Transthoracic ultrasound versus intraoperative ultrasound in patients with pulmonary fibrosis: Reappraisal of artifacts

Sperandeo, Marco; Gaudiuso, Giulia; Quarato, Carla Maria Irene; Colle, Anna Del; Inglese, Michele; Molinaro, Francesca; Cosmo, Salvatore De; Dimitri, L.; Bizzarri, M.; Frongillo, Elisabettamaria

doi:10.4081/br.2019.7

Cited by 3 publications

(4 citation statements)

References 33 publications

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“…These phenomena generate channels of acoustic permeability for the ultrasound beam as a consequence of the reduction in the difference of acoustic impedance between chest wall tissues and aerated lung. As a further confirmation, on intra-operatory VATS-US examination of fibrotic lung (when the probe is directly in contact with the pulmonary parenchyma), we can assess only an increased thickness of the pleura line without vertical artifacts below it ( 22 ).…”

Section: Sonographic Covid-19 Pneumonia Mimickersmentioning

confidence: 70%

“…On the contrary, generation of B-line artifacts does not occur in the intra-operatory ultrasound examination of fibrotic lung during video-assisted thoracoscopic surgery (VATS-US) despite the presence of B-lines in transthoracic LUS. Indeed, the VATS-US approach is not limited by differences in acoustic impedance because the ultrasound probe is directly in contact with the lung ( 22 ) ( Figures 1H,I ).…”

Section: Introductionmentioning

confidence: 99%

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COVID-19 Pneumonia: The Great Ultrasonography Mimicker

et al. 2021

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The pandemic spread of the new severe acute respiratory syndrome coronavirus 2 has raised the necessity to identify an appropriate imaging method for early diagnosis of coronavirus disease 2019 (COVID-19). Chest computed tomography (CT) has been regarded as the mainstay of imaging evaluation for pulmonary involvement in the early phase of the pandemic. However, due to the poor specificity of the radiological pattern and the disruption of radiology centers' functionality linked to an excessive demand for exams, the American College of Radiology has advised against CT use for screening purposes. Lung ultrasound (LUS) is a point-of-care imaging tool that is quickly available and easy to disinfect. These advantages have determined a “pandemic” increase of its use for early detection of COVID-19 pneumonia in emergency departments. However, LUS findings in COVID-19 patients are even less specific than those detectable on CT scans. The scope of this perspective article is to discuss the great number of diseases and pathologic conditions that may mimic COVID-19 pneumonia on LUS examination.

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Section: Sonographic Covid-19 Pneumonia Mimickersmentioning

confidence: 70%

Section: Introductionmentioning

confidence: 99%

COVID-19 Pneumonia: The Great Ultrasonography Mimicker

et al. 2021

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“…A systematic evaluation of the lung parenchyma without artifacts due to the elevated difference in acoustic impedance encountered by the ultrasound beam at the interface between the aerated lung parenchyma and the overlying soft tissues of the chest wall can be theoretically made possible by the ILU approach. As a confirmation, B-lines artifacts have been shown to be absent in ILU scans even in patients with pulmonary fibrosis, despite these ultrasound findings were observable at TUS examination in our previous experience [ 29 ] ( Figure 4 ). During open thoracotomy, in which the ribs are spread, even the obstacle constituted by these bony structures is eliminated.…”

Section: Discussionmentioning

confidence: 52%

Intraoperative Lung Ultrasound (ILU) for the Assessment of Pulmonary Nodules

et al. 2021

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Background: The primary aim of this study was to confirm the validity of intraoperative lung ultrasound (ILU) as a safe and effective method of localization for difficult to visualize pulmonary nodules during Video-Assisted Thoracoscopic Surgery (VATS) and open thoracotomy. The secondary aim was to enhance knowledge on the morphological patterns of presentation of pulmonary nodules on direct ultrasound examination. Materials and methods: 131 patients with lung nodule and indication for surgery were enrolled. All patients underwent pre-operative imaging of the chest, including Chest Computed Tomography (CT) and Transthoracic Ultrasound (TUS), and surgical procedures for histological assessment of pulmonary nodules (VATS or open thoracotomy). Results: The identification of 100.00% of lung nodules was allowed by ILU, while the detection rate of digital palpation was 94.66%. It was not possible to associate any specific ILU echostructural pattern to both benign or malignant lesions. However, the actual histological margins of the lesions in the operating samples were corresponding to those visualized at ILU in 125/131 (95.42%) cases. No complications have been reported with ILU employment. Conclusions: In our experience, ILU performed during both open surgery and VATS demonstrated to be a reliable and safe method for visualization and localization of pulmonary nodules non previously assessed on digital palpation. In addition, ILU showed to allow a clear nodule’s margins’ definition matching, in most cases, with the actual histological margins.

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“…On the contrary, if the probe is directly in contact with the lung, thus excluding the differences in acoustic impedance of chest wall soft tissues, the generation of B-lines artifacts does not occur, even in pulmonary areas affected by pulmonary fibrosis. This evidence clearly emerged in a preliminary experience of our group with intraoperative lung ultrasound during video-assisted thoracic surgery (VATS-ILU) [ 45 , 46 ].…”

Section: Discussionmentioning

confidence: 97%

The Role of Transthoracic Ultrasound in the Study of Interstitial Lung Diseases: High-Resolution Computed Tomography Versus Ultrasound Patterns: Our Preliminary Experience

et al. 2021

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Transthoracic ultrasound (TUS) is a readily available imaging tool that can provide a quick real-time evaluation. The aim of this preliminary study was to establish a complementary role for this imaging method in the approach of interstitial lung diseases (ILDs). TUS examination was performed in 43 consecutive patients with pulmonary fibrosis and TUS findings were compared with the corresponding high-resolution computed tomography (HRCT) scans. All patients showed a thickened hyperechoic pleural line, despite no difference between dominant HRCT patterns (ground glass, honeycombing, mixed pattern) being recorded (p > 0.05). However, pleural lines’ thickening showed a significant difference between different HRCT degree of fibrosis (p < 0.001) and a negative correlation with functional parameters. The presence of >3 B-lines and subpleural nodules was also assessed in a large number of patients, although they did not demonstrate any particular association with a specific HRCT finding or fibrotic degree. Results allow us to suggest a complementary role for TUS in facilitating an early diagnosis of ILD or helping to detect a possible disease progression or eventual complications during routine clinical practice (with pleural line measurements and subpleural nodules), although HRCT remains the gold standard in the definition of ILD pattern, disease extent and follow-up.

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Transthoracic ultrasound versus intraoperative ultrasound in patients with pulmonary fibrosis: Reappraisal of artifacts

Cited by 3 publications

References 33 publications

COVID-19 Pneumonia: The Great Ultrasonography Mimicker

COVID-19 Pneumonia: The Great Ultrasonography Mimicker

Intraoperative Lung Ultrasound (ILU) for the Assessment of Pulmonary Nodules

The Role of Transthoracic Ultrasound in the Study of Interstitial Lung Diseases: High-Resolution Computed Tomography Versus Ultrasound Patterns: Our Preliminary Experience

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