultrasound in the diagnostic distinction between the various causes of acute dyspnoea in the emergency department, with special attention to the differential diagnosis of pulmonary oedema and exacerbation of chronic obstructive pulmonary disease (COPD). This is made possible by using mid- to low-end scanners and simple acquisition techniques accessible to both radiologists and clinicians. Major advantages include ready availability at the bedside, the absence of ionising radiation, high reproducibility and cost efficiency. The technique is based on the recognition and analysis of sonographic artefacts rather than direct visualisation of the pulmonary structures. These artefacts are caused by the interaction of water-rich structures and air, called comet tails or B-lines. When such artefacts are widely detected on anterolateral transthoracic lung scans, diffuse alveolar-interstitial syndrome can be diagnosed, which is often a sign of acute pulmonary oedema. This condition rules out exacerbation of COPD as the main cause of acute dyspnoea.

Pulmonary ultrasound findings in a bottlenose dolphin Tursiops truncatus population

“…7). This is consistent with findings reported in both the human and veterinary literature (Volpicelli et al 2006, Louvet & Bourgeois 2008, Cardinale et al 2009, Barillari & Fioretti 2010, Sartori & Tombesi 2010, Gargani 2011, Stefanidis et al 2011). …”

“…Alveolar-interstitial syndrome (AIS) was defined as an increase of fluid or cellular infiltrate in the interstitium and reduced air in the alveolar spaces, with or without interlobular septal thickening (Volpi celli et al 2006, Louvet & Bourgeois 2008, Cardinale et al 2009). The syndrome is characterized by the presence of multiple comet-tail and/or ring-down artifacts throughout the lung fields, often clustered and seen in higher frequency than ex -248 Fig.…”

“…Specific techniques for diagnosing pleuritis, pleural effusion, pleural masses, pneumothorax, lung masses, and alveolar-interstitial diseases have been described for small animal (Stowater & Lamb 1989, Tidwell 1998, Reichle & Wisner 2000, Mattoon & Nyland 2002, Saunders & Keith 2004, Hecht 2008, Louvet & Bourgeois 2008, Larson 2009), large animal (Rantanen 1981, 1986, Jung & Bostedt 2004, Ramirez et al 2004, and human patients (Lichtenstein 2007, Cardinale et al 2009, Barillari & Fioretti 2010, Sartori & Tombesi 2010, Gar-gani 2011, Moore & Copel 2011, Stefanidis et al 2011. General descriptions of dolphin thoracic ultrasound exams have been published in marine mammal textbooks (Stone 1990, Brook et al 2001.…”

Association between B-lines detected during lung ultrasound and various factors in hemodialysis patients

“…An intercostal scan with maximum extension of the visual pleural line was performed. The chest wall was divided into eight areas (two anterior and two lateral areas per side), and two scan was obtained for each area [22][23][24][25][26]. The anterior zone of the chest wall was designated from the sternum to the anterior axillary line and was then divided into upper and lower halves (from the clavicle to the third intercostal spaces and from the third space to the diaphragm).…”

Managing Severe COPD: Addressing the Challenges with Latest Trends and Treatment Options (Part I: Pharmacological Management)

“…B lines are essentially hyperechoic reverberation artefacts that originate at the pleural line and extend vertically to the bottom of the screen. A positive ultrasound examination [26][27][28] requires two or more positive zones bilaterally, of the eight zones measured. The accuracy of this sign is such that absence of a comet-tail sign correctly rules out heart failure-related dyspnea even in patients with a history of heart failure [26].…”