Sonographic Lobe Localization of Alveolar-Interstitial Syndrome in the Critically Ill

Konstantinos Stefanidis,Dimitrios Karakitsos,Lewis A Eisen,Chrysafoula Kolofousi,Mitchell Wachtel,Demosthenes D Cokkinos,Serafim Nanas,Stavros Dimopoulos,Katerina Chatzimichail

doi:10.1155/2012/179719

Abstract

Introduction. Fast and accurate diagnosis of alveolar-interstitial syndrome is of major importance in the critically ill. We evaluated the utility of lung ultrasound (US) in detecting and localizing alveolar-interstitial syndrome in respective pulmonary lobes as compared to computed tomography scans (CT). Methods. One hundred and seven critically ill patients participated in the study. The presence of diffuse comet-tail artifacts was considered a sign of alveolar-interstitial syndrome. We designated lobar reflections along intercostal spaces and surface lines by means of sonoanatomy in an effort to accurately localize lung pathology. Each sonographic finding was thereafter grouped into the respective lobe. Results. From 107 patients, 77 were finally included in the analysis (42 males with mean age = 61 ± 17 years, APACHE II score = 17.6 ± 6.4, and lung injury score = 1.0 ± 0.7). US exhibited high sensitivity and specificity values (ranging from over 80% for the lower lung fields up to over 90% for the upper lung fields) and considerable consistency in the diagnosis and localization of alveolar-interstitial syndrome. Conclusions. US is a reliable, bedside method for accurate detection and localization of alveolar-interstitial syndrome in the critically ill.

Highlights

Fast and accurate diagnosis of alveolar-interstitial syndrome is of major importance in the critically ill
The causes were an intensive care unit (ICU) stay less than 48 hours (n = 18), subcutaneous emphysema (n = 8), pneumonectomy (n = 2), and a body mass index (BMI) ≥40 (n = 2)
A total of 144 hemithoraces were evaluated both by US and computed tomography scans (CT) scans according to the study protocol (Figure 4)

Summary

Introduction

Fast and accurate diagnosis of alveolar-interstitial syndrome is of major importance in the critically ill. We evaluated the utility of lung ultrasound (US) in detecting and localizing alveolar-interstitial syndrome in respective pulmonary lobes as compared to computed tomography scans (CT). US is a reliable, bedside method for accurate detection and localization of alveolar-interstitial syndrome in the critically ill. Serial CT examinations may be required to followup the clinical course of pulmonary disorders and the results of therapy increasing radiation exposure This may be time consuming and hazardous as critically ill patients who oftentimes suffer from severe respiratory insufficiency are transferred to another unit. There have been several studies reporting the possible role of lung US in detecting the alveolar-interstitial syndrome [3,4,5,6,7,8,9,10,11,12,13], its application in routine ICU practice remains unclear

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