Chest Sonography

248 Pages·2022·47.507 MB·English

by  Gebhard Mathis

Gebhard Mathis
Editor
Chest
Sonography
Fifth Edition
123
Chest Sonography
Gebhard Mathis
Editor
Chest Sonography
Fifth Edition
Editor
Gebhard Mathis
Rankweil, Austria
ISBN 978-3-031-09441-5 ISBN 978-3-031-09442-2 (eBook)
https://doi.org/10.1007/978-3-031-09442-2
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V
Contents
1 Indications, Technical Equipment and Investigation Procedure ........................ 1
S. Beckh
1.1 Indications .................................................................................................................................................. 2
1.2 Required Technical Equipment ............................................................................................................ 3
1.3 Investigation Procedure ......................................................................................................................... 4
References............................................................................................................................................................ 9
2 Ultrasonography of the Chest Wall ........................................................................................ 11
Helmut Prosch
2.1 Introduction ............................................................................................................................................... 12
2.2 Accumulation of Fluid ............................................................................................................................. 12
2.3 Space-Occupying Lesions of the Chest Wall ................................................................................... 13
2.4 Lymph Nodes ............................................................................................................................................. 14
2.5 Bony Thorax ............................................................................................................................................... 17
References............................................................................................................................................................ 20
3 Pleura ......................................................................................................................................................... 23
Joachim Reuß and Alexander Heinzmann
3.1 Technical Visualization of the Pleura ................................................................................................. 24
3.2 Indications for Pleural Sonography ................................................................................................... 24
3.3 Normal Pleura ............................................................................................................................................ 26
3.4 Pleural Effusion ......................................................................................................................................... 26
3.5 Solid Pleural Changes ............................................................................................................................. 34
3.6 Pneumothorax .......................................................................................................................................... 40
3.7 Traumatic Changes in the Pleural Cavity .......................................................................................... 42
3.8 Diaphragm .................................................................................................................................................. 43
References............................................................................................................................................................ 49
4 Interstitial Syndrome ...................................................................................................................... 51
Giovanni Volpicelli and Luna Gargani
4.1 General Considerations .......................................................................................................................... 52
4.2 Interstitial Syndrome .............................................................................................................................. 53
4.3 Technique.................................................................................................................................................... 53
4.4 Interpretation of the Sonographic Interstitial Syndrome .......................................................... 55
4.5 Limitations .................................................................................................................................................. 56
References............................................................................................................................................................ 57
5 Inflammatory Consolidations in the Lung ......................................................................... 59
Gebhard Mathis, Sonja Beckh, and Christian Görg
5.1 Inflammatory Consolidations in the Lung ....................................................................................... 61
5.2 Neoplastic Consolidations in the Lung: Primary Lung Tumors and Metastases ................. 72
5.3 Vascular Lung Consolidations: Pulmonary Embolism and Pulmonary Infarction ............. 80
5.4 Subpleural Lung Consolidation ........................................................................................................... 88
References............................................................................................................................................................ 100
6 Mediastinum ......................................................................................................................................... 105
Wolfgang Blank, Alexander Heinzmann, Jouke T. Annema, Maud Veseliç,
and Klaus F. Rabe
6.1 Transthoracic ............................................................................................................................................. 106
6.2 Transesophageal Sonography for Lung Cancer and Mediastinal Lesions ............................ 120
References............................................................................................................................................................ 126
V I Contents
7 Endobronchial Sonography ........................................................................................................ 131
Felix J. F. Herth and Ralf Eberhardt
7.1 Instruments and Technique .................................................................................................................. 132
7.2 Sonographic Anatomy ............................................................................................................................ 133
7.3 Indications and Results for the Endobronchial Sonography Miniprobe ............................... 133
7.4 Indications and Results for the Endobronchial Ultrasound Guided
Transbronchial Needle Aspiration (EBUS-TBNA) ............................................................ 137
7.5 Endoesopahgeal Ultrasound with the EBUS Scope (EUS-B) ...................................................... 138
