Abstract
When inspecting the lung with standard ultrasound B-mode imaging, numerous artifacts can be visualized. These artifacts are useful to recognize and evaluate several pathological conditions in Emergency and Intensive Care Medicine. More recently, the interest of the Pulmonologists has turned to the echographic study of the interstitial pathology of the lung. In fact, all lung pathologies which increase the density of the tissue, and do not consolidate the organ, are characterized by the presence of ultrasound artifacts. Many studies of the past have only assessed the number of vertical artifacts (generally known as B-Lines) as a sign of disease severity. However, recent observations suggest that the appearance of the individual artifacts, their variability, and their internal structure, may play a role for a non-invasive characterization of the surface of the lungs, directing the diagnoses and identifying groups of diseases. In this review, we discuss the meaning of lung ultrasound artifacts, and introduce hypothesis on the correlation between their presence and the structural variation of the sub-pleural tissue in light of current knowledge of the acoustic properties of the pleural plane.
Highlights
In the last years, lung ultrasonography has gained ever-growing clinical interest and curiosity because of its peculiar ability to acquire clinical information at bedside, its non-invasiveness andAppl
Lung ultrasonography is comparable to a standard morphological sonography only when assessing a pulmonary consolidation, a tissue without air, which is in direct contact with the visceral pleural
The target of ultrasonography is represented by several pathologies involving peripheral lung that do not determine parenchymal consolidation with focal or diffuse extension
Summary
Lung ultrasonography has gained ever-growing clinical interest and curiosity because of its peculiar ability to acquire clinical information at bedside, its non-invasiveness and. Lung ultrasonography is comparable to a standard morphological sonography only when assessing a pulmonary consolidation, a tissue without air, which is in direct contact with the visceral pleural In this case, the clinicians evaluate anatomic images, representing the real structure of the diseased organ. Different artifacts can be produced by the application of standard image reconstruction algorithms to these signals [20] In this case, the target of ultrasonography is represented by several pathologies involving peripheral lung that do not determine parenchymal consolidation with focal or diffuse extension. The normal pleural-line acts essentially as a specular reflector to ultrasound waves, resulting in the visualization of reverberation artifacts of the pleural-line, and both mirror and replica effects of the chest wall are visible This so-called “normal pattern”, when characterized by the detection of lung points and by the absence of sliding sign, is indicative of pneumothorax [20,21]. The acoustic properties of the normal and pathological pleural-line will be discussed together with the acoustic behavior of the sub-pleural lung when the pleural-line is not a strong near-perfect reflector
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