On the Physical Basis of Pulmonary Sonographic Interstitial Syndrome

Abstract

ung sonography is widely accepted and used in emergency medicine and critical care. [1][2][3][4][5] Moreover, many pulmonologists are interested in chest sonography for the study of pleural diseases and are increasingly discovering a role for sonography in parenchymal lung diseases. [6][7][8][9] For those physicians who are devoted to chest sonography, a clear dichotomy between usual sonography and aerated tissue sonography is obvious. Pleural sonography is effective under most circumstances, whereas lung sonography is effective only when certain physical properties of the lung (eg, the bubble system) are lost. In other words, the lung is sonographically explorable only when it is physically comparable with soft tissue. In particular, when using lung sonography, a lung that contains dispersed air and has a density that is not comparable with the density of water does not show anatomic images but rather artifactual images. 10 Therefore, lung artifacts are quite consistent with the physical properties of a lung that is not fully consolidated rather than with an anatomic image. 11 The physical properties of the subpleural nonconsolidated lung are the hallmarks of many pulmonary diseases, which can be roughly grouped into "interstitial diseases." If an ultrasound imaging system is used, all of these pulmonary diseases are classified by the generic term "sonographic interstitial syndrome" (B-lines with variable arrangements along the pleural line). 5 According to this view, it is not surprising that since 1997, 12 vertical lung artifacts, commonly named B-lines, have been associated with pathologic conditions ranging from pulmonary edema to fibrosis, which are characterized by a change in the subpleural physical features in terms of full and empty spaces. 11

Proposal for International Standardization of the Use of Lung Ultrasound for Patients With COVID‐19

“…This highly scattering environment can explain this peculiar pattern. 3,5,7 • Score 3: The scanned area shows dense and largely extended white lung with or without larger consolidations.…”

“…A decade of clinical [1][2][3][4] and physical studies [5][6][7][8][9] clearly showed that lung ultrasound (LUS) is able to detect interstitial lung disease, subpleural consolidations, and acute respiratory distress syndrome from any etiologic cause. New evidence from published studies, [10][11][12] national and international organization statements, and informal case discussions with internationally recognized experts are showing the usefulness of LUS for the management of patients with 2019 new coronavirus disease (COVID-19) pneumonia, from diagnosis to monitoring and follow-up.…”

Deep Learning for Classification and Localization of COVID-19 Markers in Point-of-Care Lung Ultrasound

“…Specifically, to evaluate the progression of the pathology, a 4-level scoring system was devised [32], with scores ranging from 0 to 3. Score 0 indicates the presence of a continuous pleural-line accompanied by horizontal artifacts called A-lines [33], which characterize a healthy lung surface. In contrast, score 1 indicates the first signs of abnormality, i.e., the appearance of alterations in the pleural-line in conjunction with vertical artifacts.…”

Chest ultrasound findings in children with confirmed pulmonary tuberculosis in low tuberculosis incidence country

“…The physical basis of our observations are well described. 5 Figure 4A); LUS detected the basal consolidation with air inside, suspected for a small cavernae although not specific (4B). CT, computed tomography; LUS, lung ultrasound the pleural line and generically defining the "sonographic interstitial syndrome", a nonspecific pattern associated to numerous conditions and still not well understood).…”