References............................................................................................................................................................ 138
8 Vascularization and Contrast Enhanced Ultrasound (CEUS) ................................. 141
C. Görg and E. Safai Zadeh
8.1 Pathophysiological Basics ..................................................................................................................... 142
8.2 Principles of Color-Doppler Sonography (CDS) ............................................................................. 143
8.3 Contrast Enhanced Ultrasound (CEUS) ............................................................................................. 148
8.4 Predominantly Anechoic Peripheral Lung Consolidation .......................................................... 152
8.5 Predominantly Echogenic Lung Consolidation ............................................................................. 154
References............................................................................................................................................................ 184
9 Image Artifacts and Pitfalls ......................................................................................................... 187
Andreas Schuler
9.1 Artifacts ....................................................................................................................................................... 188
9.2 Pitfalls ........................................................................................................................................................... 188
9.3 Ultrasound Physics in the Chest .......................................................................................................... 188
9.4 Imaging of Marginal Surfaces of the Pleura and the Diaphragm ............................................ 189
9.5 B-Mode Artifacts ....................................................................................................................................... 189
9.6 Color Doppler Artifacts and Pitfalls in the Chest ........................................................................... 194
References............................................................................................................................................................ 196
10 Interventional Chest Sonography .......................................................................................... 197
Wolfgang Blank and Thomas Müller
10.1 Introduction ............................................................................................................................................... 198
10.2 General Indications.................................................................................................................................. 198
10.3 Contraindications ..................................................................................................................................... 198
10.4 Sonography-Guided or CT-Guided Puncture ................................................................................. 199
10.5 Apparatus, Instruments and Puncture Technique ........................................................................ 201
10.6 Indications .................................................................................................................................................. 208
10.7 Risks .............................................................................................................................................................. 216
10.8 List of Materials ......................................................................................................................................... 216
References............................................................................................................................................................ 216
11 From the Symptom to the Diagnosis .................................................................................... 221
Sonja Beckh
11.1 Chest Pain ................................................................................................................................................... 222
11.2 Fever ............................................................................................................................................................. 226
11.3 Dyspnea ....................................................................................................................................................... 230
References............................................................................................................................................................ 233
VII
Contents
12 Thoracic PoCUS (Point-of-Care Ultrasound) in Emergency Patients ............... 235
Joseph Osterwalder and Gebhard Mathis
12.1 Basic Principles .......................................................................................................................................... 236
12.2 Emergency PoCUS for Chest Trauma ................................................................................................. 238
12.3 Emergency PoCUS for Diseases in the Chest (Examples of Images Are
Summarized) .............................................................................................................................................. 242
References............................................................................................................................................................ 243
Supplementary Information
Index ............................................................................................................................................................. 247
1
1
Indications, Technical
Equipment and Investigation
Procedure
S. Beckh
Contents
1.1 Indications – 2
1.2 Required Technical Equipment – 3
1.3 Investigation Procedure – 4
1.3.1 Chest Wall, Pleura, Diaphragm, Lung – 4
1.3.2 Investigation of the Upper Thoracic Aperture – 5
References – 9
© The Author(s), under exclusive license to Springer Nature Switzerland AG 2022
G. Mathis (ed.), Chest Sonography, https://doi.org/10.1007/978-3-031-09442-2_1
2 S. Beckh
1.1 Indications this dimension ultrasound may provide an imaging diag-
1 nosis even in most difficult situations (Bachmann
Ultrasonography of the lung has now become an estab- Nielsen et al. 2019; Soldati et al. 2020). Thus bedside
lished imaging procedure for chest diseases. Owing to imaging information in isolated patients will be much
comprehensive scientific investigations and studies easier (Kluge et al. 2020; Soldati et al. 2020).
(Beckh et al. 2002; Beaulieu and Marik 2005; Mathis The usefulness of chest sonography is proven in per-
et al. 2005; Niemann et al. 2009; Reuß 2010; Reissig manent enlargement of applications (Lesser 2017;
et  al. 2012; Volpicelli et  al. 2012; Bartheld 2013; Davidsen et al. 2020).
Squizzato et al. 2013) the “Point of Care Ultrasound” The ultrasound image does not provide a complete
(POCUS) has been widely accepted as a basic tool with overview of the chest. However, it does show a certain
rapid diagnostic information in medical examination. portion of the chest and thus provides diagnostic infor-
In emergency cases and in intensive care medicine mation about a variety of problems (.Fig. 1.1).

