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Sonography in early diagnosis of chest diseases
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Sonography in Early Diagnosis
of Chest Diseases
Gamal Rabie Agmy ,MD ,FCCP
Professor of Chest Diseases, Assiut University
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c
At the bedside, chest radiography remains the reference for lung imaging in
critically ill patients. However, radiographical images are often of
limited quality
• Movements of the chest wall
• Film cassette posterior to the thorax
• X-ray beam originating anteriorly, at a shorter distance than
recommended and not tangential to the diaphragmatic cupola .
Mistaken assessment
of :
c
• Pleural effusion
• Alveolar consolidation
• Alveolar-interstitial
syndrome
Bedside Chest Radiography in the Critically
ill
02 09 2012
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Risk of transportation
Lung Computed Tomography in
the Critically ill
http://www.reapitie-
univparis6.aphp.fr 02 09 2012
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Scanning Positions for Chest Sonography in ICU
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Normal Anatomy
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Tissue pattern representative of Alveolar
Consolidation
Presence of hyperechoic punctiform images representative of air bronchograms
Pleural effusion
Lower lobe
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the "seashore sign" (Fig.3).
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Absent lung sliding
Exaggerated horizontal artifacts
Loss of comet-tail artifacts
Broadening of the pleural line to a band
The key sonographic signs of
Pneumothorax
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the "seashore sign" (Fig.3).
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Pulmonary Embolism
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Schematic representation of the parenchymal, pleural and vascular
features associated with pulmonary embolism.(Angelika Reissig, Claus
Kroegel. Respiration 2003;70:441-452 )
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Alveolar-interstitial syndrome
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Multiple B-lines - « comet-tails » - interstitial edema
(B7)
7 mm apart « B lines » thickened interlobular septa
D Lichtenstein et al AJRCCM 156 : 1640-1646 , 1997 JJR 25 05
2012
http://www.reapitie-
univparis6.aphp.fr http://www.reapitie-
univparis6.aphp.fr
02 09 2012
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D Lichtenstein et al AJRCCM 156 : 1640-1646 , 1997 30 11 2011
Coalescent B lines - « comet-tails » - alveolar
edema
3 mm apart « B3 lines » ground-glass areas
http://www.reapitie-
univparis6.aphp.fr
02 09 2012
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(Chest. 2008; 133:836-837)
© 2008 American College of Chest Physicians
Ultrasound: The Pulmonologist’s New Best
Friend
Momen M. Wahidi, MD, FCCP
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