Sonography of the pleura

Rudolf Horn; Christian Görg; Helmut Prosch; Ehsan Safai Zadeh; Christian Jenssen; Christoph F. Dietrich

doi:10.1055/a-2189-5050

Ultraschall in der Medizin - European Journal of Ultrasound, Table of Contents

Ultraschall Med 2024; 45(02): 118-146
DOI: 10.1055/a-2189-5050

Continuing Medical Education

Sonografie der Pleura

Article in several languages: English | deutsch

Rudolf Horn

¹Emergency Department, Center da Sandà Val Müstair, Switzerland

,

Christian Görg

²Interdisciplinary Center of Ultrasound Diagnostics, Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital Giessen and Marburg, Philipp University of Marburg, Baldingerstraße, Marburg

,

Helmut Prosch

³Abteilung für Allgemeine Radiologie und Kinderradiologie, Medizinische Universität Wien, Austria

,

Ehsan Safai Zadeh

³Abteilung für Allgemeine Radiologie und Kinderradiologie, Medizinische Universität Wien, Austria

,

Christian Jenssen

⁴Klinik für Innere Medizin, Krankenhaus Märkisch-Oderland Strausberg/Wriezen and Brandenburg Institute for Clinical Ultrasound at Medical University Brandenburg, Neuruppin, Germany

,

Christoph F. Dietrich

⁵Department of General Internal Medicine, Kliniken Hirslanden Beau-Site, Salem und Permanence, Bern, Switzerland

› Author Affiliations

Abstract

Zusammenfassung

Die hier präsentierte CME-Übersichtsarbeit erläutert die Aussagekraft der Pleurasonografie und gibt Hinweise zu deren Anwendung. Aufgrund der Impedanz-Unterschiede kann die Pleuralinie gut abgegrenzt werden. Mit hochauflösenden Geräten kann auch eine normale Pleura mit einer Dicke von 0,2 mm beurteilt werden. In diesem Artikel werden die Besonderheiten der Untersuchungstechnik mit der Kenntnis der Vortestwahrscheinlichkeit erläutert und die Indikationen der Pleurasonografie beschrieben. Die Pleurasonografie hat einen hohen Stellenwert: sowohl in der Notfall- und Intensivmedizin, präklinisch, ambulant und stationär, in der Hausarzt- wie auch in der Spezialarzt-Praxis der Pneumologen. Dargestellt werden die Besonderheiten in der Kindheit (Pädiatrie), wie auch in der Geriatrie. Das Erkennen eines Pneumothorax, auch in schwierigen Situationen, wie auch die Beurteilung des Pleuraergusses werden erläutert. Aufgrund der heutigen hochauflösenden Technik können sowohl die Pleura selbst wie auch kleine subpleurale Veränderungen beurteilt und diagnostisch verwertet werden. Sowohl die direkten wie auch indirekten sonografischen Zeichen und Begleiterscheinungen werden beschrieben und es wird der konkrete klinische Stellenwert der Sonografie dargestellt. Dargelegt werden zudem die Bedeutung und die Kriterien des konventionellen helligkeitskodierten B-Bildes, der Farbdoppler-Sonografie (CDS), mit oder ohne Spektralanalyse des Dopplersignals (SDS), sowie des Kontrastmittel-Ultraschalls (CEUS). Auch die Elastografie und ultraschallgestützte Interventionen sollen Erwähnung finden. Eine zugehörige weitere Arbeit beschäftigt sich mit den Erkrankungen des Lungenparenchyms und eine weitere Arbeit mit den Erkrankungen der Thoraxwand, des Zwerchfells und des Mediastinums.

