How I do it: lung ultrasound

Abstract

In the last 15 years, a new imaging application of sonography has emerged in the clinical arena: lung ultrasound (LUS). From its traditional assessment of pleural effusions and masses, LUS has moved towards the revolutionary approach of imaging the pulmonary parenchyma, mainly as a point-of-care technique. Although limited by the presence of air, LUS has proved to be useful in the evaluation of many different acute and chronic conditions, from cardiogenic pulmonary edema to acute lung injury, from pneumothorax to pneumonia, from interstitial lung disease to pulmonary infarctions and contusions. It is especially valuable since it is a relatively easy-to-learn application of ultrasound, less technically demanding than other sonographic examinations. It is quick to perform, portable, repeatable, non-ionizing, independent from specific acoustic windows, and therefore suitable for a meaningful evaluation in many different settings, both inpatient and outpatient, in both acute and chronic conditions.In the next few years, point-of-care LUS is likely to become increasingly important in many different clinical settings, from the emergency department to the intensive care unit, from cardiology to pulmonology and nephrology wards.

Figure 1

Sonographic appearance of an aerated lung scan. Arrows indicate A-lines. Above A-lines the pleural line is visible with its horizontal movement, the lung sliding.

Figure 2

Sonographic appearance of multiple B-lines (indicated by the white arrows).

Figure 3

Sonographic appearance of a consolidated lung. The echo-texture of the lung becomes similar to the liver.

Figure 4

Longitudinal and oblique approach to lung ultrasound.

Figure 5

Longitudinal and oblique lung scanning. A. Longitudinal lung scanning: the upper rib, the pleural line and the lower rib draw an image that resembles a bat. B. Oblique lung scanning: the pleural line is not interrupted by the ribs, and appears as a horizontal line.

Figure 6

Eight-zone scanning scheme of the antero-lateral chest (according to Volpicelli G et al. See ref. [15]).

Figure 7

Twenty-eight scanning site scheme of the antero-lateral chest (Modified from Jambrik et al. See ref. [46]).

Figure 8

Scanning scheme for the posterior chest (Modified form Gargani L et al. See ref. [24]).

Figure 9

Left costophrenic angle. During inspiration the lung moves downward and the lung air prevents the visualization of part of the spleen.

Figure 10

Position of the patient to scan the posterior chest.

Figure 11

Multiple B-lines in cardiogenic pulmonary edema and lung fibrosis. A. Multiple B-lines in a patient with cardiogenic pulmonary edema: the arrow indicates a normal pleural line. B. Multiple B-lines in a patient with pulmonary fibrosis: the arrow indicates the abnormal pleural line, which looks irregular.