Chest Sonography

Contents
1: Indications, Technical Equipment and Investigation Procedure
1.1 Indications
1.2 Required Technical Equipment
1.3 Investigation Procedure
1.3.1 Chest Wall, Pleura, Diaphragm, Lung
1.3.2 Investigation of the Upper Thoracic Aperture
Conclusion (See Abstract)
References
2: Ultrasonography of the Chest Wall
2.1 Introduction
2.2 Accumulation of Fluid
2.2.1 Hematomas
2.2.2 Abscesses of the Chest Wall
2.2.3 Postoperative Seromas
2.3 Space-Occupying Lesions of the Chest Wall
2.3.1 Lipoma and Fibroma
2.3.2 Neurogenic Tumors
2.3.3 Sarcoma and Soft Tissue Metastases
2.4 Lymph Nodes
2.4.1 Inflammatory Lymph Nodes
2.4.2 Tuberculosis
2.4.3 Malignant Lymphoma
2.4.4 Lymph Node Metastases
2.5 Bony Thorax
2.5.1 Fractures of the Ribs and the Sternum
2.5.2 Osteolytic Metastases
2.5.3 Invasion of the Chest Wall by Bronchial Carcinoma
Conclusion
References
3: Pleura
3.1 Technical Visualization of the Pleura
3.2 Indications for Pleural Sonography
3.3 Normal Pleura
3.4 Pleural Effusion
3.4.1 Volume Assessment
3.4.1.1 Etiology of Pleural Effusion
3.4.2 Complicated Parapneumonic Effusion
3.4.3 Pleural Empyema
3.4.4 Hematothorax, Chylothorax
3.4.5 Pleurodesis
3.5 Solid Pleural Changes
3.5.1 Pleuritis
3.5.2 Pleural Peels
3.5.3 Pleural tumors
3.5.3.1 Benign Pleural Tumors
3.5.3.2 Pleural Metastasis
3.5.3.3 Malignant Pleural Mesothelioma
3.6 Pneumothorax
3.7 Traumatic Changes in the Pleural Cavity
3.8 Diaphragm
3.8.1 Normal Diaphragm
3.8.2 Visualization
3.8.3 Diaphragmatic Hernia
3.8.4 Diaphragmatic Rupture
3.8.5 Diaphragmatic Tumors
3.8.6 Diaphragmatic Eventration
3.8.7 Functional Examination
References
4: Interstitial Syndrome
4.1 General Considerations
4.2 Interstitial Syndrome
4.3 Technique
4.4 Interpretation of the Sonographic Interstitial Syndrome
4.5 Limitations
Summary
References
5: Inflammatory Consolidations in the Lung
5.1 Inflammatory Consolidations in the Lung
5.1.1 Pneumonia
5.1.1.1 Pathophysiological Prerequisites
5.1.1.2 Sonomorphology of Pneumonia
5.1.1.3 Phase of Engorgement
5.1.1.4 Air Bronchogram
5.1.1.5 Fluid Bronchogram
5.1.1.6 Poststenotic Pneumonia
5.1.1.7 Circulation
5.1.1.8 Parapneumonic Effusion
5.1.1.9 Abscess Formation
5.1.1.10 Healing Phase
5.1.1.11 Diagnostic Value
5.1.2 Tuberculosis
5.1.3 Interstitial Lung Disease
5.1.4 Interstitial Syndrome
5.2 Neoplastic Consolidations in the Lung: Primary Lung Tumors and Metastases
5.2.1 Contours of the Lung Surface
5.2.2 Delineation of Margins from Ventilated Lung Tissue
5.2.3 Invasion of Adjacent Structures: Chest Wall, Diaphragm, and Pericardium
5.2.4 Destruction of the Normal Tissue Architecture and Displacement of Regular Vessels
5.2.5 Additional Investigations to Assess the Possibility of Resection
5.2.5.1 Tumor-Related Complications in Mediastinal Vessels
5.2.5.2 Differentiation of a Central Space-Occupying Lesion from an Atelectasis
5.2.6 Heterogeneous Structural Pattern
5.2.7 Pulmonary Metastases
5.3 Vascular Lung Consolidations: Pulmonary Embolism and Pulmonary Infarction
5.3.1 Pathophysiological Requirements
5.3.2 Sonomorphology of Pulmonary Embolism
5.3.2.1 Shape and Echotexture
5.3.2.2 Size
5.3.2.3 Number
5.3.2.4 Vascular Signs
