Transthoracic US Transthoracic US (TTUS) of the Chest(TTUS) of the Chest

Clinical ApplicationsClinical Applications

ByBy

Hussein Attia MDHussein Attia MD

USES: USES:

Evaluation of

1 -Peripheral parenchymal

2 -Pleural

3 -chest wall disease

4 -Interventional procedures of the chest wall and

pleural space

Parenchymal DiseasesParenchymal Diseases

Pneumonia Pneumonia NeoplasmsNeoplasms Heart failureHeart failure InfarctInfarct Round atelectasis Round atelectasis

Pleural DiseasesPleural Diseases

Pleural effusionPleural effusion PneumothoraxPneumothorax Pleural massPleural mass MesotheliomaMesothelioma

Chest wall abnormalitiesChest wall abnormalities

Chest wall tumorsChest wall tumors Rib fractures Rib fractures

Other applicationsOther applications

Diaphragmatic paralysis Diaphragmatic paralysis

US Guided biopsy US Guided biopsy

Thoracocentesis Thoracocentesis

Technique an Technique an instrumentations instrumentations US 2-5 MHz curvilinear probeUS 2-5 MHz curvilinear probe High resolution 7.5-10 MHzHigh resolution 7.5-10 MHz Gray scale and Color Doppler Gray scale and Color Doppler

imaging imaging Patient position Patient position

a)a) Raised arm position (in recumbence) Raised arm position (in recumbence)

b)b) Posterior chest in sitting, or lateral Posterior chest in sitting, or lateral standing positionstanding position

Sitting

Lateral debcubitus

Supine suprasternal

approach

Scanning positioning Scanning positioning

Normal anatomyNormal anatomy

Diseases of the Pleural Diseases of the Pleural spacespace

Anechoic effusion

Complex septated pleural

effusion

Empyema

Diseases of the Pleural space Diseases of the Pleural space

Pleural thickening

CT mesothelioma

US mesothelioma

Diseases of the Lung Diseases of the Lung ParenchymaParenchyma Pneumonia and lung abscess Pneumonia and lung abscess

US consolidation collapse of right lung lower lobe

CD scan showing pulmonary artery branch supplying the collapsed segment

Central perihilar masses Central perihilar masses

CT central neoplasm US central neoplasm demonstrating both mass and lung consolidation

MC

Neoplasm (Pancoast tumor)Neoplasm (Pancoast tumor)

US transapical viewPlain X ray AP view

Round atelectasis Round atelectasis

US: pleural invagination sign

CT: round atelactasis within the left lung base

Diseases of the chest wall Diseases of the chest wall (lipoma)(lipoma)

MRI: T1W Coronal

US: 10 MHz

Diseases of the chest wall Diseases of the chest wall (Hemangioma)(Hemangioma)

MRI: T2W Axial image

US linear scan

Diseases of the chest wall (lymph Diseases of the chest wall (lymph nodes)nodes)

US: Hyperplastic lymph node

CD: Hyperplastic lymph node

Metastatic lymph nodes Metastatic lymph nodes

US: metastatic lymph node

PD: metastatic lymph node

Chest wall (rib fracture)Chest wall (rib fracture)

US linear scan

rib

H

Mediastinal Intervention Mediastinal Intervention

Biopsy of mediastinal massesBiopsy of mediastinal masses

Pleural effusion and basal Pleural effusion and basal collapsecollapse

Normal CPA comet-tail Normal CPA comet-tail artifactartifact

THANK YOU