Abstract
BackgroundLung ultrasound is a bedside non-irradiating tool for assessment and monitoring of lung diseases. A lung ultrasound score based on visualized artefacts allows reliable quantification of lung aeration, and is useful to monitor mechanical ventilation setting, fluid resuscitation and antibiotic response in critical care. In the context of interstitial lung diseases associated to connective tissue disorders, lung ultrasound has been integrated to computed tomography for diagnosis and follow-up monitoring of chronic lung disease progression.Case presentationThis case describes a severe acute exacerbation of interstitial lung disease associated to dermatomyositis–polymyositis requiring prolonged extra-corporeal life support. Lung ultrasound score was performed daily and allowed monitoring and guiding both the need of advanced imaging as computed tomography and immunosuppressive therapy.ConclusionsThis case suggests lung ultrasound may be a useful monitoring tool for the response to immunosuppressive therapy in acute severe rheumatic interstitial lung disease, where chest X-ray is poorly informative, and transportation is at high risk.
Highlights
ConclusionsThis case suggests lung ultrasound may be a useful monitoring tool for the response to immunosuppressive therapy in acute severe rheumatic interstitial lung disease, where chest X-ray is poorly informative, and transportation is at high risk
Lung ultrasound is a bedside non-irradiating tool for assessment and monitoring of lung diseases
This case suggests lung ultrasound may be a useful monitoring tool for the response to immunosuppressive therapy in acute severe rheumatic interstitial lung disease, where chest X-ray is poorly informative, and transportation is at high risk
Summary
Lung ultrasound score and CT were here combined to assess and monitor lung aeration of acute exacerbation of dermatomyositis–polymyositis. CT provides the best assessment of ILD and optimal quantification of lung aeration loss; for its costs, irradiation and risk related to transportation of critical patients it cannot be considered a monitoring tool. Lung ultrasound score is a reliable alternative for quantification of lung aeration [5]; it can reduce the radiation exposure in critically ill patients, can be performed bedside and requires few minutes for a complete examination in expert hands. In this case of prolonged extra-corporeal support, the need of advanced imaging was triggered by lung ultrasound findings; this led to a very limited number of CTs. Whilst the absolute value of lung ultrasound score does not provide clear information, it can be useful if compared to initial CT and to monitor lung aeration variations in response to treatments finalized at pulmonary
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