Full Text

References

References
1 Jaworska J, Buda N, Ciuca IM. et al. Ultrasound of the pleura in children, WFUMB review paper. Med Ultrason 2021;
2 Dietrich CF, Buda N, Ciuca IM. et al. Lung ultrasound in children, WFUMB review paper (part 2). Med Ultrason 2021;
3 Fang C, Jaworska J, Buda N. et al. Ultrasound of the chest and mediastinum in children, interventions and artefacts. WFUMB review paper (part 3). Med Ultrason 2022; 24: 65-67
4 Findeisen H, Trenker C, Zadeh ES. et al. Further aspects concering peripheral lung carcinoma in CEUS. Ultraschall in der Medizin – European Journal of Ultrasound 2020;
5 Safai Zadeh E, Beutel B, Dietrich CF. et al. Perfusion Patterns of Peripheral Pulmonary Lesions in COVID-19 Patients Using Contrast-Enhanced Ultrasound (CEUS): A Case Series. J Ultrasound Med 2021; 40: 2403-2411
6 Safai Zadeh E, Dietrich CF, Kmoth L. et al. Peripheral Pulmonary Lesions in Confirmed Pulmonary Arterial Embolism: Follow-up Study of B-Mode Ultrasound and of Perfusion Patterns Using Contrast-Enhanced Ultrasound (CEUS). J Ultrasound Med 2021;
7 Safai Zadeh E, Gorg C, Prosch H. et al. WFUMB Technological Review: How to Perform Contrast-Enhanced Ultrasound of the Lung. Ultrasound Med Biol 2022;
8 Safai Zadeh E, Huber KP, Dietrich CF. et al. The Value of Lung Ultrasound to Detect the Early Pleural and Pulmonary Pathologies in Nonhospitalized COVID-19-Suspected Cases in a Population with a Low Prevalence of COVID-19 Infection: A Prospective Study in 297 Subjects. J Ultrasound Med 2021;
9 Safai Zadeh E, Keber CU, Dietrich CF. et al. Perfusion Patterns of Peripheral Pulmonary Granulomatous Lesions Using Contrast-Enhanced Ultrasound (CEUS) and Their Correlation with Immunohistochemically Detected Vascularization Patterns. J Ultrasound Med 2022; 41: 565-574
10 Safai Zadeh E, Weide J, Dietrich CF. et al. Diagnostic Accuracy of B-Mode- and Contrast-Enhanced Ultrasound in Differentiating Malignant from Benign Pleural Effusions. Diagnostics (Basel) 2021; 11
11 Demi L, Wolfram F, Klersy C. et al. New International Guidelines and Consensus on the Use of Lung Ultrasound. J Ultrasound Med 2023; 42: 309-344
12 Alhyari A, Gorg C, Dietrich CF. et al. Diagnostic Performance of Point Shear Wave Elastography Using Acoustic Radiation Force Impulse Technology in Peripheral Pulmonary Consolidations: A Feasibility Study. Ultrasound Med Biol 2022;
13 Dietrich CF, Gorg C, Horn R. et al. Ultrasound of the lung. Ultraschall Med 2023; 44: 2-19
14 Safai Zadeh E, Gorg C, Prosch H. et al. The Role of Thoracic Ultrasound for Diagnosis of Diseases of the Chest Wall, the Mediastinum, and the Diaphragm-Narrative Review and Pictorial Essay. Diagnostics (Basel) 2023; 13
15 Dietrich CF, Goudie A, Chiorean L. et al. Point of Care Ultrasound: A WFUMB Position Paper. Ultrasound Med Biol 2017; 43: 49-58
16 Maio G. Medicine and the Holistic Understanding of the Human Being: Ultrasound Examination as Dialog. Ultraschall in der Medizin – European Journal of Ultrasound 2014; 35: 98-107
17 Volpicelli G, Elbarbary M, Blaivas M. et al. International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med 2012; 38: 577-591
18 Volpicelli G, Caramello V, Cardinale L. et al. Bedside ultrasound of the lung for the monitoring of acute decompensated heart failure. Am J Emerg Med 2008; 26: 585-591
19 Jambrik Z, Monti S, Coppola V. et al. Usefulness of ultrasound lung comets as a nonradiologic sign of extravascular lung water. Am J Cardiol 2004; 93: 1265-1270
20 Picano E, Frassi F, Agricola E. et al. Ultrasound lung comets: a clinically useful sign of extravascular lung water. J Am Soc Echocardiogr 2006; 19: 356-363
21 Soldati G, Smargiassi A, Inchingolo R. et al. Proposal for International Standardization of the Use of Lung Ultrasound for Patients With COVID-19: A Simple, Quantitative, Reproducible Method. J Ultrasound Med 2020; 39: 1413-1419
22 Allinovi M, Parise A, Giacalone M. et al. Lung Ultrasound May Support Diagnosis and Monitoring of COVID-19 Pneumonia. Ultrasound Med Biol 2020; 46: 2908-2917
23 Matthias I, Panebianco NL, Maltenfort MG. et al. Effect of Machine Settings on Ultrasound Assessment of B-lines. J Ultrasound Med 2020; 40: 2039-2046
24 Mento F, Demi L. Dependence of lung ultrasound vertical artifacts on frequency, bandwidth, focus and angle of incidence: An in vitro study. J Acoust Soc Am 2021; 150: 4075