5.3.2.5 Pleural Effusion
5.3.2.6 Localization
5.3.2.7 Signal Emboli
5.3.2.8 Color-Coded Duplex Sonography in Pulmonary Embolism
5.3.2.9 Contrast Enhanced Ultrasound (CEUS)
5.3.2.10 Healing Phase: Infarct Pneumonia
5.3.3 Accuracy of Thoracic Sonography in the Diagnosis of Pulmonary Embolism
5.3.4 Multi-organ Ultrasound in Thromboembolism
5.3.5 Echocardiography
5.4 Subpleural Lung Consolidation
5.4.1 Definition
5.4.2 Pathomorphology
5.4.3 Sonomorphology
5.4.4 Compression atelektaseis
5.4.5 Obstruktive Atelektase
5.4.6 Lung Contusion
References
6: Mediastinum
6.1 Transthoracic
6.1.1 Sonographic Investigation Technique and Reporting
6.1.2 Sonoanatomy
6.1.3 Imaging Compartments of the Mediastinum
6.1.4 Imaging Tumors in the Mediastinum
6.1.5 Diagnostic Value of Sonography, Chest Radiographs and Computed Tomography
6.1.6 General Indications
6.1.7 Specific Sonographic Findings in Selected Space-Occupying Masses in the Mediastinum
6.1.7.1 Lymph Node Disease
6.1.7.2 Tumors of the Thymus
6.1.7.3 Germinal Cell Tumors
6.1.7.4 Neurogenic Tumors
6.1.7.5 Retrosternal Portions of the Thyroid and Parathyroid
6.1.7.6 Mediastinal Cysts
6.1.7.7 Pericardial Alterations
6.1.7.8 Esophageal Disease
Summary
6.2 Transesophageal Sonography for Lung Cancer and Mediastinal Lesions
6.2.1 Technical Aspects
6.2.2 Transesophageal Sonography-Guided Fine-Needle Aspiration and Lung Cancer
6.2.2.1 Diagnosing Lung Cancer
6.2.2.2 Staging of Lung Cancer
6.2.2.3 Clinical Implications
6.2.2.4 Transesophageal Sonography in Lung Cancer Staging Algorithms
6.2.3 Transesophageal Sonography-Guided Fine-Needle Aspiration and Sarcoidosis
6.2.4 Transesophageal Sonography and Cysts
Summary
References
Transthoracic
Transesophageal Sonography for Lung Cancer and Mediastinal Lesions
7: Endobronchial Sonography
7.1 Instruments and Technique
7.1.1 Endobronchial Sonography Miniprobes
7.1.2 Endobronchial Sonography Transbronchial Needle Aspiration
7.2 Sonographic Anatomy
7.3 Indications and Results for the Endobronchial Sonography Miniprobe
7.3.1 Early Cancer
7.3.2 Advanced Cancer
7.3.3 Peripheral Lesions
7.3.4 Lymph Node Staging
7.3.5 Endobronchial Sonography in Therapeutic Interventions
7.4 Indications and Results for the Endobronchial Ultrasound Guided Transbronchial Needle Aspiration (EBUS-TBNA)
7.5 Endoesopahgeal Ultrasound with the EBUS Scope (EUS-B)
Summary
References
8: Vascularization and Contrast Enhanced Ultrasound (CEUS)
8.1 Pathophysiological Basics
8.2 Principles of Color-Doppler Sonography (CDS)
8.3 Contrast Enhanced Ultrasound (CEUS)
8.4 Predominantly Anechoic Peripheral Lung Consolidation
8.4.1 Color-Doppler Sonography (CDS)
8.4.2 Contrast Enhanced Ultrasound (CEUS)
8.5 Predominantly Echogenic Lung Consolidation
8.5.1 Lung Infarction
8.5.1.1 Color-Doppler Sonography (CDS)
8.5.1.2 Contrast Enhanced Ultrasound (CEUS)
8.5.2 Pleurisy
8.5.2.1 Color-Doppler Sonography (CDS)
8.5.2.2 Contrast Enhanced Ultrasound (CEUS)
8.5.3 The Peripheral Round Lesion/Lung tumor
8.5.3.1 Color-Doppler Sonography (CDS)
Contrast Enhanced Ultrasound (CEUS)
8.5.4 Large Lung Consolidation: Pneumonia
8.5.4.1 Color-Doppler Sonography (CDS)
8.5.4.2 Contrast Enhanced Ultrasound (CEUS)
