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. 2008 Apr 29:6:16.
doi: 10.1186/1476-7120-6-16.

Chest sonography: a useful tool to differentiate acute cardiogenic pulmonary edema from acute respiratory distress syndrome

Roberto Copetti  1 , Gino Soldati, Paolo Copetti
Affiliations

Chest sonography: a useful tool to differentiate acute cardiogenic pulmonary edema from acute respiratory distress syndrome

Roberto Copetti et al. Cardiovasc Ultrasound. .

Abstract

Background: Differential diagnosis between acute cardiogenic pulmonary edema (APE) and acute lung injury/acute respiratory distress syndrome (ALI/ARDS) may often be difficult. We evaluated the ability of chest sonography in the identification of characteristic pleuropulmonary signs useful in the diagnosis of ALI/ARDS and APE.

Methods: Chest sonography was performed on admission to the intensive care unit in 58 consecutive patients affected by ALI/ARDS or by acute pulmonary edema (APE).

Results: Ultrasound examination was focalised on finding in the two groups the presence of: 1) alveolar-interstitial syndrome (AIS) 2) pleural lines abnormalities 3) absence or reduction of "gliding" sign 4) "spared areas" 5) consolidations 6) pleural effusion 7) "lung pulse".AIS was found in 100% of patients with ALI/ARDS and in 100% of patients with APE (p = ns). Pleural line abnormalities were observed in 100% of patients with ALI/ARDS and in 25% of patients with APE (p < 0.0001). Absence or reduction of the 'gliding sign' was observed in 100% of patients with ALI/ARDS and in 0% of patients with APE. 'Spared areas' were observed in 100% of patients with ALI/ARDS and in 0% of patients with APE (p < 0.0001). Consolidations were present in 83.3% of patients with ALI/ARDS in 0% of patients with APE (p < 0.0001). A pleural effusion was present in 66.6% of patients with ALI/ARDS and in 95% of patients with APE (p < 0.004). 'Lung pulse' was observed in 50% of patients with ALI/ARDS and in 0% of patients with APE (p < 0.0001). All signs, except the presence of AIS, presented a statistically significant difference in presentation between the two syndromes resulting specific for the ultrasonographic characterization of ALI/ARDS.

Conclusion: Pleuroparenchimal patterns in ALI/ARDS do find a characterization through ultrasonographic lung scan. In the critically ill the ultrasound demonstration of a dyshomogeneous AIS with spared areas, pleural line modifications and lung consolidations is strongly predictive, in an early phase, of non-cardiogenic pulmonary edema.

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Figures

Figure 1
Figure 1
Percentage of the different signs in the two groups.
Figure 2
Figure 2
Spared areas: present in ARDS (panel A), absent in APE (panel B).
Figure 3
Figure 3
Lung consolidations with air bronchograms in posterior lung fields in ARDS (panel A and B).
Figure 4
Figure 4
Pleural line: altered in ARDS (panel A), normal in APE (panel B).
Figure 5
Figure 5
Small subpleural consolidations: present in ARDS (panel A), absent in APE (panel B).
Figure 6
Figure 6
Particular of pleural line with linear probe (10 MHz): above the spared area the pleural line is normal while it is altered above the area of AIS.
Figure 7
Figure 7
Pleural effusion: small pleural effusion in ARDS (panel A), larger pleural effusion in APE (panel B).
See this image and copyright information in PMC

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References

    1. Ware LB, Matthay MA. The acute respiratory distress syndrome. N Engl J Med. 2000;342:1334–49. doi: 10.1056/NEJM200005043421806. - DOI - PubMed
    1. Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, Lamy M, Legall JR, Morris A, Spragg R. The American European consensus conference on ARDS: definitions mechanisms, relevant outcomes and clinical trial coordination. Am J Respir Crit Care Med. 1994;149:818–824. - PubMed
    1. Gattinoni L, Caironi P, Pelosi P, Goodman LR. What has computed tomography taught us about the acute respiratory distress syndrome? Am J Respir Crit Care Med. 2001;164:1701–11. - PubMed
    1. Gattinoni L, Caironi P, Cressoni M, Chiumello D, Ranieri VM, Quintel M, Russo S, Patroniti N, Cornejo R, Bugedo G. Lung recruitment in patients with the acute respiratory distress syndrome. N Engl J Med. 354:1775–86. doi: 10.1056/NEJMoa052052. 2006 Apr 27. - DOI - PubMed
    1. Pesenti A, Tagliabue P, Patroniti N, Fumagalli R. Computerised tomography scan imaging in acute respiratory distress syndrome. Intensive Care Med. 2001;27:631–6. doi: 10.1007/s001340100877. - DOI - PubMed

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