Abstract
Transthoracic ultrasound (TUS) is a validate complementary technique widely used in everyday medical practice. TUS is the gold-standard for studying pleural effusion and for echo-guided thoracentesis, moreover, it is employed in detection of pleural and pulmonary lesions adherent to pleural surface and their ccho-guided percutaneous needle biopsy (PTNB).1 We used TUS technique to study severe asthma patients. We found that several patterns are constant in these patients. One of these patterns, i.e. lack of gliding sign, mimic pneumothorax (PNX). In this study, we attempted an echographic approach to asthma, trying to lay the first stone for the individuation of common ultrasound patterns in this disease.
Highlights
Asthma is an important cause of morbility and mortality worldwide and it can affect people of any age
A complete TUS exam was performed by an expert clinician and we compared it with a CT of the patient
Ultrasound imaging, taken with convex probe (5 MHz), indicate the absence of gliding sign, which was confirmed by Barcode sign in M-mode (Figure 1C) and an irregular thickening of the hyperechoic pleural line (3.1–3.6 mm, where the normal value is under 3 mm) (Figure 1D)
Summary
Asthma is an important cause of morbility and mortality worldwide and it can affect people of any age. In pneumothorax diagnosis, ultrasound negative predictive value is almost 99%10 because the presence of gliding sign in B-mode and of the sea-shore sign in M-mode would exclude the pneumothorax, while ultrasound positive predictive value in detecting PNX is lower because there are many other pathological conditions which mimic its ultrasound features.[4,11] In particular, pathological condition characterized by air trapping and lung hyperinflation, like bullous emphysema,[7,12] were found marked by the absence of gliding sign and so considered as TUS “false positive” of pneumothorax On this background, we tried to understand if severe asthmatic patients could show echografic signs similar to PNX that correlates with a condition of air-trapping and hyperinflation, like in COPD and other pulmonary diseases. HRCT is the gold-standard to investigate the morphological changes of the lung and bronchi, providing quantitative morphometry of airways and distal lungs and highlighting airway wall thickness,[2] and it helps to identify lung abnormalities due to asthma, as bronchiectasis, bronchial wall thickening and morphological anomalies.[14]
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