Chest
Volume 101, Issue 4, April 1992, Pages 931-934
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Clinical Investigations
Ultrasonographic Approach to Diagnosing Hydropneumothorax

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Ultrasound results for 11 patients with HPN confirmed by CXR were compared with those for 100 healthy subjects. The observation of the hyperechogenic line of the pleuropulmonary surface (normal subjects) showed back-and-forth respiratory movements in every case which we call the “gliding sign.” Ultrasonographic signs were shown in all patients with HPN. Visualizing the gassy effusion above the pleural fluid, the disappearance of the “gliding sign” (n = 11) indicates PN. The image of the HPN allows in addition a “curtain sign” which depicts the movement of air/fluid level (n= 11), the pulmonary collapse being calculated across the liquid window whose echostructure is analyzed. A “polymicrobullous” image (n = 2) caused by air microbubbles within the fluid effusion, is reported. We conclude that echography appears to be a new approach to diagnosing HPN, which is particularly useful during or after ultrasonically guided procedures including pleural drainage, and should be recognized by sonographers.

Section snippets

MATERIALS AND METHODS

We conducted a retrospective study in 11 patients from April 1986 to December 1989. Several sonographic images typical of the presence of the air and fluid in the pleura were compared with the findings in 100 healthy test subjects. All patients had unilateral HPN visible on standard frontal or lateral x-ray films.

The causes of PN were primary spontaneous pneumothorax (n = 6), chronic bronchitis and emphysema (n = 4) and aspiration of a pleural effusion (n = 1). The 11 patients, 8 men and 3

Healthy Test Subjects

In the 100 control subjects, the observation of the hyperechogenic line of the pleuropulmonary surface in every case showed back-and-forth movements synchronous with respiratory movements. This hyperechogenic band of pleural reflection and a large area of reverberation echo artifacts accompanying it showed very characteristic inspiratory lowering and expiratory rising.

The use of high frequency probes (7.5 MHz), especially through the intercostal space, facilitates the observation of this

DISCUSSION

On the basis of an echographic study of 11 cases of HPN that were radiologically confirmed, we have set forth the ultrasound diagnosis signs compared with those of 100 healthy subjects. Several sonographic patterns are presented. The loss of the “gliding sign” indicates gassy effusion above the pleural fluid. The “curtain sign” which follows the movement of the air-fluid level, the extent of the pulmonary collapse visualizing through the fluid window and the echostructure of the pleural

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Manuscript received June 14; revision accepted August 13

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