Contrast-enhanced ultrasonography in peripheral lung consolidations: What’s its actual role?

Abstract

CEUS could be useful in the diagnostic workup of pleuropulmonary lesions. A delayed TE or a score ≥ 7.5 suggest the neoplastic nature of a lesion.

Contrast‐enhanced ultrasound of embolic consolidations in patients with pulmonary embolism: A pilot study

“…PA blood supply existed when the TE was short (1–6 seconds), and the enhancement occurred before the systemic (ie, liver, spleen, chest wall) accumulation of the contrast medium. Although this arbitrary cutoff of 1–6 seconds worked well in our small study population, the time of contrast medium accumulation may vary owing to physiologic or pathophysiologic determinants (eg, drugs, metabolic conditions, cardiac output, or heart rate) . When the TE was longer than 6 seconds, a temporal distinction between PA and systemic (ie, BA or intercostal) supply was not possible.…”

“…Several attempts have been made over recent years to reduce the use of CTA for investigating unexplained chest pain. Thoracic US and CEUS are increasingly emerging as diagnostic tools for several conditions such as pneumonia, PE, and IP . For instance, multiorgan US (eg, lung, heart, and leg vein US) has been shown to be more sensitive for diagnosing PE than single‐organ US is, with an overall sensitivity of 90% and specificity of 86.2% .…”

Ultrasound contrast agents

“…This later enhancement pattern has a high probability for neoplasia but caution is required as infarcted lung can appear similarly. [64656667]…”

Romanian National Guidelines on Contrast Enhanced Ultrasound in clinical practice

“…The lung has a dual vascularization consisting of pulmonary artery and systemic bronchial artery supply [186]. An arrival time in a consolidation area of less than 8-10 seconds ("early arterial enhancement") significates pulmonary arterial supply, while a delayed arrival time, over 10 seconds ("late arterial enhancement") indicates supply by the bronchial arteries [186,187]. In pneumonia there is early and intense arterial enhancement (<10 sec); "wash-out" is mild and late [186,188].…”

“…In atelectasis, similar to pneumonia, the enhancement is early and intense (<10 s), followed by a plateau [186,190]. In pulmonary tumors, due to an arterial supply from the bronchial system, enhancement is usually late [186,187]. Unenhancing areas such as abscesses in pneumonia, or a hypoenhanced area representing a central tumor, in obstructive atelectasis can be easily detected by CEUS [186].…”