the findings of ultrasound allow a conclusive and strate- About 99% of the ultrasonic wave is reflected by the
gic course of action (Diacon et al. 2005; Soldati et al. healthy lung. Intrapulmonary processes can be registered
2006; Arbelot et al. 2008; Copetti and Cattarossi 2008; by ultrasound only when they extend to the visceral pleura
Copetti et al. 2008; Noble et al. 2009; Moore and Copel or can be visualized through a sound-conducting medium
2011; Blank and Heinzmann 2012; Volpicelli et al. 2012; such as fluid or consolidated lung tissue (.Fig. 1.2).

Böer et al. 2014; Squizzato et al. 2015; Blank et al. 2019; Acoustic shadowing occurs due to nearly complete
Mayo et al. 2019; Kluge et al. 2020; Soldati et al. 2020). absorption of the ultrasonic wave on bone, especially
The acceptance of the method is reflected in a number behind the sternum, the scapula, and the spine.
of well-known international guidelines (Havelock et al. Impairment due to the rib shadow can be balanced, at
2010; Hooper et al. 2010; Piscaglia et al. 2012; Bamber least in part, by appropriate breathing techniques.
et al. 2013; Cosgrove et al. 2013; Detterbeck et al. 2013; The immediate retrosternal and posterior portions
AWMF Leitlinie 2015, 2018; Ewig et al. 2016; Dalhoff of the mediastinum cannot be viewed from the percuta-
et al. 2018; Rose et al. 2017; Stoelben et al. 2018). neous aspect. Transesophageal and transbronchial
New developed handheld devices in the size of a ultrasound may be used additionally, but it should be
mobile phone create an “ultrasound-stethoscope”. In noted that these examination procedures are invasive in
Conclusive In addition to
procedure X-ray, CT, MRI, PET-CT
– Biopsy/puncture – Differentiation solid/liquid
– Strategic tool in – Infiltration of pleura/chest wall
emergency medicine – Vascularization of the lesion
– Therapeutic drainage and surroundings
– Intraoperative – Real-time examination
Sonographic
examination
In addition to physical
Emergency sonography
examination
– Dyspnea – Auscultation findings
– Chest pain – Percussion findings
– Chest trauma – Palpable lesion
– Inflow congestion – Topical pain
– Fever
. Fig. 1.1 Spectrum of applications of ultrasonography for pleural and pulmonary diseases
1
3
Indications, Technical Equipment and Investigation Procedure
– Adherence of a space-occupying lesion
– Invasion by a space-occupying lesion
– Mobility of the diaphragm
5 Lung
– Interstitial syndrome
– Benign peripheral lesions:
– Inflammation, abscess, embolism, atelectasis
– Malignant peripheral lesions:
– Peripheral metastasis, peripheral carcinoma,
tumor/atelectasis
– Mediastinum, percutaneous:
– Space-occupying lesions in the upper anterior
mediastinum
– Lymph nodes in the aortopulmonary window
. Fig. 1.2 Entities and pathological changes that can be accessed – Suspected thrombosis in the vena cava and its
by ultrasound
afferent vessels
– Visualization of collateral circulation
terms of effort and handling (Lam and Becker 1996; – Pericardial effusion
Aabakken et al. 1999; Herth et al. 2004; Annema et al.
2010; Haas et al. 2010; Walker et al. 2012; Silvestri et al. Additional pathologies of the heart that can be visual-
2013; 7 Sect. 6.2, 7 Chap. 7). ized by ultrasonography will not be addressed in this

Ultrasonography provides diagnostic information book; for further information the reader may consult
during the investigation of individual entities in the appropriate echocardiography textbooks.
chest (Overview).
Diagnostic Information During the Investigation of 1.2 Required Technical Equipment
Individual Entities in the Chest
5 Chest wall Devices used for ultrasound investigation of the abdomen
– Benign lesions: and the thyroid may also be used for investigation of the
– Benign neoplasms (such as lipoma) chest. A high-resolution linear transducer of 5–10 MHz
– Hematoma is suitable for imaging the chest wall and the parietal
– Abscess pleura (Mathis 2004). Additionally, the recently intro-
– Reactivated lymph nodes duced probes of 7.5–18 MHz are very useful for evaluat-
– Perichondritis, Tietze syndrome ing lymph nodes (Prosch et al. 2014), nerves (Winter et al.
– Rib fracture 2019) the pleura, and the surface of the lung.
– Malignant lesions: A convex or sector probe of 3–4 MHz ensures suffi-
– Lymph node metastases (primary diagnosis cient depth of penetration for investigation of the lung
and the course of disease under treatment) (Mathis 2004).
– Growing invasive carcinomas Vector, sector or narrow convex probes are recom-
– Osteolyses mended for the mediastinum. The smaller the footprint,
5 Pleura the better the probe can be placed on the jugulum or the
– Solid structures: supraclavicular fossa. The frequency range should be
– Thickening of the pleura, callosity, calcifica- 3.5–5 MHz. It should be noted that the device settings
tion, asbestos-induced plaques commonly used for examining the heart are not suitable
– Space-occupying lesion: for the rest of the mediastinum. Contrast, image rates
– Benign: fibrous tumor, lipoma and the grayscale balance must be aligned to the visual-
– Malignant: clearly identifiable metastases, ization of mediastinal structures.
diffuse carcinosis, pleural mesothelioma A special probe with an appropriate connecting
– Fluid: channel to the ultrasound device is needed to perform a
– Effusion, hemothorax, pyothorax, chylothorax transesophageal ultrasound investigation.
– Dynamic investigation: Endobronchial ultrasonography is performed with
– Pneumothorax special thin high-frequency probes (12–20 MHz) which
– Differentiating between an effusion and a are introduced through the working channel of the flex-
callosity ible bronchoscope.