Pleural Ultrasonography
Section snippets
Pleural ultrasonography physics
Medical ultrasonography uses ultrasound waves to create images of the body for diagnostic purposes and to guide procedures. Whether imaging the abdomen, heart, vascular structures, or pleura, the physical principles of ultrasonography are the same. The transducer sends out a brief pulse of high-frequency sound that penetrates the tissue. The sound waves are reflected back to the transducer, which serves as the sensor and the source of signal. Ultrasound is reflected at tissue boundaries and
Ultrasound machine requirements for pleural ultrasonography
Pleural ultrasonography may be performed with a simple two-dimensional ultrasound machine. Doppler capability is not needed. Machines designed in the early 1990s are adequate for imaging pleural effusion or other pleural pathology. Just as a simple older machine suffices, a sophisticated high-end cardiac ultrasound machine also can image the pleura. An ultrasound machine that is capable of abdominal or cardiac imaging has utility in examining the pleural space. As discussed in the physics
Normal pleura
Ultrasound examination of the normal pleura is easy to perform. When the probe is applied to an interspace in longitudinal scanning plane between adjacent ribs, the normal pleura appears as a bright, highly echogenic line interposed between the chest wall and the air artifact of the lung. With small movement of the transducer, the examiner may orientate the rib shadows, such that the pleural line is centrally located on the screen. The marker on the probe should be pointed toward the head of
Pleural disease and pleural ultrasonography
Pleural effusions are seen easily with pleural ultrasonography. In addition, many types of less common pleural pathology may be identified.
Ultrasound-guided thoracentesis and other pleural interventions
Ultrasound-guided thoracentesis is a valuable technique that can be mastered easily by the pulmonary critical care medicine clinician. It is associated with a very low risk of pneumothorax. A special application is in patients who are on mechanical ventilatory support. Supine chest radiographs do not permit determination of a safe thoracentesis site; iatrogenic pneumothorax in a patient on positive-pressure mechanical ventilatory support is particularly dangerous because there is a high risk of
Training in pleural ultrasonography
Training in ultrasonography requires factual knowledge of the field, skill in image acquisition, and skill in image interpretation (Box 3):
- 1.
Factual knowledge. This article provides an overview of the field of pleural ultrasonography. To introduce ultrasonography into clinical practice, the authors recommend reviewing a standard textbook and atlas of chest ultrasonography [2].
- 2.
Image acquisition. Implicit to clinical application of pleural ultrasonography is that the physician personally performs
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