25 Leote J, Muxagata T, Guerreiro D. et al. Influence of Ultrasound Settings on Laboratory Vertical Artifacts. Ultrasound Med Biol 2023; 49: 1901-1908
26 Mento F, Demi L. On the influence of imaging parameters on lung ultrasound B-line artifacts, in vitro study. J Acoust Soc Am 2020; 148: 975
27 Miller DL, Dou C, Raghavendran K. Dependence of thresholds for pulmonary capillary hemorrhage on diagnostic ultrasound frequency. Ultrasound Med Biol 2015; 41: 1640-1650
28 Wolfram F, Miller D, Demi L. et al. Best Practice Recommendations for the Safe use of Lung Ultrasound. Ultraschall Med 2023;
29 Miserocchi G. Physiology and pathophysiology of pleural fluid turnover. Eur Respir J 1997; 10: 219-225
30 Dickman E, Terentiev V, Likourezos A. et al. Extension of the Thoracic Spine Sign: A New Sonographic Marker of Pleural Effusion. J Ultrasound Med 2015; 34: 1555-1561
31 Vargas CA, Quintero J, Figueroa R. et al. Extension of the thoracic spine sign as a diagnostic marker for thoracic trauma. Eur J Trauma Emerg Surg 2020;
32 Hassan M, Rizk R, Essam H. et al. Validation of equations for pleural effusion volume estimation by ultrasonography. J Ultrasound 2017; 20: 267-271
33 Balik M, Plasil P, Waldauf P. et al. Ultrasound estimation of volume of pleural fluid in mechanically ventilated patients. Intensive Care Med 2006; 32: 318
34 Mayo PH, Doelken P. Pleural ultrasonography. Clin Chest Med 2006; 27: 215-227
35 Dietrich CF, Mathis G, Cui XW. et al. Ultrasound of the pleurae and lungs. Ultrasound Med Biol 2015; 41: 351-365
36 Bedawi EO, Hassan M, Rahman NM. Recent developments in the management of pleural infection: A comprehensive review. Clin Respir J 2018; 12: 2309-2320
37 Mercer RM, Corcoran JP, Porcel JM. et al. Interpreting pleural fluid results. Clin Med (Lond) 2019; 19: 213-217
38 Joseph J, Badrinath P, Basran GS. et al. Do we need all three criteria for the diagnostic separation of pleural fluid into transudates and exudates? An appraisal of the traditional criteria. Med Sci Monit 2003; 9: CR474-CR476
39 Light RW, Macgregor MI, Luchsinger PC. et al. Pleural effusions: the diagnostic separation of transudates and exudates. Ann Intern Med 1972; 77: 507-513
40 Porcel JM. Identifying transudates misclassified by Light's criteria. Curr Opin Pulm Med 2013; 19: 362-367
41 Rufino R, Marques BL, Azambuja Rde L. et al. Pleural cholesterol to the diagnosis of exudative effusion. Open Respir Med J 2014; 8: 14-17
42 Shi HZ, Liang QL, Jiang J. et al. Diagnostic value of carcinoembryonic antigen in malignant pleural effusion: a meta-analysis. Respirology 2008; 13: 518-527
43 Shen Y, Zhu H, Wan C. et al. Can cholesterol be used to distinguish pleural exudates from transudates? evidence from a bivariate meta-analysis. BMC Pulm Med 2014; 14: 61
44 Wilcox ME, Chong CA, Stanbrook MB et al. Does this patient have an exudative pleural effusion? The Rational Clinical Examination systematic review. JAMA 2014; 311: 2422-2431
45 Ferreiro L, Toubes ME, San Jose ME. et al. Advances in pleural effusion diagnostics. Expert Rev Respir Med 2020; 14: 51-66
46 Bhoil R, Kumar R, Kaur J. et al. Diagnosis of Traumatic Pneumothorax: A Comparison between Lung Ultrasound and Supine Chest Radiographs. Indian J Crit Care Med 2021; 25: 176-180
47 Karpathiou G, Stefanou D, Froudarakis ME. Pleural neoplastic pathology. Respir Med 2015; 109: 931-943
48 Katzman D, Sterman DH. Updates in the diagnosis and treatment of malignant pleural mesothelioma. Curr Opin Pulm Med 2018; 24: 319-326
49 Lin Z, Wu D, Wang J. et al. Diagnostic value of ultrasound-guided needle biopsy in undiagnosed pleural effusions: A systematic review and meta-analysis. Medicine (Baltimore) 2020; 99: e21076
50 Murata Y, Aoe K, Mimura Y. Pleural effusion related to IgG4. Curr Opin Pulm Med 2019; 25: 384-390
51 Tello-Sanchez M, Rodriguez-Duque MS, Loidi-Lopez C. et al. Pleural and Pericardial Effusion as the Only Manifestation of IgG4-Related Disease. Arch Bronconeumol 2020; 56: 597-599
52 Felekis VA. Causes and management of pleural fibrosis. Respirology 2005; 10: 402
53 Huggins JT, Sahn SA. Causes and management of pleural fibrosis. Respirology 2004; 9: 441-447
54 Wang XB, Yin Y, Miao Y. et al. Flex-rigid pleuroscopic biopsy with the SB knife Jr is a novel technique for diagnosis of malignant or benign fibrothorax. J Thorac Dis 2016; 8: E1555-E1559
55 Mathis G, Horn R, Morf S. et al. WFUMB position paper on reverberation artefacts in lung ultrasound: B-lines or comet-tails?. Med Ultrason 2021; 23: 70-73