Abstract
BackgroundDifferential 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.MethodsChest sonography was performed on admission to the intensive care unit in 58 consecutive patients affected by ALI/ARDS or by acute pulmonary edema (APE).ResultsUltrasound 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.ConclusionPleuroparenchimal 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.
Highlights
Acute respiratory distress syndrome (ARDS) and acute lung injury (ALI) are clinical syndromes characterized by inflammatory pulmonary edema, severe hypoxemia, stiff lungs, and diffuse endothelial and epithelial injury[1]
Pleuroparenchimal patterns in ALI/ARDS do find a characterization through ultrasonographic lung scan
Different studies have addressed the ultrasonographic appearance of ALI/ARDS but non have yet been able to give a detailed characterisization of the syndrome permitting a differential diagnosis from the ultrasonographic appearance of acute cardiogenic pulmonary edema (APE) [12,17,18,19]
Summary
Acute respiratory distress syndrome (ARDS) and acute lung injury (ALI) are clinical syndromes characterized by inflammatory pulmonary edema, severe hypoxemia, stiff lungs, and diffuse endothelial and epithelial injury[1]. Chest sonography in alveolar-interstitial syndrome Ultrasound lung comets (ULCs) are an ultrasonographic sign of subpleural interlobular septal thickening either due to hydrostatic edema, as in pulmonary edema, or to connective tissue, as in pulmonary fibrosis [10]. Their absolute number is strictly correlated with the entity of extravascular lung water [20,21,22,23,24]. Greatly important in the initial characterization of patients with ALI/ARDS, CT scanning has many disadvantages First of all it has the major disadvantage of exposing patients to high amounts of ionizing radiation. We evaluated the ability of chest sonography in the identification of characteristic pleuropulmonary signs useful in the diagnosis of ALI/ARDS and APE
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