8.5.5 Large Lung Consolidation: Compressive Atelectasis
8.5.5.1 Color-Doppler Sonography
8.5.5.2 Contrast Enhanced Ultrasound (CEUS)
8.5.6 Large Lung Consolidation: Obstructive Atelectasis
8.5.6.1 Color-Doppler Sonography (CDS)
8.5.6.2 Contrast Enhanced Ultrasound (CEUS)
8.5.7 Space-Occupying Lesion of the Chest Wall
8.5.7.1 Color-Doppler Sonography (CDS)
8.5.7.2 Contrast Enhanced Ultrasound (CEUS)
References
9: Image Artifacts and Pitfalls
9.1 Artifacts
9.2 Pitfalls
9.3 Ultrasound Physics in the Chest
9.4 Imaging of Marginal Surfaces of the Pleura and the Diaphragm
9.5 B-Mode Artifacts
9.5.1 Ultrasound Beam Artifacts in Chest Sonography Reverberations (Repetitive Echoes): Margin Between Tissue and Air, Bone Fracture Fissures
9.5.1.1 Image Artifacts and Pitfalls
9.5.1.2 Mirror Artifacts: Liver Parenchyma in the Diaphragm, Vessels at the “Pleura”
9.5.1.3 Arcuate Artifacts: Rib Reflex in Pleural Effusion
9.5.2 Artifacts Caused by Alterations in Echo Enhancement Acoustic Shadow/Echo Obliteration
9.5.2.1 Echo Resolution Artifacts
9.5.2.2 Image Artifacts and Pitfalls
9.5.3 Other Artifacts Comet-Tail (Resonance Artifact), B-Lines: In Aerated Structures
9.6 Color Doppler Artifacts and Pitfalls in the Chest
9.6.1 Pulse Repetition Frequency
9.6.2 Directional Artifact
9.6.3 Aliasing
9.6.4 Motion Artifacts
9.6.5 Unfavorable Angles
References
10: Interventional Chest Sonography
10.1 Introduction
10.2 General Indications
10.3 Contraindications
10.4 Sonography-Guided or CT-Guided Puncture
10.5 Apparatus, Instruments and Puncture Technique
10.5.1 Puncture Needles
10.5.1.1 Fine Needles
10.5.1.2 Cutting Biopsy Needles
10.5.1.3 Gross Needles
10.5.2 Drainage Catheter
10.5.3 Checking the Position of the Needle and the Catheter
10.5.4 Hygiene, Preparation and Execution of Puncture
10.6 Indications
10.6.1 Processes of the Chest Wall
10.6.2 Pleural Cavity
10.6.2.1 Thoracocentesis
10.6.2.2 Pleura Biopsy
10.6.2.3 Percutaneous Pleural Drainage
10.6.3 Lung Consolidations
10.6.4 Mediastinum
10.7 Risks
10.7.1 Pneumothorax After Puncture
Summary
10.8 List of Materials
References
11: From the Symptom to the Diagnosis
11.1 Chest Pain
11.1.1 Chest Pain as a Symptom of Life-Threatening Diseases
11.1.1.1 Tension Pneumothorax
11.1.1.2 Pulmonary Embolism
11.1.2 Acute Dissection of the Aorta
11.1.3 Pain Due to Diseases of the Chest Wall
11.1.3.1 Rib Fracture
11.1.3.2 Tumor Invasion of the Chest Wall
11.2 Fever
11.2.1 Fever with Chest Pain
11.2.1.1 Abscesses in the Chest Wall
11.2.1.2 Pleuritis
11.2.1.3 Pulmonary Embolism
11.2.1.4 Pericarditis
11.2.2 Fever with Dyspnea
11.2.2.1 Pneumonia
11.2.2.2 Pleural Empyema
11.2.3 Fever with Dyspnea and Chest Pain
11.2.4 Fever as the Sole Symptom in Chest Diseases
11.2.4.1 Polyserositis
11.2.4.2 Mycobacteriosis
11.2.4.3 Endocarditis
11.3 Dyspnea
11.3.1 Respiratory Tract
11.3.2 Pleura
11.3.3 Lung
11.3.4 Heart
11.3.5 Respiratory Muscles
Summary
References
12: Thoracic PoCUS (Point-of-Care Ultrasound) in Emergency Patients
12.1 Basic Principles
12.2 Emergency PoCUS for Chest Trauma
12.3 Emergency PoCUS for Diseases in the Chest (Examples of Images Are Summarized in . Table 12.7)
References
Index